If you or a dependant reside in a nursing home, you may have questions as to what products and services are eligible for reimbursement under the Public Service Health Care Plan (PSHCP). Some of the services or products that are not covered by the Plan include the following:
The PSHCP Drug Benefit provides reimbursement for prescription costs regardless of where you or your dependant(s) reside. However, many nursing homes offer prescription services to residents so that you no longer need to go to the pharmacy yourself. Charges for these services are not eligible for reimbursement under the PSHCP.
Short-term or long-term accommodation costs
Costs for short-stay, long-term, respite care or other accommodation provided within a nursing home are not eligible for reimbursement under the Plan. A nursing home is not considered a legally licensed hospital under the PSHCP, and therefore, reimbursement for accommodation does not apply.
Nursing and foot care services
Nursing and foot care services provided by salaried employees of the nursing home in which you or your dependant(s) reside are not covered by the Plan. Nurses working in such facilities receive a salary from the establishment for the services provided.
Wheelchairs, walkers, and other durable medical equipment
If you anticipate that you or your dependant(s) may require certain durable medical equipment such as a wheelchair or a walker that are not provided by the nursing home, it is recommended that you contact the PSHCP Sun Life Call Centre at the numbers below to inquire as to the limitations or exclusions that may apply.
From anywhere in North America
From the National Capital Region
Other non-medical service costs
Costs for services or programs provided by a nursing home such as hairdressing, transportation or in-room phone or cable are not eligible for reimbursement under the Plan.