Whereas a Memorandum of Understanding (MOU) dated December 1, 1999 between Treasury Board, the 17 National Joint Council (NJC) Bargaining Agents and the Federal Superannuates National Association in respect of the Public Service Health Care Plan (referred hereinafter as "PSHCP" or "Plan") sets out the long-term financial and management framework for the Plan, this directive is to implement that MOU with the bargaining agents.
Application
This directive applies to employees, within the meaning of the Public Service Labour Relations Act (PSLRA), of Her Majesty in right of Canada as represented by the Treasury Board, and is deemed to be part of the collective agreements between the Treasury Board and bargaining agents that are parties to the (NJC).
Effective date
This directive was effective on April 1, 2006.
Purpose and scope of the PSHCP
The purpose of the Public Health Care Plan (PSHCP) is to reimburse Plan participants for all or part of costs they have incurred for eligible services and products, as identified in the Plan Document, only after they have taken advantage of benefits provided by their provincial/territorial health insurance plan or other third party sources of health care expense assistance to which the participant has a legal right. Unless otherwise specified in the Plan Document, all eligible services and products must be prescribed by a physician or a dentist who is licensed, or otherwise authorised in accordance with the applicable law, to practice in the jurisdiction in which the prescription is made.
The PSHCP reimburses eligible expenses on a 'reasonable and customary' basis to ensure that the level of charges are within reason in the geographic area where the expense is incurred, subject to limitations which are identified in the Plan Document.
Terms and Conditions
The terms and conditions in respect of coverage are as set out in the PSHCP that is to be established by a trust for the benefit of, among others, the employees to which this directive applies, and that is to be administered by the trustees of the trust in accordance with the PSHCP and the agreement providing for the establishment of the trust.
Claims appeal procedure
The grievance procedure set out in Section 14 of the NJC By-laws does not apply to this directive or the PSHCP or any policy relating thereto. A separate and distinct appeal procedure is provided under the Public Service Health Care Plan. Any decision taken by the Trustees, within the meaning of the PSHCP, in respect of an appeal regarding claims or coverage shall be final and binding.
Purpose of the Public Service Health Care Plan
The purpose of the Public Service Health Care Plan (PSHCP) is to reimburse Plan participants for all or part of costs they have incurred for eligible services and products, as identified in the Plan Document, only after they have taken advantage of benefits provided by their provincial/territorial health insurance plan or other third party sources of health care expense assistance to which the participant has a legal right. Unless otherwise specified in the Plan Document, all eligible services and products must be prescribed by a physician or a dentist who is licensed, or otherwise authorised in accordance with the applicable law, to practice in the jurisdiction in which the prescription is made.
The PSHCP reimburses eligible expenses on a 'reasonable and customary' basis to ensure that the level of charges are within reason in the geographic area where the expense is incurred, subject to limitations which are identified in the Plan Document.
Management of the Public Service Health Care Plan
PSHCP Trust
The PSHCP is managed through a Trust having Trustees appointed by the three PSHCP Parties.
Financial Management
The Plan is operated on a self-insured basis, which essentially means that the Plan assumes full liability for the payment of all costs related to the operation of the Plan, including the payment of claims.
The PSHCP is funded through contributions from the Treasury Board of Canada, participating employers, and the Plan members in accordance with the Trust Agreement which takes effect April 1, 2000, between the Bargaining Agents of the National Joint Council, the Federal Superannuates National Association, and the Treasury Board of Canada (known as the PSHCP Parties).
Amendment of the Plan Document
The Plan Document may be amended in accordance with the Trust Agreement.
Administration of the PSHCP
Administrator
The Administrator is responsible for the consistent adjudication and payment of eligible claims in accordance with the Plan Document and for providing services as specified in the Administrative Services Only contract.