Home » Directives » Public Service Health Care Plan Directive » July 1, 2023 » 1 Eligibility

1 Eligibility

1.1  Employees, Civilian Members of the RCMP

1.1.1 An employee taken on strength on a full-time or part-time basis is eligible to join the Plan on the following dates:

  1. if employed for an indeterminate period, or for a season or a session of any length, the date taken on strength;
  2. if employed for a term of more than six (6) months, the date taken on strength;
  3. if employed for a term of six (6) months or less and is later appointed:
    1. to another term of six (6) months or less, the day following the day on which the employee completes six (6) months of continuous employment,
    2. to a term of more than six (6) months, the date of appointment to a term of more than six (6) months,
    3. to an indeterminate, a seasonal or a sessional position, the date of appointment to the indeterminate, seasonal or sessional position,
    4. retroactively for an indeterminate period, for a season or a session of any length or for a term of more than six (6) months, the date of the instrument of change.

Notes:

  1. Continuous employment for the purpose of completion of six (6) months employment means employment for six (6) months with no break in employment of seven working days or more.
  2. An employee engaged locally outside Canada is not eligible for coverage under the Plan.
  3. An employee who is not a member of the Plan when proceeding on leave without pay (LWOP) or on off-season/off-session is not eligible to join the Plan until they return to duty.
  4. A member may only hold one valid PSHCP certificate number in their own right.

1.2  Members of the RCMP and of the CAF Regular and Reserve Component

1.2.1 Members of the RCMP may become members of the Plan when they have an eligible dependant. Members of the RCMP may not hold coverage in their own right but may apply for coverage for their eligible dependant(s).

1.2.2 Members of the CAF regular component and Class C reservists may become members of the Plan when they have an eligible dependant. Such members of the CAF may not hold coverage in their own right but may apply for coverage for their eligible dependants.

1.2.3 Class A reservists are eligible to join the Plan in their own right and on behalf of an eligible dependant(s). The date of eligibility is the date the Class A reservist is taken on strength. A Class A reservist is responsible for paying both the employee and employer share of contributions in order to participate in the Plan.

1.2.4 Class B reservists engaged for a period of less than or equal to 180 days are eligible to join the Plan in their own right and on behalf of an eligible dependant(s). The date of eligibility is the date the Class B reservist is taken on strength. A Class B reservist is responsible for paying both the employee and employer share of contributions to participate in the Plan.

1.2.5. Class B reservists engaged for a period of greater than 180 days may not hold coverage in their own right but may apply for coverage for their eligible dependant(s). The date of eligibility is the date the Class B reservist acquires a dependant.

1.2.6 Members of the RCMP, CAF regular component and reservists who may not hold coverage in their own right, may apply for coverage for their dependant child when on LWOP if the purpose of the LWOP was to acquire a dependant child.

1.3  Pensioners

1.3.1 Any person in receipt of an ongoing pension, survivor’s benefit or children’s benefit pursuant to an Act identified in Schedule IV of this Plan Document is eligible to join or to continue coverage under the PSHCP when their pension becomes payable if the pensionable service associated with the pension is at least six (6) years and the person that accumulated the pensionable service retired from a participating employer. The six (6) year pensionable service requirement does not apply to:

  1. a person who is a member of the PSHCP as a pensioner immediately before April 1, 2015;
  2. a person who becomes entitled to a survivor/children’s benefit from a recognized pension benefit as per Schedule IV pursuant to the death of an employee;
  3. a person who becomes entitled to a survivor benefit/children’s benefit from a recognized pension benefit as per Schedule IV pursuant to the death of a pensioner provided the deceased pensioner was eligible to join or was a member of the PSHCP;
  4. a person who was entitled to a deferred pension benefit pursuant to any Act listed in Schedule IV immediately before April 1, 2015, once the recognized ongoing pension benefit becomes payable;
  5. a person in receipt of a pension benefit pursuant to the Judge’s Act;
  6. a person in receipt of a pension benefit pursuant to the Governor General’s Act or the Lieutenant Governors Superannuation Act;
  7. a person in receipt of a pension benefit pursuant to any Act listed in Schedule IV to the Plan Document due to disability;
  8. a person in receipt of a pension benefit pursuant to any Act listed in Schedule IV to the Plan Document having become the subject of a separation in accordance with the provisions contained within the Work Force Adjustment Directive (WFAD); Appendix A of the Work Force Adjustment Directive (WFAD/A); the Severance provision within the Terms and Conditions of Employment for Executives or is laid off from a participating employer who is not subject to the Work Force Adjustment Directive (WFAD) and Workforce Adjustment Agreement (WFAD/A).

Notes:

  1. Pensionable service means service accumulated by a person under an Act or combination of Acts identified in Schedule IV, plus any years of service that would have been considered pensionable service if not for their age.
  2. Retired from a participating employer means a person who was employed by a participating employer on the later of the last day the person was required to contribute to a recognized pension benefit identified in Schedule IV, or the last day the person would have been required to contribute if not for their age.
  3. Notwithstanding the preceding, if a person was a member of the Plan as a retiree and subsequently returns to work such that their pension benefit is suspended, whether for a non-participating or participating PSHCP employer, the person shall be eligible to rejoin the plan as a retiree once their recognized pension benefit resumes, following the cessation of their employment and resumption of recognized pension benefits.

1.3.2 Veterans of the Canadian Armed Forces (CAF) with a rehabilitation need that is service related as validated by Veterans' Affairs Canada (VAC), and who do not otherwise have post-release PSHCP eligibility may participate in the PSHCP as a pensioner.

1.3.3 Former CAF members who have been approved for benefits under the Canadian Armed Forces Long Term Disability (CAF LTD) plan and who do not otherwise have post-release PSHCP eligibility may participate in the PSHCP as a pensioner.

1.3.4 Eligible RCMP/CAF members in receipt of a recognized pension pursuant to RCMP Superannuation Act (RCMPSA)/CAF Superannuation Act and have sufficient years of service to be eligible for PSHCP coverage, shall have the PSHCP waiting period waived and become eligible for PSHCP the day after release from the RCMP/CAF service.

1.3.5 Notwithstanding subsection 1.3.4, RCMP/CAF members, who choose not to participate in the PSHCP immediately following their retirement (within 60 days) must serve the applicable waiting period prior to joining the Plan.

1.3.6 The survivor, as defined in the Veterans Well-Being Act, or an orphan(s) of a veteran or Canadian Armed Forces member whose death was confirmed by Veterans’ Affairs Canada (VAC) as being a result of military service without the survivor or orphan being entitled to a survivor benefit/children’s benefit from a recognized pension benefit as per Schedule IV, may participate in the PSHCP as a pensioner.

1.4  Dependants

1.4.1 A member's dependant is eligible to participate in the Plan provided the dependant is legally married to the member or satisfies the eligibility criteria stipulated in the definition of "dependant child" or “common-law partner”.

Exception

1.4.2 Upon application by an employee posted outside Canada, persons who would not normally be eligible for PSHCP coverage, may be deemed to be a dependant of the employee posted outside of Canada if they are financially dependent upon the employee and they are residing with the employee.

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