After years of negotiations, a new tentative agreement has been reached with the Employer to update the Public Service Health Care Plan (PSHCP). The tentative agreement is being presented to Treasury Board for ratification shortly.
Negotiations for the PSHCP are done outside of the collective bargaining process and timelines. They have been ongoing since 2019 and the proposals were developed through membership consultation via a survey before the negotiations. The goal of these negotiations was to modernize the PSHCP to ensure it offers relevant benefits for federal public sector employees and their families, but also to ensure it was sustainable financially so it could adapt to future cost changes.
Key gains were made on mental health benefits, vision care, paramedical practitioners’ coverage, gender affirmation coverage, smoking cessation drugs, miscellaneous expense benefits, premium rates while on parental and caregiving leave and more.
“Our members have been waiting for an agreement around the Public Service Health Care Plan for a long time and the outcome is overall positive,” said Greg Phillips. “There are significant increases in spending amounts available for many of the key benefits our members use. These improvements are of particular significance and a huge step forward in modernizing the Plan.”
– Greg Phillips, CAPE President
For a detailed list of benefit improvements in the tentative plan, please see below.
These improvements to your health care benefits will take effect on July 1, 2023. As well, at that time a new service provider, Canada Life, will take over the administration of the plan.
CAPE will follow up with further updates from TBS and Canada Life as more details become available in the next few months.
For any questions, please seek clarification from your Employer. For any questions for CAPE please contact us at general@acep-cape.ca.
Detailed list of benefit improvements
The following list is part of the tentative agreement. When the final approved Plan is available it will be shared.
Vision care
- Maximum eligible amount increased to $400 every two years (from $275)
- Maximum lifetime eligible amount for laser eye surgery increased to $2,000 per lifetime (from $1,000)
Paramedical practitioners
Increased annual maximum eligible amounts for:
- Each one of massage therapy, osteopath, naturopath, podiatrist or chiropodist to $500 (from $300)
- Nursing services to $20,000 (from $15,000)
- Psychological practitioners to $5,000 (from $2,000)
- Speech language pathology to $750 (from $500)
Additional benefits secured:
- Electrolysis to a reasonable and customary amount with an annual maximum of $1,200, with prescriptions waived for members going through gender affirmation procedures
- Expansion of psychological providers to include coverage for psychotherapists, social workers (for all members, regardless of place of residence) and registered counsellors
- Removed prescription requirements for massage therapy, physiotherapy, psychological services and speech therapy
- Audiologists are now eligible under the speech therapy category
- New coverage for the following practitioners: dieticians, occupational therapists, and lactation consultants each at eligible maximum of $300 per year
- Acupuncture is now eligible when performed by a registered acupuncturist at an eligible maximum of $500 per year
- Foot care is now covered under the podiatrist/chiropodist amount when done at community nursing stations
- Removal of $500-$1,000 member-paid corridor for physiotherapy with a new annual eligible maximum of $1,500
Hospital and emergency coverage
- Level 1 of the baseline coverage for hospitalization to increase to $90 per day (from $60)
- Level 2 and 3 rates to increase $30 each ($170 for level 2 and $250 for level 3)
- Out of country coverage to be for 40 days exclusive of periods of work, with coverage now at $1M per trip (from $500,000)
- Family Assistance benefits overall maximum to increase to $5,000 (from $2,500)
- Daily allowance for meals and accommodations under family assistance benefits to increase to $200 per day (from $150)
Drug coverage
- Smoking cessation drugs increase to $2,000 per life (from $1,000)
Miscellaneous expense benefits
Increase maximum eligible amounts for:
- Orthopedic shoes to $250 per year (from $150)
- Insulin jet injector device to $1,000 every 36 months (from $760)
- CPAP supplies to $500 per year (from $300)
- Hearing aids to $1,500 every 60 months (from $1,000)
- Wigs to $1,500 every 60 months (from $1,000)
Additional benefits secured:
- Introduced coverage for injectable synovial fluid to treat joint pain and arthritis (e.g. Synvisc) to an eligible maximum of $600 per year
- Allow claims for a new wheelchair within the existing five-year time limit where a patient’s medical condition changes requiring a different type of wheelchair. The maximum eligible claim for the new wheelchair will be reduced by any amount reimbursed for other wheelchair purchases in the previous five years
- Delete requirement that walkers and wheelchairs must be for use inside the patient’s private residence
- Introduced coverage for needles for injectable drugs, not just diabetes, to a maximum of $200 per year
- Introduced coverage for hearing aids batteries of up to $200 per year separate from the increased amount for hearing aids
Coverage for diabetic conditions
- Introduced coverage for diabetic monitors without use of insulin pump, to a maximum of $700 per 60 months
- Introduced coverage for continuous glucose monitor supplies (type I diabetics) at $3,000 per year
- Introduced coverage for other diabetic testing supplies (for type II diabetics) such as flash glucose supplies and testing strips to a maximum of $3,000 per year
- Removed reference to “blood” glucose monitors
Other benefit amendments
- Enhanced gender affirmation coverage at lifetime eligible maximum of $75,000
- Introduced coverage for medically necessary monitors including oxygen saturation meters, pulse oximeters, saturometers, blood pressure monitors (once every 60 months each)
- Allowed nurse practitioners to provide prescriptions for nursing coverage or medical supplies, provided it is in their scope of practice
Amendments to retirement benefits
- Relief provisions will be extended for retired members who retire after 2015 at the same level to those who retired before 2015 (i.e. if eligible for the Guaranteed Income Supplement, only 25% of premiums are payable)
- Retirees with six years of service are eligible for retiree benefits, even if all six years are not pensionable due to age
- Anyone who returned to work after retirement shall not lose access to their retiree benefits once they retire again
Amendments to coverage during leave and other definitions
- Coverage now at regular premium rates for the full period of parental leave and any period of caregiving leave
- Definition of common law spouse amended to remove the requirement that one must publicly represent themselves as spouses
Amendments to drug coverage and pharmacist fees
- Implementation of a Mandatory Generic Substitution with a 180-day grandfathering period and exceptions only based on medical necessity
- Implementation of a system of prior authorization for high-cost drugs. Approval will be granted using an evidence-based model and all members will be fully grandfathered with the exception that they may be required to switch their existing biologic drug to a biosimilar
- Reimbursement of pharmacist fees will be capped at a maximum of five times per year for each maintenance drug prescribed. Exceptions will be made for safety or storage or where a member’s co-pay for a three-month supply of a given drug is more than $100
- Reimbursement of pharmacy dispensing fees will be capped at $8 per fee. This limit does not apply to biologic drugs or compounded drugs
- Compound drugs will only be covered where at least one active ingredient has a DIN and would otherwise be covered, subject to a 180-day grandfathering period
- Increase to the out-of-pocket maximum for catastrophic drug coverage will increase to $3,500 (from $3,000)
