# PSHCP retired public service Canada-Anyone with real life experience



## John Wiens (Jul 18, 2011)

Hi - I am retired from the Public Service in Canada and my wife and I are dual citizens living in Oregon. I am eligible for the PSHCP and already use the dental plan. I am on Medicare, but my wife is on Blue Cross and their rates keep shooting up. Is there anyone out there who has used PSHCP comprehensive while living in the U.S.? For retirees, the hospital part is missing, so there needs to be another way to cover that. Would an HSA account or high deductible medical insurance make sense? Anyone out there who has experience with this? Any feedback would be greatly appreciated...I have searched the web and found little info. Thanks


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## PSC (Jul 19, 2011)

*Info Requested*



John Wiens said:


> Hi - I am retired from the Public Service in Canada and my wife and I are dual citizens living in Oregon. I am eligible for the PSHCP and already use the dental plan. I am on Medicare, but my wife is on Blue Cross and their rates keep shooting up. Is there anyone out there who has used PSHCP comprehensive while living in the U.S.? For retirees, the hospital part is missing, so there needs to be another way to cover that. Would an HSA account or high deductible medical insurance make sense? Anyone out there who has experience with this? Any feedback would be greatly appreciated...I have searched the web and found little info. Thanks



How do I make a claim for benefits under the PSHCP?

Claims are made by completing the PSHCP claim form, attaching original bills and receipts and forwarding these to the PSHCP administrator, Sun Life Assurance Company of Canada. The PSHCP Claim Form is available online. Once you have submitted your first claim, the administrator will provide you with a personalized claim form for future use.

There are time limits for submitting claims and these are described in the Plan Document and the Plan member booklet.

Questions about PSHCP claims should be directed to Sun Life Assurance Company of Canada at:
■1-888-757-7427 (toll-free in North America)
■(613) 247-5100 in the National Capital Region

Alternatively, members can find information on the status of their claims from the Plan Administrator, Sun Life Financial. An Access-ID and a Personal Identification Number (PIN) are needed. You can get these by calling the Plan Administrator. The contact information is located on their web site.


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## PSC (Jul 19, 2011)

PSC said:


> How do I make a claim for benefits under the PSHCP?
> 
> Claims are made by completing the PSHCP claim form, attaching original bills and receipts and forwarding these to the PSHCP administrator, Sun Life Assurance Company of Canada. The PSHCP Claim Form is available online. Once you have submitted your first claim, the administrator will provide you with a personalized claim form for future use.
> 
> ...


Comprehensive Coverage

This coverage is intended for members and their eligible dependants who are residing with the member outside Canada and who are not covered under a provincial/territorial health insurance plan or in a non-government hospital insurance plan. A person covered under Comprehensive Coverage will continue to be covered under this benefit after their return to Canada until such time as they become eligible to be insured under a provincial/territorial health insurance plan. This coverage consists of the:
•Extended Health Provision (80% reimbursement/deductible) except for: ◦Catastrophic Drug Coverage which provides 100% reimbursement for eligible drug expenses in excess of $3,000 out-of-pocket cap, exclusive of the deductible;
◦Hospital Provision (100% reimbursement/no deductible);
◦Out-of-Province Benefit is not available under Comprehensive Coverage.

•Basic Health Care Provision (100% reimbursement/no deductible);
•Hospital Expense (Outside Canada) Provision (100% reimbursement/no deductible). This provision does not apply to pensioners.


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## John Wiens (Jul 18, 2011)

Thanks...my question is more about how the PSHCP actually works out in real life. What do you do to cover the hospital part that is missing in the PSHCP for retired public service workers? Do the payment actually cover costs in the U.S.? Is the PSHCP accepted by doctors and hospitals? Anyone out there with PSHCP experience in the U.S.?


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## PSC (Jul 19, 2011)

John Wiens said:


> Thanks...my question is more about how the PSHCP actually works out in real life. What do you do to cover the hospital part that is missing in the PSHCP for retired public service workers? Do the payment actually cover costs in the U.S.? Is the PSHCP accepted by doctors and hospitals? Anyone out there with PSHCP experience in the U.S.?


