PSHCP Coverage for CPAP and BiPAP Devices

July 30, 2019

PSHCP members who suffer from moderate to severe sleep apnea are eligible for reimbursement of the rental or purchase of CPAP and BiPAP devices. To determine if you are eligible for an aerotherapeutic device under the PSHCP you must provide the following information:

• The results of a sleep study both with and without the aerotherapeutic device in place. Two types of sleep study qualify – a polysomnogram or an overnight oximetry;

• A physician’s prescription, and;

• A copy of the attending specialist’s consultation letter summarizing your case.

Once the documentation is provided to the Plan Administrator, it will be reviewed to determine whether or not you are eligible for reimbursement. It is important to note that the cost of the sleep tests are not eligible for reimbursement. If the rental or purchase of the device is approved, the PSHCP will reimburse 80% of the reasonable and customary charges incurred.

Claims are limited to once every five years. However, the PSHCP provides coverage for up to $300 a year (reimbursed at 80%) in repairs, servicing, and replacement parts (such as tubing, filters, cushions, and masks) for eligible aerotherapeutic devices. Please note that warranties and cleaning solutions and supplies are not covered.

The PSHCP may consider a dental or oral appliance in lieu of a CPAP or BiPAP devices in certain limited circumstances. In addition to the information normally required for a device as outlined above, you must also submit medical information that confirms that you are unable to tolerate the use of the CPAP or BiPAP device. The reimbursement level and provision for repair and replacement remain the same.

If you are unsure of whether or not your claim is eligible for reimbursement, please contact the PSHCP Call Centre at 1-888-757-7427 (toll-free from anywhere in North America) or 613-247-5100 (in the National Capital Region).