Does your PSHCP coverage

1 Number 28. February 2013. Bulletin does your PSHCP coverage continue when you retire? Yes, pensioners are eligible for coverage under the PSHCP when receiving a public service pension. If you choose to continue your PSHCP coverage as a pensioner and you are not changing your level of coverage , you can simply complete a form provided by your compensation advisor upon retirement or by your Pension Centre. Please be aware that your claims will not be processed until the transition from an active employee to a pensioner is complete. During this transition period, if a claim is declined at your pharmacy (if using your benefit card), or by Sun Life (if submitting a paper claim), you should resubmit the claim to Sun Life once you notice that the PSHCP deduction is taken from your pension cheque.

2 Sun Life will reprocess your claim and issue a reimbursement if the expense is eligible under the Plan. Should you require maintenance medication TABLE OF such as insulin, you may wish to purchase a sufficient quantity prior to your date CONTENTS of retirement or pay out-of-pocket for your medication and submit the claim at a later date. Please note there is a 100-day supply limit does your PSHCP coverage on the purchase of prescription avoid continue when you retire? .. 1 problems with refilling your prescription too soon, your PSHCP Dental Benefit . 2. contact the PSHCP Call Centre to request prior approval of your intended purchase. Do your research before you receive treatment .. 2 If you are changing your level of coverage at the time of your retirement or after, you must your PSHCP Hospital apply to do so through your Pension Centre.

3 Benefit .. 3. In the event of such a change request, please your PSHCP Bulletin is be aware that a waiting period may ensue. going Green ! .. 4 This waiting period can run concurrently with Member Satisfaction Survey that of the transition period from an active Coming in 2013 .. 4 employee to a pensioner but may not be identical. Once your change request is processed, Sun Life will be advised and the new contribution amount will appear on your pension cheque. Claims submitted after this change occurs will be processed at the new coverage level.. 1. PSHCP Bulletin Number 28 February 2013. your PSHCP Dental Benefit Do your research before you receive treatment We receive numerous inquiries concerning the Plan's Dental Benefit The PSHCP covers some paramedical coverage .

4 The PSHCP covers dental work required for natural teeth services, such as physiotherapy and that have been injured in an accident and some specific oral surgical psychology. However, there are certain procedures that are not accident-related. These benefits are separate limitations to the coverage for these from those covered by dental care plans. If you are covered under services under the Plan. the Public Service Dental Care Plan, the Pensioners' Dental Services As per the PSHCP Plan provisions, to Plan, the RCMP Dependants Dental Care Plan, or the CF Dependants be eligible for reimbursement under the Dental Care Plan, claims for expenses incurred for the treatment of Plan, most paramedical services require an accidental dental injury should first be submitted to the PSHCP .

5 A prescription from a physician who is The PSHCP provides reimbursement for the services of a dental licensed to practice in your province or surgeon and costs for dental prosthesis required for the treatment territory. This prescription should be of a fractured jaw or accidental injury to natural teeth. The fracture included with your claim unless it is or injury must be caused by an external and violent blow to the already on file with Sun Life. mouth not associated with normal day-to-day behaviour such as cleaning, chewing, and eating. The treatment must be completed Under the Medical Practitioners Benefit, within 12 months following the accident, or in the case of an eligible paramedical services must be performed dependant child under 17, before their 18th birthday.

6 The PSHCP by qualified practitioners who are does not provide reimbursement for other dental claims such as registered, licensed and practicing in cleanings, scaling and routine restorations. These claims should be the province or territory where the submitted to your dental care plan. services were rendered. Before incurring any treatment costs, we encourage you The PSHCP also provides reimbursement for a list of specific oral to research any provider that you are surgical procedures performed by a dentist. Some of the most considering to ensure they have the common eligible procedures include osteoplasty, gingivectomy, appropriate credentials. removal of impacted teeth, biopsy, apicoectomy, etc. A complete list of eligible procedures can be found in the PSHCP Member Booklet Some services have a maximum limit that located on the Plan Member Services website.

7 Can be claimed during any given calendar your dentist will send a predetermination of benefits to Sun Life to year. For example, the maximum that determine the eligibility of a specific oral surgical procedure. If you can be claimed for the services of a are covered under any other dental care plan, claims for expenses naturopath during a calendar year is incurred for the treatment of an oral surgical procedure should first $300. This limit refers to the maximum be submitted to the other dental care plan(s). eligible expense that can be claimed, not to the maximum amount that may Eligible expenses under the PSHCP be reimbursed to you. Reimbursement Dental Benefit are reimbursed at under the PSHCP for a naturopath's 80% of the current applicable services is 80% of the maximum covered fee guide, once the Plan's eligible expenses, after the annual annual deductible deductible has been satisfied.

8 Amount is satisfied. If two or more There are other limitations that apply courses of treatment to specific paramedical services. Please are considered, the consult your PSHCP Member Booklet PSHCP will pay for located on the Plan Member Services the lesser of the two website or contact the PSHCP Call treatments. Centre to confirm the specific limitations. 2. PSHCP . PSHCP . Bulletin Bulletin Number Number 28 24 February June 2010. 2013. your PSHCP Hospital Benefit The PSHCP Hospital Benefit provides reimbursement charges in excess of $140/day/room, the hospital may for charges not covered by your provincial health require you to pay for the difference in cost when you care plan. Reimbursement is up to specified dollar are discharged.

9 Amounts, for daily hospital accommodation charges in You should ensure that your level of hospital coverage a licensed hospital. The benefit does not cover semi- is adequate and reflects the daily rates at your local private and private accommodations specifically, but hospital(s) for the type of hospital accommodation that rather, provides a specified dollar amount per day. you select. To determine the current daily rates in your A licensed hospital is defined as a legally licensed area, we suggest that you call your hospital and confirm hospital that provides facilities for diagnosis, major the cost for semi-private and private accommodation. surgery and the care and treatment of a person If you wish to amend your level of hospital coverage , suffering from disease, or injury on an in-patient contact your compensation advisor or your pension basis, with 24-hour services by registered nurses and centre.

10 Unless otherwise specified, there is a three- physicians. In order to be eligible under the PSHCP , month waiting period before the change takes treatment for mental illness, drug and alcohol addiction effect. This waiting period can be waived in certain must be obtained in a legally licensed hospital as circumstances, such as if the application is received defined by the Plan. Please note that licensed hospitals within 60 days of acquiring coverage for a spouse or a do not include nursing homes, homes for the elderly, dependant child. If you do choose to increase your level rest homes or other facilities providing similar care. of hospital coverage , your monthly contribution rate The specific dollar amount you are covered and toward the Plan will also increase.