Make sure services or providers are eligible under the PSHCP before you incur an expense
September 22, 2021
Being informed when it comes to your health care benefits may prevent having a claim denied. Before incurring an expense, make sure that the service and the provider are eligible under the Plan. Some services may not be covered under the Plan, some services may have certain restrictions, and Sun Life may have delisted some providers.
For example, based on the current Plan Directive, acupuncture treatments are eligible services, but they must be performed by a physician. In addition, some products, such as compression stockings, may have an annual maximum. Coverage information is available on our website at www.pshcp.ca/coverage You can also consult the Plan Member Booklet or the Plan Directive for additional details.
To find a service provider in your area, Sun Life’s Plan Member Services Website offers a provider search tool that you can access by logging in at www.sunlifeca/pshcp and;
- Select Benefits.
- Look for Lumino Provider Search and Browse by specialty or Search by name.
It is important to note that the PSHCP does not cover all medical providers or clinics listed in the search results, and claims will be considered according to the Plan provisions. For instance, dieticians may appear in the Provider Search results, but their services are not eligible under the PSHCP. It is your responsibility to ensure that the provider offering the services you are seeking is eligible under the PSHCP. And it is important to confirm this eligibility before the expenses are incurred, through www.sunlifeca/pshcp ;
- Go to Coverage information
- Look for Medical coverage
- Select the claimant and the service/provider type
It is also recommended that you periodically review the list of delisted service providers to ensure that you do not unknowingly use their services There is a possibility that a provider you may have visited in the past, who may appear in your claims history, is no longer eligible. Information on delisted providers is updated regularly and can be viewed by logging in to the Plan Member Services website and selecting “Delisted providers list” located in the Benefits Centre under the Take me to navigation bar. You can still choose to obtain services or supplies from a delisted provider; however, your claim will not be eligible for reimbursement.
If you have any questions about delisted providers, contact the PSHCP Call Centre at 1-888-757-7427 (toll-free) or 613-247-5100 (in the National Capital Region).