Treasury Board approves new public service health care plan for 2023

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