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</div> <div class="row"> <div class="col-12 col-xl-9"> <div class="page-header"><h1>Public Service Health Care Plan Directive</h1></div> <div class="page-content new-list-styles"><div class="directive-9 dv-283"><ul><li><a href="/directive/d9/v283/s817/en#s817-tc-tm">General</a> <ul> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_1">Application</a></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_2">Effective Date</a></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_3">Purpose and Scope of the PSHCP</a></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_4">Claims Appeal Procedure</a></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_5">Management of the Public Service Health Care Plan</a> <ul> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_5_1">PSHCP Governance</a></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_5_2">Financial Management</a></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_5_3">Amendment of the Plan Directive</a></li> </ul></li> <li><a href="/directive/d9/v283/s817/en#s817-tc-tm_6">Definitions</a></li> </ul></li><li><a href="/directive/d9/v283/s819/en#s819-tc-tm">1 Eligibility</a> <ul> <li><a href="/directive/d9/v283/s819/en#s819-tc-tm_1">1.1 Employees, Civilian Members of the RCMP</a></li> <li><a href="/directive/d9/v283/s819/en#s819-tc-tm_2">1.2 Members of the RCMP and of the CAF Regular and Reserve Component</a></li> <li><a href="/directive/d9/v283/s819/en#s819-tc-tm_3">1.3 Pensioners</a></li> <li><a href="/directive/d9/v283/s819/en#s819-tc-tm_4">1.4 Dependants</a></li> </ul></li><li><a href="/directive/d9/v283/s820/en#s820-tc-tm">2 Commencement, Amendment and Termination of Coverage</a> <ul> <li><a href="/directive/d9/v283/s820/en#s820-tc-tm_1">2.1 When an Application is Required</a></li> <li><a href="/directive/d9/v283/s820/en#s820-tc-tm_2">2.2 Effective Date of Coverage</a> <ul> <li><a href="/directive/d9/v283/s820/en#s820-tc-tm_2_1">Waiting Period</a></li> </ul></li> <li><a href="/directive/d9/v283/s820/en#s820-tc-tm_3">2.3 Termination of Coverage</a> <ul> <li><a href="/directive/d9/v283/s820/en#s820-tc-tm_3_1">Voluntary Cessation of Coverage</a></li> <li><a href="/directive/d9/v283/s820/en#s820-tc-tm_3_2">Involuntary Cessation of Coverage</a></li> </ul></li> </ul></li><li><a href="/directive/d9/v283/s821/en#s821-tc-tm">3 Contributions</a> <ul> <li><a href="/directive/d9/v283/s821/en#s821-tc-tm_1">3.1 General</a></li> <li><a href="/directive/d9/v283/s821/en#s821-tc-tm_2">3.2 Payment of Contributions While on Leave Without Pay (LWOP)</a></li> <li><a href="/directive/d9/v283/s821/en#s821-tc-tm_3">3.3 Employee Contributions Only</a></li> <li><a href="/directive/d9/v283/s821/en#s821-tc-tm_4">3.4 Employee and Employer Contributions</a></li> <li><a href="/directive/d9/v283/s821/en#s821-tc-tm_5">3.5 Retroactive Change in Coverage</a></li> <li><a href="/directive/d9/v283/s821/en#s821-tc-tm_6">3.6 Administrative Errors</a></li> </ul></li><li><a href="/directive/d9/v283/s822/en#s822-tc-tm">4 Available Coverage</a> <ul> <li><a href="/directive/d9/v283/s822/en#s822-tc-tm_1">4.1 Supplementary Coverage</a></li> <li><a href="/directive/d9/v283/s822/en#s822-tc-tm_2">4.2 Comprehensive Coverage</a></li> <li><a href="/directive/d9/v283/s822/en#s822-tc-tm_3">4.3 Eligibility for Provisions</a> <ul> <li><a href="/directive/d9/v283/s822/en#s822-tc-tm_3_1">Employees, Dependants of Members of the CAF and of the RCMP</a></li> <li><a href="/directive/d9/v283/s822/en#s822-tc-tm_3_2"> Pensioners</a></li> </ul></li> </ul></li><li><a href="/directive/d9/v283/s818/en#s818-tc-tm">5 Plan Provisions</a> <ul> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_1">5.1 Claims</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_2">5.2 Appeals</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_3">5.3 Payment of Benefits</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_4">5.4 Co-Payment</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_5">5.5 Overpayments</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_6">5.6 Coordination of Benefits</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_7">5.7 Subrogation</a></li> <li><a href="/directive/d9/v283/s818/en#s818-tc-tm_8">5.8 General Exclusions and Limitations</a></li> </ul></li><li><a href="/directive/d9/v283/s832/en#s832-tc-tm">6 Extended Health Provision</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_1">6.1 General</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2">6.2 Drug Benefit (For All Members)</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2_1">PSHCP Benefit Card</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2_2">Prior Authorization</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2_3">Mandatory Generic/Biosimilar Substitution</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2_4">Pharmacy Dispensing Fees and