Does your Public Service Health Care Plan (PSHCP ) coverage continue now that you are living outside of Canada?
Yes. PSHCP coverage can continue; however, you must complete an amended application to ensure coverage is continued at the desired level. To obtain the required documentation and to verify to what limits reimbursements can be made, contact the Public Service Pension Centre. Claims will be paid in the currency of the country where you reside. 

Does your Pensioners' Dental Services Plan (PDSP ) coverage continue now that you are living outside of Canada?
Yes. PDSP coverage will continue and the reimbursement will be based on reasonable and customary charges in the area where the services were performed. Claims will be paid in Canadian funds. 

Please contact the Public Service Pension Centre

If you are an Active Member and have questions concerning your insurance benefits, please contact your Compensation Advisor. 

Telephone

Toll free: 1-800-561-7930

Monday to Friday 
8:00 a.m. to 4:00 p.m. (Your Local Time) 

Outside Canada and the United States: 506-533-5800
(collect calls accepted) 

Monday to Friday 
8:00 a.m. to 5:00 p.m. (Atlantic Time) 

Telephone Teletype (TTY): 506-533-5990 
(collect calls accepted) 

Monday to Friday 
8:00 a.m. to 5:00 p.m. (Atlantic Time) 

Facsimile

418-566-6298

Note: Always include your pension number or Personal Record Identifier (PRI) when providing information by facsimile. 

On-line or by e-mail

Email: [email protected]

General Inquiry


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## John Wiens (Jul 18, 2011)

The question is still not answered. Anyone out there with personal experience using PSHCP as a retired public servant living in the U.S. and having to cover their own hospital portion.


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## CanUS (Aug 5, 2013)

John Wiens said:


> The question is still not answered. Anyone out there with personal experience using PSHCP as a retired public servant living in the U.S. and having to cover their own hospital portion.


Don't know if you are still a member of this forum, but found your thread, and wondered if you ever got an answer to your question. I am in a virtually identical situation to yours, with retirement from my current job now looming. (Employer currently covers health insurance, but now wonder whether PSHCP is a viable or better alternative to my other options regarding supplemental coverage.)


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## John Wiens (Jul 18, 2011)

CanUS said:


> Don't know if you are still a member of this forum, but found your thread, and wondered if you ever got an answer to your question. I am in a virtually identical situation to yours, with retirement from my current job now looming. (Employer currently covers health insurance, but now wonder whether PSHCP is a viable or better alternative to my other options regarding supplemental coverage.)


Hi - I now have the PSHCP coverage in the U.S. I need it mostly as a supplement for my wife since I am on Medicare. Are you located here? I may be able to answer some of your questions. (I never did get a reply on this forum.) What specifically would you like to know?


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## CanUS (Aug 5, 2013)

*PSCHP as Supplement to Medicare*



John Wiens said:


> Hi - I now have the PSHCP coverage in the U.S. I need it mostly as a supplement for my wife since I am on Medicare. Are you located here? I may be able to answer some of your questions. (I never did get a reply on this forum.) What specifically would you like to know?


I am still employed, but my company-sponsored health care will disappear when I retire in 2015. My wife and I will both be enrolled in Medicare at that time, so I am looking into it from the standpoint of its usefulness as a supplemental insurance to the Medicare coverage.

I will be 65 at that point, and my company offers eligibility for enrollment in a sponsored supplemental plan to Medicare. I notice that it's provisions look very similar to the supplement that PSC Comprehensive coverage provides, but is more expensive. 

I'm anxious to determine if the less expensive PSCHP coverage is not just a better deal, but also easily administered. (less hassle or delay in claims processing etc.) 

(I guess there will also be a question of whether or not it is "qualified" insurance coverage under the Obamacare plan, but that is a separate question.) 

Nice to run into you on this forum. We live in Orlando Florida - left Canada in 2000 for employment purposes, and are now dual citizens.


