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Public Service Health Care Plan PSHCP [Merged]

Occam

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For PSHCP...the three different "packages" as you call them are not packages.  There are three different levels of coverage for Hospital room and board charges (semi-private and private rooms).  Level 1 is $60/day, level 2 is $140/day, and level 3 is $220/day.  All three levels include the drug, vision care, and medical practitioners benefits at 80% coverage.  The difference in the premiums for the three levels is ridiculously small, although I don't remember the exact amounts.

You select the level of coverage you want based on the local "going rate" for semi-private/private rooms in your local hospital.  This presumes, of course, that there are semi-private/private rooms available.  Otherwise, you're paying for a higher level of coverage for nothing, because you'll end up in a ward anyways.

PSHCP is administered by Sun Life Assurance.

Dependents Dental Care Plan is administered by GreatWest Life, and is no charge to the member.
 

Occam

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Looking at my old Pay Statements, Level III coverage for PSHCP was $4.00/month.
 

dapaterson

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The benefits to CF members include deductibles.  He can probably combine benefits - that is, claim under both plans to get 100% reimbursement.  PSHCP has some info on that topic.  Google PSHCP for lots more info - the TBS website has lots.

He and his wife should look at the two plans and figure out whether it's worthwhile to maintain both and combine benefits, or if the money would be less if they just pay the deductible under the CF plans.


As previously stated, the three levels only relate to the maximum hospital room rate that's reimbursed; other than that, the PSHCP coverage is identical at all three levels.
 

Jarnhamar

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Perfect. I'll print this and give it to the soldier, thanks everyone.
 

DAA

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CF members are provided with Level III Supplementary coverage which is $4.00 per month.  If your posted OUTCAN, you are enrolled in the Level III Comprehensive Package which costs $4.01 per month. 

See Annex B of Schedule V - http://www.njc-cnm.gc.ca/directive/index.php?sid=87&hl=1&lang=eng

It's not uncommon for a CF member to have coverage for their dependants while their spouse has coverage through their employer and combining the benefit.

Here is the link to the main website - http://www.njc-cnm.gc.ca/directive/index.php?vid=9&lang=eng
 

Jarnhamar

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So basically this guy's wife is paying $60 a month for benefits with her employer and if he has her covered through the CF instead she will be paying $4.00 a month?
 

DAA

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ObedientiaZelum said:
So basically this guy's wife is paying $60 a month for benefits with her employer and if he has her covered through the CF instead she will be paying $4.00 a month?

Yup.....He will pay the $4.00 per month and the coverage provided is outlined in the benefits package.  He may wish to review her plan in comparison with ours to make sure they have the coverage they need, especially if there are any unique medical issues.

On a side note, he may want to have a closer look at his most recent pay statement because it is entirely possible that he is already enrolled/paying PSHCP premiums.  This is generally part of the admin process with the OR when you change your marital status or on enrolment.
 

dapaterson

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No.

He would pay $4.00 per month (or whatever the current rate is) for Level III hospital coverage.

However, the PSHCP coverage might be less than hers.  They need to assess whether or not the $720 per year she's paying is more or less than what they'd pay under PSHCP, given the deductibles.

 

Occam

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ObedientiaZelum said:
So basically this guy's wife is paying $60 a month for benefits with her employer and if he has her covered through the CF instead she will be paying $4.00 a month?

He'll be paying $4.00 off his pay, correct.

You have to remember that as dapaterson has mentioned, there are some circumstances under which it would be worthwhile for the member to get PSHCP, and his spouse to continue paying for her coverage through her own employer.  If you have a dependent who has expensive medication, or requires lots of medical practitioner expenses, then you'd have to crunch the numbers to determine if coordination of benefits makes it worthwhile for the spouse to continue paying the $60/mo through her employer.  There are certainly some families out there that would find this beneficial.

