Important Information about the New Public Service Health Care Plan Benefit Card
As of November 1, 2010 the Public Service Health Care Plan (PSHCP) benefit card will be accepted at pharmacies across Canada. You will no longer have to pay 100% of the cost of your covered prescription drugs and eligible medical supplies at time of purchase before submitting your claims for reimbursement. The card will allow your pharmacist to process your expenses electronically.
Please note that you MUST complete the enrolment form from Sun Life or commencing November 1, 2010 your claims will no longer be reimbursed.
The following Questions and Answers are only meant as a general introduction to the new PSHCP card. Complete details will be provided to you shortly by Sun Life. See below for other sources of information.
CLARIFICATION - REIMBURSEMENT OF MEDICAL PRESCRIPTIONS
(A) With the new card, are reimbursements now based on the cost of a generic drug instead of on the cost of the specific drug prescribed by my physician?
Sun Life bases your reimbursement on the (lower) cost of a generic drug not on the cost of the specific medication you were prescribed.
However, if your physician is of the opinion that only the name brand drug should be used, then “no substitutions allowed” must be specified on the prescription. This will ensure that your pharmacist will dispense the specific drug prescribed and that you will be reimbursed accordingly.
Members who have prescriptions dated before November 1st where the doctor has not indicated “no substitutions” should have them renewed and the wording adjusted immediately to avoid this situation.
We will keep members informed of the resolution of this issue as developments occur.
(B) What should I do if I run into this situation?
You should contact Sun Life and provide them with proof that your prescription calls for “no substitutions”. Sun Life will then process an adjustment to your reimbursement.
Questions and Answers
(1) What is the difference between the PSHCP card and the existing medical claim reimbursement process?
With the new PSHCP card, you will no longer need to file a claim for reimbursement and send in your receipts. Your coverage will be applied immediately to the purchase and you will only be required to pay the balance. There are exceptions to this new process, so make sure you read PSHCP Bulletin #24, which can be found at www.pshcptrust.ca/english/bulletins/default.shtml
(2) When can I start using the card?
The PSHCP card will be accepted at pharmacies across Canada beginning November 1, 2010.
(3) Am I automatically enrolled in the new system?
No. You MUST enroll as soon as possible or your claims will not be processed after November 1, 2010.
PIPSC strongly recommends that you enroll by September 15, 2010 at the latest to allow for processing time and to ensure a smooth transition to the new system.
(4) What do I have to do to enroll?
Sun Life will soon start sending out information packages to PSHCP members, either by mail or by email. Complete details on the enrolment process are included in these kits. Note that you can complete the registration process online even if you receive a mailed copy. The enrolment process will begin on July 15, 2010.
(5) What do I do if I don’t receive my information package soon?
Sun Life will send these information packages to PSHCP members only if it has a valid postal or email address for them. Some Plan members have never submitted a claim, or they may have changed email or physical addresses over the years. Please ensure that your contact information is up to date with Sun Life:
(a) If you are already registered on the Sun Life Plan Member Services website, review your contact information to make sure it is up to date.
(b) If you not registered with Sun Life, go to www.sunlife.ca/pshcp, click Register now and follow the instructions.
You can also contact your employer’s Human Resources department if you are experiencing difficulty obtaining your package.
You can contact the PIPSC Pension and Benefits Advisor if you require further assistance. See http://www.pipsc.ca/portal/page/portal/website/issues/pensioninfo for contact information.
(6) What do I do with my receipts between now and November 1, 2010?
Keep submitting your medical claim reimbursement as usual. There is no change in the process until November 1, 2010.
(7) Where can I get further information?