For: all members
This provision provides reimbursement for reasonable and customary charges, up to specified amounts, for each day of hospital confinement for the cost of hospital room and board charges other than standard ward charges (i.e., semi-private or private accommodation), whether the member is residing in Canada or outside Canada. There is a maximum amount which may be payable under this provision for each day of confinement, depending on the level of coverage the member has chosen. The levels are shown in the summary of Maximum of Eligible Expenses. All members of the PSHCP must be covered under one level of the Hospital Provision.
Eligible Expenses
Level I, II and III
- Eligible expense for all participants (other than pensioners residing outside Canada) are charges for semi-private or private hospital room and board charges in excess of the charges for public ward up to the maximum specified in the Summary of Maximum Eligible Expenses for each day of hospitalisation, excluding hospital charges referred to as coinsurance charges or user fees.
- Eligible expenses for pensioners residing outside Canada are hospital charges up to the maximum specified in the Summary of Maximum Eligible Expenses for each day of hospitalisation.
- No deductible or co-payment applies.
Exclusions
No benefit is payable for:
- expenses incurred under any of the conditions listed under General Exclusions and Limitations in the Plan Provisions;
- co-insurance charges or similar charges for hospital care which are in excess of charges payable by a provincial or territorial government health or hospital insurance plan, except charges as provided under the terms of the hospital provision. However, co-insurance charges for a chronic care hospital for a patient who is confined to a chronic care hospital, and has made at least one claim for such charges before September 1, 1992 and makes a further claim for the same period of confinement, are eligible;
- personal charges such as televisions and telephones.