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Treasury Board approves new public service health care plan for 2023

By Pay, Pension and Benefits

On Monday, Treasury Board announced it approved the new federal public service health care plan (PSHCP) for 2023, following August’s announcement that an agreement on the plan had been reached between it and unions.

The new plan comes into effect July 1, 2023, and will also see the transition from Sun Life to Canada Life for the administration of the plan.

In August, Treasury Board highlighted updates to the new plan, such as:

  • increased support for mental health and well-being, including increased coverage for psychological services and an expansion of mental health service providers;
  • for the first time, coverage to be available for gender affirmation;
  • provisions to help support the accessibility needs of members and their dependants, including greater access to benefits for mobility devices such as wheelchairs and hearing aids;
  • amendments to eligibility requirements to benefit low-income and working seniors; and,
  • plan improvements for families and young people including amendments to coverage during parental and caregiving leaves and increases in coverage, such as paramedical services, mental health services and laser eye surgery.

In its statement this week, Treasury Board also provided a detailed table for public servants on the improvements and changes to the plan, which can be viewed below:

Improvements

BenefitCoverage reimbursed at 80%Details
Medical practitioners’ services
1. Registered Dietician$300 per calendar yearNew benefit
No prescription required
2. Occupational therapist$300 per calendar yearNew benefit
No prescription required
3. Lactation consultant$300 per calendar yearNew benefit
No prescription required
4. Acupuncturist$500 per calendar yearService can now be provided by acupuncturists
No prescription required
5. Nurse practitionerN/ANurse practitioners can now prescribe medical supplies and prescriptions, if authorized by their provincial or territorial government
Miscellaneous Expenses
6. Batteries for hearing aids$200 per calendar yearNew benefit
7. Injectable lubricants for joint pain and arthritis$600 per calendar yearNew benefit
Prescription required
8. Gender Affirmation$75,000 per lifetimeNew benefit
Coverage for services designed to support and affirm an individual’s gender identity
Medical practitioner’s services
9. Psychological services (Psychologist)$5,000 per calendar yearMental health services can now be provided across Canada by:
Psychotherapists
Social workers
Registered counsellors

Prescription not required
10. Physiotherapist$1,500 per calendar yearRemoval of member-paid corridor
Prescription not required
11. Massage therapist$500 per calendar yearIncreased benefit from $300 to $500
Prescription not required
12. Osteopath$500 per calendar yearIncreased benefit from $300 to $500
Prescription not required
13. Naturopath$500 per calendar yearIncreased benefit from $300 to $500
Prescription not required
14. Podiatrist or chiropodist$500 per calendar yearNow includes foot care at a community nursing station
15. Nursing services$20,000 per calendar yearIncreased benefit from $15,000 to $20,000
16. Electrologist$1,200 per calendar yearNo prescription required if undergoing gender affirmation
17. Speech language pathologist$750 per calendar yearAudiologists are now covered under this benefit
Prescription not required
Vision care
18. Prescription eyeglasses, contact lenses (purchase and repairs)$400 every two years starting on the odd yearIncreased benefit from $275 to $400
19. Laser eye surgery$2,000 per lifetimeIncreased benefit from $1,000 to $2,000
Drug benefit
20. Smoking cessation drugs$2,000 per lifetimeIncreased benefit from $1,000 to $2,000
Miscellaneous expenses
21. Wigs$1,500 every 5 yearsIncreased benefit from $1,000 to $1,500
22. Orthopedic shoes$250 per calendar yearIncreased benefit from $150 to $250
23. Aerotherapeutic supplies$500 per calendar yearIncreased benefit from $300 to $500
24. Hearing aids$1,500 every 5 yearsIncreased benefit
25. Needles and syringes for injectable drugs$200 per calendar yearNew benefit
Prescription required to confirm medical necessity
Diabetes Management
26. Insulin jet injector$1,000 every 3 yearsIncreased benefit from $760 to $1,000
27. Continuous Glucose Monitor supplies$3,000 per calendar yearNew benefit – For Type I diabetics only
28. Diabetic monitors$700 per 5 yearsNew benefit – Eligible with or without insulin pump
29. Diabetic testing supplies$3,000 per calendar yearRemoved blood testing requirement
Durable Equipment
30. Walkers and wheelchairsNo changeNo longer restricted for use in a private residence only.
Now allows for claims for a new wheelchair within the five-year limit when a medical condition changes and requires a different type of chair.
Reimbursement will be for the amount of the new chair less the amount reimbursed for the previously claimed chair (if claimed within the same five-year period).
31. Medical monitoring devicesLimited to one every 5 yearsThe following devices are now covered:
Oxygen saturation meter
Pulse oximeter
Saturometer
Blood pressure monitor
Hospital Coverage
32. Level I$90 per dayIncreased benefit from $60 to $90
33. Level II$170 per dayIncreased benefit from $140 to $170
34. Level III$250 per dayIncreased benefit from $220 to $250
Out-of-province benefit
35. Emergency benefit while travelling$1 million per tripIncreased benefit from $500,000 to $1 million.
Out-of-province coverage for 40 consecutive days, excluding any time out of the province for business on official travel status.
36. Family Assistance Benefits$5,000 per travel emergencyAdditional $200 per day for meals and accommodations
Relief provision
37. Pensioner relief provisionN/ARelief provision to include members who retire after April 1, 2015, extended until March 31, 2025

