Frequently asked questions

The Government of Canada, along with the PSHCP Partners Committee, comprised of bargaining agents, the employer and pensioner representatives have successfully negotiated benefit improvements and changes to the PSHCP that came into effect July 1, 2023. Information about the improvements and changes can be found at canada.ca/pension-benefitsOpens a new website in a new window - Opens in a new window . 

The improvements and changes to the PSHCP are unrelated to the change in plan administrator. Canada Life will administer your coverage based on the PSHCP Directive, which is available on the National Joint Council website at njc-cnm.gc.caOpens a new website in a new window - Opens in a new window .

If you’ve completed positive enrolment for the Public Service Health Care Plan (PSHCP), you’re set up in our system to have your claims reimbursed. 

Your pharmacist needs your certificate and plan number (the information on your PSHCP benefit card) to accurately submit claims to Canada Life. 

Your certificate number is the same as it was with Sun Life and can be found on an old explanation of benefits or on your old benefit card. However, your plan number changed based on your month of birth:

• (52111) January, February, March
• (52112) April, May, June
• (52113) July, August, September
• (52114) October, November, December
• (52115) the plan number for eligible surviving dependants (spouse or eligible children) 

Please note that these numbers are the same for you and your eligible dependants. 

Additionally, please ask them to confirm if they’ve correctly entered the following information:

• Carrier number 12
• Your plan number (based on your birth month)
• Certificate number (the same as it was with Sun Life)
• Card issue number 01
  

Effective July 1, 2023, prescription drugs under the Public Service Health Care Plan (PSHCP) are subject to mandatory generic substitution. This means that the PSHCP provides coverage for eligible prescription drugs at 80% of the lowest-cost generic drug when a generic is available. Generic drugs are approved by Health Canada and are pharmaceutically equivalent to the brand name drug as they contain the identical medicinal ingredients. 

If you were taking a brand name drug prior to July 1, 2023, the PSHCP will provide a legacy period ending December 31, 2023. During the legacy period, prescribed brand name drugs will still be reimbursed at 80% of their cost for those with existing prescriptions. Before this period ends, discuss the 3 options below with your health care provider. 

If you have a prescription for a brand name drug and a generic version is available, there are 3 options: 

1. Purchase the generic drug. The PSHCP will reimburse 80% of the eligible cost.
2. Purchase the brand name drug. The PSHCP will reimburse 80% of the cost of the generic drug and you’ll have a higher out-of-pocket cost (this is known as the co-payment amount).For example, a brand name drug costs $100 and the generic costs $80. If you purchase the generic, the PSHCP will cover 80% of the $80 charge, which is $64. Your out-of-pocket amount is $16. If you choose to purchase the brand name, the PSHCP will still cover $64, but your out-of-pocket amount will be $36. 
3. If there’s a medical reason why you cannot take the generic drug, have your doctor complete a PSHCP – "Request for brand name drug coverage" form, available on the Forms page on the PSHCP Member Services website. Any fees your physician may charge for providing this information will not be reimbursed. Submit the completed form to Canada Life at the mailing address, email address or fax number on the form .Please allow 7 to 10 business days to complete a review of the medical information provided. Canada Life will send a letter outlining the decision.

The pharmacy’s computer system believes that you or your dependant under the Public Service Health Care Plan (PSHCP) has “Other insurance” (OI). 

OI can be other private insurance or provincial/territorial health insurance. 

There are different intervention codes for private insurance and provincial/territorial health insurance. If your pharmacy has entered the wrong intervention code, a “DIN Covered by Other” message might appear. 

This message will also appear if your pharmacy has entered an intervention code when OI does not exist. 

Confirm with your pharmacy that they have entered the correct intervention code. If you or your dependants do not have any OI, you can easily update this information on your PSHCP Member Services accountOpens a new website in a new window - Opens in a new window . Simply go to the 'Your Profile' section and select 'Dependants and other Coverage'. Then click on 'Your other Coverage' and make the necessary updates. 

Any updates made to your PSHCP Member Services account may take 1 to 2 days to take effect.

This error will show up in 2 cases:

• The pharmacy has entered a date of birth that does not match what’s in your positive enrolment information in our system.
• The date of birth provided by the pharmacy is correct, but they mistakenly entered the wrong relationship code. For example, the medication is meant for your dependant, but the pharmacist entered the relationship code 01, which is intended for you, the plan member.