Frequency Limits</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2_5">Catastrophic Drug Coverage in the Event of High Drug Costs</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_2_6">Exclusions</a></li> </ul></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_3">6.3 Vision Care Benefit (For All Members)</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_3_1">Exclusions</a></li> </ul></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_4">6.4 Medical Practitioners Benefit (For All Members)</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_4_1">Exclusions</a></li> </ul></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_5">6.5 Miscellaneous Expense Benefit (For All Members)</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_5_1">Exclusions</a></li> </ul></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_6">6.6 Dental Benefit (For All Members)</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_6_1">Lower Cost Alternative</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_6_2">Accidental Injury</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_6_3">Oral Surgical Procedures</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_6_4">Exclusions</a></li> </ul></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_7">6.7 Out-of-Province Benefit (For Members with Supplementary Coverage)</a> <ul> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_7_1">Emergency Benefit While Travelling</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_7_2">Emergency Travel Assistance Services</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_7_3">Official Travel Status</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_7_4">Referral Benefit</a></li> <li><a href="/directive/d9/v283/s832/en#s832-tc-tm_7_5">Exclusions</a></li> </ul></li> </ul></li><li><a href="/directive/d9/v283/s833/en#s833-tc-tm">7 Hospital Provision (For All Members)</a> <ul> <li><a href="/directive/d9/v283/s833/en#s833-tc-tm_1">7.1 General</a></li> <li><a href="/directive/d9/v283/s833/en#s833-tc-tm_2">7.2 Eligible Expenses - Level I, II and III</a> <ul> <li><a href="/directive/d9/v283/s833/en#s833-tc-tm_2_1">Exclusions</a></li> </ul></li> </ul></li><li><a href="/directive/d9/v283/s834/en#s834-tc-tm">8 Basic Health Care Provision (For All Members with Comprehensive Coverage)</a> <ul> <li><a href="/directive/d9/v283/s834/en#s834-tc-tm_1">8.1 General</a></li> <li><a href="/directive/d9/v283/s834/en#s834-tc-tm_2">8.2 Eligible Expenses</a> <ul> <li><a href="/directive/d9/v283/s834/en#s834-tc-tm_2_1">Exclusions</a></li> </ul></li> </ul></li><li><a href="/directive/d9/v283/s835/en#s835-tc-tm">9 Hospital (Outside Canada) Provision (For All Employees with Comprehensive Coverage, Excluding Pensioners)</a> <ul> <li><a href="/directive/d9/v283/s835/en#s835-tc-tm_1">9.1 General</a></li> <li><a href="/directive/d9/v283/s835/en#s835-tc-tm_2">9.2 Eligible Expenses</a> <ul> <li><a href="/directive/d9/v283/s835/en#s835-tc-tm_2_1">Exclusions</a></li> </ul></li> </ul></li><li><a href="/directive/d9/v283/s836/en#s836-tc-tm">10 Summary of Maximum Eligible Expenses</a> <ul> <li><a href="/directive/d9/v283/s836/en#s836-tc-tm_1">Length of Time a Prescription is Valid</a></li> </ul></li><li><a href="/directive/d9/v283/s823/en#s823-tc-tm">Schedule I – Participating Employers</a></li><li><a href="/directive/d9/v283/s824/en#s824-tc-tm">Schedule II – Employers Withdrawn from the PSHCP</a></li><li><a href="/directive/d9/v283/s825/en#s825-tc-tm">Schedule III - Designated Persons, Boards and Agencies</a></li><li><a href="/directive/d9/v283/s826/en#s826-tc-tm">Schedule IV - Recognized Ongoing Pension Benefits</a></li><li><a href="/directive/d9/v283/s827/en#s827-tc-tm">Schedule V - Monthly Contribution Rates</a> <ul> <li><a href="/directive/d9/v283/s827/en#s827-tc-tm_1">Appendix A – Employee Monthly Contribution Rates</a></li> <li><a href="/directive/d9/v283/s827/en#s827-tc-tm_2">Appendix B – Members of the Canadian Armed Forces CAF/RCMP Monthly Contribution Rates</a></li> <li><a href="/directive/d9/v283/s827/en#s827-tc-tm_3">Appendix C – Pensioner Monthly Contribution Rates</a></li> <li><a href="/directive/d9/v283/s827/en#s827-tc-tm_4">Appendix D – Employer Monthly Contribution Rates</a></li> </ul></li><li><a href="/directive/d9/v283/s828/en#s828-tc-tm">Schedule VI - Full Employer-Paid Coverage</a></li><li><a href="/directive/d9/v283/s829/en#s829-tc-tm">Schedule VII - Life-Sustaining Drugs</a></li></ul> <div class="page-navigation text-center margin-bottom-20"> <a href="/directive/d9/v283/s817/en" title="General" class="btn btn-primary next"><span>Next</span></a> </div></div></div> </div> <div class="col-12 col-xl-3 hidden-print"> <nav class="inpage-menu"> <div class="card"> <h5 class="card-header bg-light">Related Links</h5> <div class="card-body"> <a href="/directive/d9/v283/en?print" 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