Commencement, Amendment and Termination of Coverage

When an Application is Required

An application on a form prescribed by the Trustees is required:

1. when joining the Plan, e.g.
   • including those persons who become entitled to survivor/children's benefit;
   • even if the employee is entitled to full employer-paid coverage;
2. when amending coverage, e.g.
   • from single to family (and vice versa);
   • from one level of Hospital Provision to another;
3. when transferring coverage, e.g.
   • to transfer from Supplementary Coverage to Comprehensive Coverage (and vice versa);
   • pensioners, members of the CF or RCMP upon becoming employed in the Public Service;
   • to transfer from full employer-paid to non employer-paid coverage;
4. when continuing coverage e.g. Comprehensive Coverage of surviving dependants of an employee who has died while residing outside Canada.

The designated officer shall certify on the application whether or not the person is eligible to participate in the Plan.

Note:

1. An application is not required to continue the same coverage when a member retires and is in receipt of an immediate recognised ongoing pension benefit, but deductions from the pension must be authorised in writing.

Effective Date of Coverage

Waiting Period

When an application is received more than 60 days after the date of eligibility, coverage starts on the first day of the fourth month following the date the application is received by the designated officer. This is considered to be a three-month waiting period. When decreasing or cancelling coverage, the reduced or cancelled coverage is effective the first day of the third month following receipt of the application by the designated officer. This is considered to be a two-month waiting period.

A.  When Joining the Plan

Unless otherwise stated, coverage will become effective on the first day of the month following receipt of the application by the designated officer if the application is received within 60 days of the applicant becoming eligible.

Where the application is received more than 60 days after the applicant becomes eligible or after the event requiring an application, the effective date of coverage will be the first day of the fourth month following receipt of the application by the designated officer.

Coverage will become effective on the first day of the fourth month following receipt of the application by the designated officer in the following circumstances:

• when a pensioner, who was not a member of the Plan immediately prior to retirement, applies for coverage. However, this requirement is waived for pensioners under the Members of Parliament Retirement Allowance Act and those employees who could not be covered under the PSHCP as an employee as identified in Schedule I of this Plan Document, if the application to join the Plan is received within 60 days of the ongoing pension benefit becoming payable;
• when the survivor or child (where no survivor exists) of a deceased employee or pensioner who was not a member of the Plan or who had single coverage only applies for coverage;
• when a member cancels their coverage and then later decides to re-apply for the PSHCP without a break in service, regardless of when they re-apply for coverage;
• when a member who is on leave without pay chooses to cancel their coverage and later wishes to re-apply for coverage. However the employee will not be allowed to reinstate their coverage while they are on leave without pay.

B.  When Amending Coverage

Unless otherwise specified, if an application to amend coverage is received within 60 days of an event requiring a change, the coverage will change effective the first day of the month following receipt of the request for change by the designated officer. Otherwise, a three-month waiting period will apply.

From single to family coverage and vice versa

Coverage will become effective on the date of acquiring a dependant if the application is received by the designated officer within 60 days of the event. Otherwise a three-month waiting period will apply.

An employee may not amend their coverage while on leave without pay or during the off-season or off-session except where a member applies to increase coverage from single to family on acquiring a dependant.

Increasing the Level of Coverage under the Hospital Provision

Unless otherwise specified, an increase to the level of Hospital Provision will not take effect until the first day of the fourth month following receipt of the application by the designated officer.

Exceptions

A three-month waiting period does not apply when the application to increase the level of Hospital Provision is received within 60 days of

1. the addition of a dependant(s) on acquiring a spouse or child,
2. ceasing to be covered under a provincial or territorial health insurance plan or vice versa when transferring coverage from Supplementary to Comprehensive or from Comprehensive to Supplementary,
3. an employee becoming in receipt of a recognised ongoing immediate pension benefit,
4. a member of the CF or RCMP or a pensioner becoming employed in the Public Service,
5. a survivor or dependant child(ren) of a deceased member becoming in receipt of an ongoing recognised survivor's or children's benefit.

The three-month waiting period also does not apply when the application to increase coverage coincides with the application to delete a dependant, i.e. when amending coverage from family to single.

Decreasing the Level of Coverage under the Hospital Provision

Where an application is submitted to decrease the level of coverage under the Hospital Provision, the amended coverage is effective on the first day of the month following the sixtieth day after receipt of the application by the designated officer. The new coverage is effective on the first day of the month following the month of the first deduction at the new rate.

