Public Service Health Care Plan

What is the overall purpose of the plan?

The general purpose of the plan is to provide reimbursement for expenses for certain medical services and products which are not covered by a member's provincial health plan.

Why does the plan provide three levels for hospital coverage? Why not just cover the full costs for semi private and private hospital rooms?

The plan covers members all across Canada, and the charges for semi-private and private hospital confinement differ significantly between provinces. If all pensioners were to pay the same contribution rates for "semi-private" coverage, then the pensioner in Alberta, where the costs are quite low, would be subsidizing the costs for pensioners in provinces such as Ontario where the costs are high.

Explaining "Deductible" and "Co-payment"

The annual deductible is a specific dollar amount that you must satisfy each calendar year before you receive reimbursement by the plan, and it applies to the year that medical expenses are incurred. If you have "single" coverage, your annual deductible amount is $60, and if you have "family" coverage your annual deductible amount is $100. These amounts are subtracted from your first claim(s) during the year, and are indicated on your Explanation of Benefits (EoB). In the case of "family" coverage, a $60 annual deductible is applied to the family member who incurs the first eligible expense for the year. The remaining $40 annual deductible amount is applied if and when a second covered family member claims. If only one family member claims during the entire year, then only the $60 annual deductible amount is applied.

The Extended Health Care Benefit of the PSHCP reimburses you for 80% of eligible costs, after you satisfy the plan's annual deductible amount. The remaining 20% is the amount that you are required to pay toward each eligible expense, and if referred to as the co-payment.

[ Top of Page | List of Topics | Feedback | Home ]