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## John Wiens (Jul 18, 2011)

CanUS said:


> I am still employed, but my company-sponsored health care will disappear when I retire in 2015. My wife and I will both be enrolled in Medicare at that time, so I am looking into it from the standpoint of its usefulness as a supplemental insurance to the Medicare coverage.
> 
> I will be 65 at that point, and my company offers eligibility for enrollment in a sponsored supplemental plan to Medicare. I notice that it's provisions look very similar to the supplement that PSC Comprehensive coverage provides, but is more expensive.
> 
> ...


I have a Medigap policy that costs $132 as well as the PSHCP at $117. The Medigap Plan F covers just about everything and about the only PSHCP expense for me is to pick up medication costs. The drawback of the PSHCP plan if you are retired is that it doesn't cover hospital costs which could be a big deal.

My wife has Blue Cross, and PSHCP covers almost all of her medication and most other costs. (She's not had to go to the hospital which would not be covered in most cases.) However, it will not cover a nutritionist or mental health in some cases and probably not hospital emergency visits. It works great for medication. If a medication is $200, and if Blue Cross rates knock it down to say $120, then in the 80/20 arrangement of PSHCP they will cover all the rest because its 80/20 of the $200 amount.

For doctor visits, PSHCP pays 3 times what Ontario pays, and a basic doctor visit in Ontario is something like $23 so they cover $69. That seems unreal. The doctors in the US charge $175-$275. It's all based on codes. With Medicare, the government knocks the cost of the service way down and Medigap Plan F covers the rest.

PSHCP is very good about paying. I'm assuming you or your wife worked for the Government of Canada at some point.

I talked to Cover Oregon, the Obamacare program here and they said I could have a supplement to Obamacare. 

Not sure if that covers it, but feel free to ask.

We are also dual citizens.


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## CanUS (Aug 5, 2013)

John Wiens said:


> I have a Medigap policy that costs $132 as well as the PSHCP at $117. The Medigap Plan F covers just about everything and about the only PSHCP expense for me is to pick up medication costs. The drawback of the PSHCP plan if you are retired is that it doesn't cover hospital costs which could be a big deal.
> 
> My wife has Blue Cross, and PSHCP covers almost all of her medication and most other costs. (She's not had to go to the hospital which would not be covered in most cases.) However, it will not cover a nutritionist or mental health in some cases and probably not hospital emergency visits. It works great for medication. If a medication is $200, and if Blue Cross rates knock it down to say $120, then in the 80/20 arrangement of PSHCP they will cover all the rest because its 80/20 of the $200 amount.
> 
> ...


Wow, that is very good information! Thanks.

I was aware that out-of-country hospital costs are not covered by PSHCP, as a retiree, but thought Medicare would essentially take care of that. Need to do a bit more research into that, and details of both my company plan and PSHCP.

Yes, I did 6 years in the Navy, and almost 23 in National Defence as a civilian, and am told that I can enroll in PSHCP.


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## John Wiens (Jul 18, 2011)

CanUS said:


> Wow, that is very good information! Thanks.
> 
> I was aware that out-of-country hospital costs are not covered by PSHCP, as a retiree, but thought Medicare would essentially take care of that. Need to do a bit more research into that, and details of both my company plan and PSHCP.
> 
> Yes, I did 6 years in the Navy, and almost 23 in National Defence as a civilian, and am told that I can enroll in PSHCP.


If my wife and I just had Medicare, I would get the Medigap insurance plus the Medicare drug plan. The hospital coverage is the big deal there. What PSHCP adds is glasses, hearing aids....stuff like that, (with limits) plus covering drug costs not covered by the Medicare drug plan. So, I guess you'd have to figure out if there were enough of those types of expenses to make it worthwhile. Drug costs could make PSHCP worthwhile if they were huge for you.


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## CanUS (Aug 5, 2013)

*Change in Expectations*

Just found out that my company just dropped its participation in medical benefit plans for retirees as of the first of January this year. So the estimates I had previously done based on this, are useless. Your (John Wiens) experience and situation seems now to be very close to what I should expect.
Currently don't have much in the way of medical expenses - the odd prescription plus one longer term (statin) for my wife - annual checkups etc. But of course, things will deteriorate with age, and I'll need to plan for that. 
I was looking at the coverages of the PSHCP comprehensive, and it sounded similar to the Medicare part B, but from what you said earlier, it doesn't sound like PSHCP is sufficient to replace that, and also cover the other things like glasses, hearing aids etc. Is this correct?