C.  When Transferring Coverage

Unless otherwise specified, where the application is received within 60 days of becoming eligible to transfer coverage, coverage will become effective on the first day of the month following receipt of the required application by the designated officer. Otherwise, coverage is effective from the first day of the fourth month following receipt of the application by the designated officer.

When two members are spouses and wish to have one membership under the Plan

There is no waiting period when two members are spouses and wish to have one membership under the Plan. No gap in coverage should occur.

However a three-month waiting period will apply to an increase in the level of Hospital Provision if either the member or the dependant is thereby increasing their level of coverage.

Dependant becoming a member in their own right:

A person who is covered as a dependant under the PSHCP and who applies for their own coverage under the PSHCP within 60 days of ceasing to be covered as a dependant, including while on leave without pay, is not subject to the three-month waiting period. Coverage commences on the day coverage as a dependant ceases. However, if the member wishes to increase their level of hospital coverage as a dependant, the increased coverage will be subject to a three-month waiting period.

From Supplementary to Comprehensive Coverage (and vice versa )

Coverage for members posted outside Canada

Members posted outside Canada are required to have Comprehensive Coverage under the PSHCP for the month of departure from Canada.

Coverage for pensioners, employees on educational leave without pay or on international assignment

If an application to transfer from Supplementary to Comprehensive Coverage is received by the designated officer within 60 days of ceasing to be covered by a provincial/territorial health insurance plan, coverage is effective the first of the month following the date of receipt. If an application is received more than 60 days after ceasing to be covered under a provincial/territorial health insurance plan, a three-month waiting period will apply.

When transferring from Comprehensive to Supplementary Coverage, the Supplementary Coverage cannot commence until the date the coverage commences under a provincial/territorial health insurance plan.

Members of the CF and of the RCMP and Pensioners becoming employed in the Public Service

Upon employment in the Public Service, a member of the CF or RCMP who has dependants covered under the PSHCP may apply for coverage as a public service employee. If the application is received by the designated officer within 60 days of the date of ceasing coverage under the CF or RCMP medical provisions, coverage is effective the day the member ceases to be covered under the CF or RCMP medical provisions. Otherwise a three-month waiting period will apply.

Likewise, upon employment in the Public Service, a pensioner may apply for coverage as an employee. If the application is received by the designated officer within 60 days of becoming an employee, coverage is effective the day the pensioner becomes an employee.

Should the member also wish to amend their level of hospital coverage at this time, they may do so without a waiting period. If the member applies more than 60 days after the date of transfer to the Public Service, a three-month waiting period will apply.

D. When Continuing Coverage

Coverage under the Plan continues when:

1. an employee who was a member of the Plan immediately prior to retirement and who on retirement is entitled to an immediate ongoing pension benefit;
2. a member dies and their dependants are in receipt of a recognised survivor's or children's benefit;
3. a member is totally disabled on the date of termination of the employment. Coverage continues during total disability for a period of up to six months following the date of termination of the person's employment provided that acceptable proof of such disability is received by the Administrator. This does not apply if the member is eligible to be a participant as a pensioner or a dependant;
4. a member ceases to be employed during pregnancy and is not in receipt of a ongoing pension benefit; she may continue her coverage until the end of the month in which the pregnancy is terminated or the end of the month in which the child is born;
5. a member dies leaving a survivor who is pregnant and who was covered as a dependant on the date of death of the member, if the survivor applies within 60 days of the member's death. The coverage will continue for the period during which the survivor is pregnant and confined following the pregnancy. This does not apply if the survivor is in receipt of a recognised ongoing pension benefit or of a survivor's benefit;
6. a member with Comprehensive Coverage dies leaving a dependant. The dependant may be covered under Comprehensive Coverage for a period of six months after the date of death;
7. the member is laid-off under the Workforce Adjustment Directive (WFAD). Coverage may be continued for one year or until the member is entitled to an ongoing pension benefit whichever is the shorter period. This does not apply to employees who have resigned under the WFAD, including those employees who have accepted a cash-out, a retention payment or a contracting out settlement;
8. a member is re-employed as an eligible employee before coverage ceases;
9. a pensioner who was a member of the Plan immediately prior to being appointed to a term of six months or less;
10. a former deputy head is a participant under the Special Retirement Arrangements Act;
11. an employee accepts a specified period appointment regardless of its length while on leave without pay from an indeterminate position, provided coverage was maintained during the leave without pay. PSHCP contributions may be deducted from their specified period employment remuneration. However, if coverage under the PSHCP was not maintained during the leave without pay, the employee's coverage under the PSHCP can only be reinstated if:
    1. the employee is appointed for a specified period of more than six months; or
    2. if the employee is appointed for a specified period of six months or less, and is later appointed for another specified period when the employee completes six months of continuous employment.
12. an employee is on leave without pay, unless that employee provides notice in writing that he or she wishes to opt out of the Plan during the period of LWOP
13. an employee on suspension or on seasonal/sessional lay-off provided the required contributions are submitted to the designated officer.