To expand on that:  You submit a drug claim through PSHCP for $100.  They pay for $80 out of that.  Under coordination of benefits, you can submit the remaining $20 under the spouse's coverage.  If your medical expenses are high enough such that the amounts transferred to the spouse's claims exceed $720/year, then it's worthwhile to maintain coverage through both employers.
 

exgunnertdo

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The other thing to consider is that as HER spouse, he can claim under her plan, but not on PSHCP.  There are things that he could claim (contact lenses and prescription sunglasses come to mind) that we can't get through our medical system.  There are probably others, chiropractic, I think?

Another thing to consider is dental - if her plan is both medical and dental, and they have kids who may need braces, he needs to look at that too.  There is often a lengthy wait time for braces if she opts back in later upon discovering someone needs braces (a couple of years).  Our coverage for orthodontics is 50%, and I forget the lifetime max, but it is used up very quickly in today's costs.  Her plan can cover the remaining 50%, and they would get her lifetime maximum too.
 

Neolithium

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Thanks for the links as well everyone, I think I may have to go visit my clerks for clarification because unless I'm really reading my pay stubs wrong it looks like my PSHCP deductions are $112 a month.
 

DAA

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Neolithium said:
Thanks for the links as well everyone, I think I may have to go visit my clerks for clarification because unless I'm really reading my pay stubs wrong it looks like my PSHCP deductions are $112 a month.

In Block K of your pay statement under Medical Insurance Plans ------>  http://www.cmp-cpm.forces.gc.ca/dgcb-dgras/ps/pay-sol/dmp-dts/psd-des/doc/dps-des.pdf

One thing I have noticed over the years is people being posted out of BC and the BC Med deductions not being ceased.
 

Occam

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Neolithium said:
Thanks for the links as well everyone, I think I may have to go visit my clerks for clarification because unless I'm really reading my pay stubs wrong it looks like my PSHCP deductions are $112 a month.

I think you're reading your pay stubs incorrectly.

If you look at the "Pay Deductions" box, there should be a box there called "Medical Insurance Plans".  You should see an amount in there for PSHCP (in my case, $4.00 for Level III coverage).

Don't look at the "Transaction Details" box, as there may be an amount there called "NON TAXABLE FRINGE BENEFITS MONTHLY/YEARLY", where you'll see an amount for PSHCP.  That's the employer-contributed amount of the premiums.
 

captloadie

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Occam said:
To expand on that:  You submit a drug claim through PSHCP for $100.  They pay for $80 out of that.  Under coordination of benefits, you can submit the remaining $20 under the spouse's coverage.  If your medical expenses are high enough such that the amounts transferred to the spouse's claims exceed $720/year, then it's worthwhile to maintain coverage through both employers.

This is true, except that under PSHCP, you have to submit the claims through the spouse's plan first, then submit a claim for the remainder. Of the remainder, you will still likely only get 80% covered. On things like prescriptions and glasses, it is not possible to get 100% of the money back (unless the spouse' s plan covers everything).
 

Occam

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captloadie said:
This is true, except that under PSHCP, you have to submit the claims through the spouse's plan first, then submit a claim for the remainder.

Ah, I knew there was an order they were submitted in, but I took a 50/50 chance and blew it.  Thanks for the correction.
 

Neolithium

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Occam said:
I think you're reading your pay stubs incorrectly.

If you look at the "Pay Deductions" box, there should be a box there called "Medical Insurance Plans".  You should see an amount in there for PSHCP (in my case, $4.00 for Level III coverage).

Don't look at the "Transaction Details" box, as there may be an amount there called "NON TAXABLE FRINGE BENEFITS MONTHLY/YEARLY", where you'll see an amount for PSHCP.  That's the employer-contributed amount of the premiums.

Thank you kindly for the correction.  I was way off in how I was reading it and your info helped clear it up nicely.
 

wo2kehler

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I was just told by someone that they had their PSHCP premium's claimed as medical expense. In the army, doesnt the army pay for the PSHCP? And if they pay, how can we deduct it...
 
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