Changes

BenefitDetails
38. Mandatory Generic Drug SubstitutionThe PSHCP will implement Mandatory Generic Drug Substitution following a 180-day legacy period commencing July 1, 2023. During the legacy period, prescribed brand name drugs will still be reimbursed at 80% of their cost. After the legacy period, all prescription drugs covered under the PSHCP will be reimbursed at 80% of the cost of the lowest-priced alternative generic drug. Exceptions will be granted based on medical necessity.
39. Prior AuthorizationA Prior Authorization system will be implemented for the PSHCP effective July 1, 2023. A Prior Authorization system is a process administered by the plan administrator where certain drugs need to be pre-approved before they are reimbursed under the PSHCP. It is an evidence-based program that will be supported by medical professionals at Canada Life, the new plan administrator as of July 1, 2023. Permanent legacy protections will be granted for members who were on prescribed drugs listed in the Prior Authorization formulary before July 1, 2023. However, members may need to switch their existing biologic drug to a biosimilar under the new system.
40. Compound DrugsThe PSHCP will implement a change to compound drug eligibility following a 180-day legacy period commencing July 1, 2023. After the legacy period, compound drugs will require one active ingredient with a Drug Identification Number (DIN) that is covered under the PSHCP, to be reimbursed.
41. Catastrophic Drug CoverageEffective July 1, 2023, eligible drug expenses will be reimbursed at 100% when out-of-pocket drug expenses incurred exceed $3,500 in a calendar year.
Pharmacy Dispensing Fees
42. Frequency LimitsEffective July 1, 2023, pharmacist dispensing fees will be reimbursed up to a maximum of five times per year for maintenance drugs. Exceptions will be granted if:

There are safety concerns with the prescribed drug (e.g. controlled substance)

There are storage limitations for the prescribed drug (e.g. requiring deep freeze temperatures)

The prescribed drug’s 3-month supply co-pay is more than $100
43. Fee CapsEffective July 1, 2023, the PSHCP will reimburse up to a maximum of $8 for the pharmacy dispensing fee. The fee cap will not apply to biologic or compound drugs.

Treasury Board said in its statement that, “more information and details will be made available shortly.”

Other links:

Treasury Board statement: Approval of a modernized Public Service Health Care Plan

Treasury Board information notice: Improvements and changes to the Public Service Health Care Plan

Treasury Board announces tentative agreement reached with unions on a renewed health care plan for 2023

By Pay, Pension and Benefits

Yesterday, Treasury Board announced an agreement had been reached between it as the employer for the federal public service and unions, as well as retiree representatives on a renewed health care plan for public servants.

If ratified, the renewed health care plan would take effect July 1, 2023.

Highlights

In its announcement, Treasury Board highlighted some of the new features in the renewed plan, such as:

  • increased support for mental health and well-being, including increased coverage for psychological services and an expansion of mental health service providers;
  • for the first time, coverage would be available for gender affirmation;
  • provisions that would help support the accessibility needs of members and their dependants, including greater access to benefits for mobility devices such as wheelchairs and hearing aids;
  • amendments to eligibility requirements that would benefit low-income and working seniors; and,
  • plan improvements for families and young people including amendments to coverage during parental and caregiving leaves and increases in coverage, such as paramedical services, mental health services and laser eye surgery.

Unions react

The Public Service Alliance of Canada (PSAC)

Calling it a “victory,” PSAC said that it, “secured improvements to vision care and massage therapy benefits. Plan members will also see a major increase to psychological services, as well as an expansion of eligible psychological practitioners covered. Acupuncture will now be covered when performed by a licensed acupuncturist, and a prescription will no longer be required to access paramedical benefits like massage therapy or chiropractic treatment.

PSAC also won a significant victory to protect the rights of 2SLGBTQIA+ members, increasing coverage for gender-affirming care and procedures.”

PSAC included a detailed list of benefits improvements which can be found below.

The Canadian Association of Professional Employees (CAPE)

CAPE highlighted that, “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.”

The Professional Association of Foreign Service Officers (PAFSO)

Similarly, PAFSO said, “the new agreement secures key gains for our members in the areas of mental health benefits, paramedical practitioner coverage, gender affirmation coverage, and premium rates while on parental and caregiving leave, to list but a few. It also introduces new cost-containment measures to keep pace with future PSHCP cost increases, including a prior authorization program, mandatory generic substitution and pharmacist dispensing fee caps. Also, a provision to renegotiate the plan in 4 years’ time will ensure that the plan can evolve and continue to meet the healthcare coverage needs of our members.