Note:

1. If an employee on seasonal/sessional lay-off or on suspension fails to make the required payments, the coverage terminates at the end of the month following the month in which the last contribution was paid. The employee will not be covered for the period of leave without pay, but coverage will be reinstated on return to duty. When a member returns to duty, the contributions resume automatically from pay in the month the employee returns to work. Coverage is effective from the first day of the month following the month during which the first contribution is deducted from pay.
2. If an employee is on leave without pay when coverage would normally become effective, coverage only becomes effective the first of the month following return to duty.
3. All reference to leave without pay assumes that the leave has been duly authorised by the employer.

Families with both Supplementary and Comprehensive Coverage

Coverage for dependants residing outside Canada while the member is also residing outside Canada

When a member is residing outside Canada and has Comprehensive Coverage, a dependant of that member who is also residing outside Canada but who is not residing with the member (e.g. is attending school), may have Comprehensive Coverage as a dependant of the member.

Any dependant who remains in or returns to Canada temporarily (i.e. for three months or less) after the member's departure may have Comprehensive Coverage while in Canada if they are not covered under a provincial/territorial health insurance plan.

Coverage for dependants residing in Canada while the member resides outside Canada

Any dependant who resides in Canada other than on a temporary basis (i.e. for more than three months) is ineligible for Comprehensive Coverage and must enrol in a provincial/territorial health insurance plan. However, the dependant will have Supplementary Coverage if eligible and if the member is paying family contributions for Comprehensive Coverage.

Coverage for dependants residing outside Canada while the employee resides in Canada

When an employee with Comprehensive Coverage who was residing outside Canada returns to Canada and enrols in a provincial/territorial health insurance plan, but one or more covered dependants of that employee temporarily, i.e. for three months or less, remain outside Canada, the employee and any dependants in Canada will be covered under Supplementary Coverage. The dependants residing outside Canada may continue to have Comprehensive Coverage until they return to Canada and are eligible for coverage under a provincial/territorial insurance plan provided the employee has family Comprehensive Coverage.

No coverage for dependants residing outside Canada while the member resides in Canada

When a member resides in Canada but has a dependant who is residing outside Canada and therefore is not eligible to be covered under a provincial/territorial health insurance plan, that dependant is not eligible for PSHCP coverage.

Termination of Coverage

Voluntary cessation of coverage

A member who wishes to cancel their PSHCP coverage must put their request in writing to the designated officer. Deductions will cease no later than two months following the date notification was received by the designated officer. Coverage will continue for one month following the month that the last deduction was made.

A retroactive cancellation cannot be authorised.

Employees who cancel their coverage at any time while on leave without pay, will not be allowed to reinstate their coverage until they return to duty, at which time a three-month waiting period will apply.

When cancelling a dependant's coverage, the dependant's coverage ceases no later than two months following the date that the application is received by the designated officer. The deductions at the lower rate start the month prior to the effective date of the new coverage.

Except in case of death of a dependant or of a designated officer not ceasing deductions within two months of receiving an application, no contributions will be refunded when the member cancels their dependant's coverage.

Involuntary cessation of coverage

When a member ceases to be an eligible employee or an eligible pensioner, if a contribution is deducted in the month during which the member ceases to be eligible, coverage of the member and their dependant(s) will continue until the end of the following month.

In the case of a dependant's death, the contributions are adjusted effective the month of death of the dependant, provided the application is received by the designated officer within 60 days of death. If the application is received after 60 days, contributions are adjusted effective the first of the month following receipt of the application by the designated officer.

A member ceases to be eligible on the date of:

1. cessation of employment if they are not in receipt of an immediate recognised ongoing pension benefit,
2. becoming an employee locally engaged outside Canada,
3. becoming employed in a portion of the Public Service excluded from the Plan, or
4. ceasing to receive the disability pension because they have recovered their health.