On August 3, the Partners Committee of the Public Service Health Care Plan (PSHCP) issued a joint recommendation to accept a proposed overhaul to the plan’s benefits and coverage. This marks the completion of nearly 4 years of consultations with the Treasury Board on updates to the plan.
Plan changes will be implemented July 1, 2023.
This updated plan sees money directed away from inflated drug costs and excessive pharmacy fees, and directed towards the things that make a difference to you and your health.
New limits on dispensing fees, filling frequency, and certain high-cost drugs have allowed the plan to greatly expand the coverage you requested. By being smart in where and how you choose to fill your medication, you can save significantly on your co-pay and avoid exceeding plan limits.
Additional information will be made available by PIPSC and the Administrative Authority of the PSHCP as it becomes available.
Plan change highlights
For informational purposes only. Please refer to final updates as listed on the plan website when they become available before making a purchase. Plan changes effective July 1, 2023.
Promotes health and wellness through evidence-based medical care and plan design
- Mental healthcare services when provided by an accredited psychologist, social worker, psychotherapist, or counsellor at to $5000 per year (from $2000). No prescription required. Covered professionals vary by province.
- Glasses/contact lens benefit at $400 every 2 years (from $275)
- Laser eye surgery at $2000 per lifetime (from $1000)
- Increase of the massage, podiatrist/chiropodist benefit to $500 (from $300)
- Smoking cessation coverage at $2000 (from $1000) per lifetime
- New coverage for dieticians, occupational therapists, and lactation consultants at $300 per year
Provides comprehensive coverage to care for members in difficult life situations
- A prior authorization program for a limited number of high-cost drugs to ensure treatment plan is appropriate and cost-effective (new). Grandfathering provisions for members currently on affected high-cost drugs.
- Gender affirmation coverage at $75,000 per lifetime (new) and automatic coverage for electrolysis
- Electrolysis at $1200 per year (previously capped per session)
- Wigs at $1500 (from $1000) and coverage for new conditions
- Injectable joint lubricant coverage at $600 (new)
- Naturopath and osteopath coverage at $500 (from $300)
- Footcare performed by a community nurse covered under the podiatrist benefit (new)
- Nursing coverage at $20,000 (from $15,000)
- Speech language at $750 (from $500) and audiologist coverage under this benefit (new)
- CPAP supplies at $500 (from $300)
- Orthopaedic shoes at $250 (from $150)
- Wheelchair coverage within 5 years of last claim when medical condition changes so that a new type of chair is required (new exception)
- New coverage for medically necessary monitors including oxygen saturation meter, pulse oximeter, saturometer, and blood pressure monitor, once every 60 months each
- Coverage and contribution rates extended for parental and caregiving leave (previously limited)
- Premium waiver for low-income retirees extended to those who retired after 2015 (previously excluded)
- Retirees with 6 years of service are eligible for retiree benefits regardless of if this service is pensionable or not (can accumulate PSHCP eligible service after retirement/age 71)
- Post-retirement re-employment will no longer negatively impact subsequent retiree coverages
- Insulin jet injectors at $1000 every 3 years (from $760)
- Coverage for diabetic monitors without use of insulin pump up to $700 per 5 years
- New coverage for continuous glucose monitor supplies (type I diabetics) at $3000
- New coverage for other diabetic testing supplies (type II diabetics) such as flash glucose supplies and testing strips up to $3000
Innovates with digital tools, industry partnerships, new technologies, and preventative care
- Allow nurse practitioners to provide prescriptions for nursing coverage or medical supplies, provided it is in their scope of practice (previously excluded)
- Removal of the physiotherapy corridor and introduction of a $1500 maximum (new cap)
- New coverage for needles when prescribed at $200
- Spousal definition amendment to remove the requirement that the relationship is publicly known
- Acupuncture coverage at $500 when performed by an accredited acupuncturist (doctor requirement removed)
- $200 annual hearing aid repair allowance (new), battery allowance ($200) and $1500 max every 5 years (from $1000)
- Permanence of coverage for certain medical procedures not covered in all provinces and territories (previously excluded)
Adopts a long term vision of sustainable, efficient, and affordable health care that delivers top value to current members, retired members, and the Canadian public
- Mandatory Generic Substitution/biosimilar substitution with a rigorous exception process (new criteria for exceptions)
- Dispensing fee cap at $8 per medication except for certain special medications (new)
- Maintenance drug frequency filling maximum at 5 times per year when appropriate and when co-pay is less than $100 for a 3-month period (new)
- Compound drugs only covered when one active ingredient would otherwise be covered under the drug benefit (new)
- Catastrophic drug-coverage maximum raised to $3500 (from $3000)
- Members can avoid increased out-of-pocket drug costs or even lower them by filling medications for 3-month periods (when allowed) and choosing a low-cost pharmacy such as a mail order or membership club pharmacy. These options are available to all plan members without a membership or extra fees.
The PSHCP is an employer-sponsored health care plan for current and retired federal public service employees and their families working or retired from the Core Public Administration and most agency employers. It covers many healthcare expenses not insured by your provincial healthcare plan.
While benefits are non-negotiable under federal public service labour legislation, the Treasury Board has adopted a consultative forum to review the plan on a cyclical basis. Plan updates are based on member feedback, including by way of a 2017 member survey, and benchmarking with comparable private and public sector plans.