New administrator to take over plan

Back in December, Treasury Board announced that the next contract to administer the Public Service Health Care Plan had been awarded to Canada Life following a competitive process that began in 2018.

The contract will take effect July 1, 2023, following a transition period.

Treasury Board said that transitioning will be a, “complex project and an opportunity to streamline PSHCP processes. The new contract will allow the plan to be more responsive to the changing administrative health care needs of plan members and innovations in the health care industry.”

The previous contract was awarded to Sun Life in 2009.

Other links:

Treasury Board news release

PSAC news release

CAPE news release

PAFSO news release

Detailed list of benefits improvements:

Vision care

  • Maximum eligible amount increased to $400 every 2 years (from $275)
  • Maximum lifetime eligible amount for laser eye surgery increased to $2,000 per lifetime (from $1,000)

Paramedical practitioners

Increase annual maximum eligible amounts for:

  • Each 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 pathologist to $750 (from $500)
  • Electrolysis to reasonable and customary amount with an annual maximum of $1,200; prescriptions waived for members receiving gender-affirming care
  • Expansion of psychological providers to include coverage for psychotherapists, social workers (for all members, regardless of place of residence), and registered counsellors
  • Remove prescription requirements for massage therapy, physiotherapy, psychological services and speech therapy
  • Audiologists to be 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 registered acupuncturist at eligible maximum of $500 per year
  • Foot care when done at community nursing stations, to be covered under the podiatrist/chiropodist amount
  • Physiotherapy: Removal of $500-$1,000 member-paid corridor, with new annual eligible maximum of $1,500

Hospital and emergency coverage

  • Level 1 for 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. Coverage to be 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)
  • Introduce 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 5-year time limit where a patient’s medical condition changes such that s/he requires 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 5 years
  • Delete requirement that walkers and wheelchairs must be for use inside the patient’s private residence
  • Introduce coverage for needles for injectable drugs, not just diabetes, to a maximum of $200 per year
  • Introduce coverage for hearing aids batteries of up to $200 per year separate from the increased amount for hearing aids

Coverage for diabetic conditions

  • Introduce coverage for diabetic monitors without use of insulin pump, to a maximum of $700 per 60 months
  • Introduce coverage for continuous glucose monitor supplies (type I diabetics) at $3,000 per year
  • Introduce 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
  • Remove reference to “blood” glucose monitors

Other benefit amendments

  • Gender affirmation coverage – enhanced coverage at lifetime eligible maximum of $75,000
  • Introduce coverage for medically necessary monitors including Oxygen Saturation Meter, Pulse Oximeter, Saturometer, Blood Pressure Monitor (once every 60 months each)
  • Allow 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 to 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 (6) years of service are eligible for retiree benefits, even if all 6 years are not pensionable due to age
  • Anyone returned to work after retirement shall not lose access to their retiree benefits once they retire again

Amendments to coverage during leaves and other definitions

  • Coverage 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 legacy period. Exceptions will only be based on medical necessity
  • Implementation of a system of prior authorization for high-cost drugs. Such approval for drugs will be granted using an evidence-based model. All members will be fully legacied 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 3-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 legacy period
  • Increase to the out-of-pocket maximum for catastrophic drug coverage will increase to $3,500 (from $3,000)

Public Service Health Care Plan contract awarded to Canada Life

By Pay, Pension and Benefits

Last week, Treasury Board posted that the next contract to administer the Public Service Health Care Plan (PSHCP) had been awarded to Canada Life following a competitive process that began in 2018.

The contract will take effect July 1, 2023, following a transition period.

Treasury Board said that transitioning will be a, “complex project and an opportunity to streamline PSHCP processes. The new contract will allow the plan to be more responsive to the changing administrative health care needs of plan members and innovations in the health care industry.”

The previous contract was awarded to Sun Life in 2009.

Impact on cost for public servants

While work behind the scenes may be intensive and complex, Treasury Board reassured that there won’t be any impact on cost for plan members:

“A new plan administrator will have no impact on the cost of the PSHCP for plan members or to the benefits available to them and their families. Contribution rates are approved annually by the President of the Treasury Board, and plan changes are negotiated at the PSHCP Partners Committee, a collaborative forum comprised of Bargaining Agent, Employer and Pensioner representatives.”

Treasury Board said that, “this procurement process is entirely separate and forms part of the life cycle of any public service benefit plan, and that the award of the new contract to Canada Life simply changes who administers the PSHCP and adjudicates claims, starting July 1, 2023.”

Action items for public servants

Treasury Board said that in terms of next steps:

  • Plan members will receive regular updates on the transition progress;
  • Public servants will be asked to take a few simple actions leading up to the move to the new administrator and Treasury Board asks public servants to respond to these requests; and
  • Public servants keep their contact information current with Sun Life to help ensure that there is no interruption in PSHCP coverage when the new contract starts on July 1, 2023.

Other links:

Treasury Board information notice: New contract awarded to administer the Public Service Health Care Plan