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## John Wiens (Jul 18, 2011)

CanUS said:


> Just found out that my company just dropped its participation in medical benefit plans for retirees as of the first of January this year. So the estimates I had previously done based on this, are useless. Your (John Wiens) experience and situation seems now to be very close to what I should expect.
> Currently don't have much in the way of medical expenses - the odd prescription plus one longer term (statin) for my wife - annual checkups etc. But of course, things will deteriorate with age, and I'll need to plan for that.
> I was looking at the coverages of the PSHCP comprehensive, and it sounded similar to the Medicare part B, but from what you said earlier, it doesn't sound like PSHCP is sufficient to replace that, and also cover the other things like glasses, hearing aids etc. Is this correct?


The big difference between PSHCP and Medicare is the hospital coverage. A stay at a hospital could be VERY expensive and PSHCP wouldn't help much. PSHCP would cover things like glasses and hearing aids (to a limit) but $117 x 12 is $1404 per year. For me at this point it's worth it because of doctor visits that are only partially covered by Blue Cross, the drug plan and glasses. I think you can always enroll in the PSHCP at some future point. By the way, do you have the Public Service dental plan? For us, that is worth the money.


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## CanUS (Aug 5, 2013)

John Wiens said:


> The big difference between PSHCP and Medicare is the hospital coverage. A stay at a hospital could be VERY expensive and PSHCP wouldn't help much. PSHCP would cover things like glasses and hearing aids (to a limit) but $117 x 12 is $1404 per year. For me at this point it's worth it because of doctor visits that are only partially covered by Blue Cross, the drug plan and glasses. I think you can always enroll in the PSHCP at some future point. By the way, do you have the Public Service dental plan? For us, that is worth the money.


Yes, we are enrolled in the PS Dental Plan. That has definitely been worth it, even though my employer plan is currently in effect. It works well as a co-insurance, until I have exceeded my employer limit, then acts as primary until that limit is also reached. For 2 years running, and other occasions since 2000, that has proved to be very handy.


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## Bren1712 (Aug 5, 2014)

*Info pleae?*



John Wiens said:


> The big difference between PSHCP and Medicare is the hospital coverage. A stay at a hospital could be VERY expensive and PSHCP wouldn't help much. PSHCP would cover things like glasses and hearing aids (to a limit) but $117 x 12 is $1404 per year. For me at this point it's worth it because of doctor visits that are only partially covered by Blue Cross, the drug plan and glasses. I think you can always enroll in the PSHCP at some future point. By the way, do you have the Public Service dental plan? For us, that is worth the money.


Hi I was wondering if you or John Wiens are out there. I am a public service retiree, age59, retired from CRA, and just about to marry a US CITIZEN I live in Windsor Ontario and will be moving to the spouses residence just 10 minutes across the river in Detroit Michigan.
Im really confused as to what to do. I have the PSHCP AND gsmip level two coverage as well as the dental.
If possible I really would just like to keep my medical doctor, dentist, optician in Windsor, its just ten minutes away. I would even like to just continue getting my few meds in windsor still.
Any recommendations?. Not sure how to do this. I can buy into my spouses medical plan at 595.00 a month in the U.S. If i want, BUT it has no dental or optical. I also realize the obamacare private plan is a furthur option. Also, i am keeping my hpuse in Windsor, but will be living full time in Detroit. any recommendation? 
Thanks very much
Id like to keep my government coverage but want to make sure I have adequate coverage in the US


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## Usa4me (Dec 16, 2016)

My wife and I are planning move to USA from Canada. I am dual citizen, retired, with long Gov of Canada career. I am familiar with PSHCP Comprehensive coverage but unsure how to add hospital coverage. Any suggestions would be much appreciated. Considering a move to Vermont or New York.


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