Please inform the pharmacy about the patient's relationship with you as the plan member.

To check the list of dependants covered under your Public Service Health Care Plan (PSHCP), navigate to 'Your Profile' and select 'Dependants and other Coverage'. 

If you cannot add a dependant or the option is not available for you, please ensure that you have changed your coverage level from ‘Single’ to ‘Family’. If you need to change your coverage from Single to Family, or vice versa:

• Active employees can amend their coverage type through the secure online Compensation Web Application (CWA). If you cannot access the CWA, you may complete a paper application form and submit it to your departmental compensation office or Pay CentreOpens a new website in a new window - Opens in a new window .
• Retired members can submit a paper application form to their pension office. 

A waiting period may be applied by your employer, and Canada Life will not receive notice of this change until it is finalized. Your file will be updated to allow you to add a dependant in your PSHCP Member Services account once your employer or pension office informs us that your change request has been authorized.

To update your address for the Public Service Health Care Plan (PSHCP), sign in to your PSHCP Member Services account. 

Navigate to the 'Your Profile' tab and select 'Personal Information.'

Our Benefit Payment Office service turnaround time is measured from the date the claim is received to the date the claim is resolved. 

Our average service level is as follows:

• Electronic claims – 5 calendar days
• Paper claims (except out-of-province) – 9 calendar days
• Out-of-province claims – 10 calendar days
• Comprehensive Coverage claims – 10 calendar days 

We might occasionally exceed the above service levels due to:

• Experiencing higher claim volumes
• Claims that are complex and require additional review

Please allow 1 to 2 days from the submission date to show up on your Claim History.

Sun Life will continue to process claims that were pending before July 1, 2023. Please check your Sun Life Member Services account. 

If you cannot find the information on your Sun Life Member Services account, you can resubmit the claim to Canada Life. 

Please note that if claims get paid by both Sun Life and Canada Life, the resulting overpayment will be collected.

If you’ve processed Public Service Health Care Plan (PSHCP) claims through Sun Life, you may access the report by signing into your Sun Life Member Services account. 

Similarly, for claims processed by Canada Life, you may download them from your Canada Life PSHCP Member Services account.  You may also call the PSHCP Member Contact Centre at 1-855-415-4414Opens in a new window1 8 5 5 4 1 5 4 4 1 4, Monday to Friday from 8 am to 5 pm, your local time, to request a paper report be sent to you in the mail.

Plastic benefit cards will not be issued for the Public Service Health Care Plan (PSHCP). This is a green initiative supported by the Government of Canada and Canada Life. You may access your PSHCP benefit card for yourself and your covered dependants through the PSHCP Member Services website and save it to your mobile device and/or print it. You may also call the PSHCP Member Contact Centre at 1-855-415-4414Opens in a new window1 8 5 5 4 1 5 4 4 1 4, Monday to Friday from 8 am to 5 pm, your local time, to request a paper PSHCP benefit card be sent to you in the mail. 

If you have difficulty downloading your card once you’ve located it, log out, check to see that your browser is permitting pop-ups and then try again.

If you’ve completed positive enrolment for the Public Service Health Care Plan (PSHCP), but your claim is still not going through at the pharmacy, ask the pharmacist to confirm the following:

• Did the pharmacist enter your new plan number and your existing certificate number? These numbers can be found on your new Canada Life PSHCP benefit card.
• Your certificate number is the same as it was with Sun Life and can be found on an old explanation of benefits or on your old benefit card. However, your plan number changed based on your month of birth:
  • (52111) January, February, March
  • (52112) April, May, June
  • (52113) July, August, September
  • (52114) October, November, December
  • (52115) the plan number for eligible surviving dependants (spouse or eligible children)
• Did the pharmacist select “Carrier 12” which is the unique number associated with the PSHCP? The carrier number is the same as it was with Sun Life.
• Did the pharmacist enter the TELUS provider number associated with PSHCP Carrier 12, and not the provider number used with Canada Life’s other clients?  

When your pharmacist submits claims for your eligible dependants (spouse, common-law partner or eligible children) your pharmacist will need to enter their name exactly as you did when you completed positive enrolment. If you want to verify the spelling used during positive enrolment, sign in to your PSHCP Member Services account through the PSHCP Member Services website or the positive enrolment confirmation package you received in the mail, to see your dependants.