This Directive was developed in partnership by employer and bargaining agent representatives at the National Joint
Council. Its provisions form part of the collective agreements of the participating parties under the By-Laws of the
National Joint Council. The provisions also apply to persons not covered by collective agreements as indicated in the
Directive or by employer policy.
For more information on the National Joint Council, visit their web site at http://www.njc-cnm.gc.ca.
Table of Contents
General
Application
Effective date
Purpose and scope of the PSHCP
Terms and Conditions
Claims appeal procedure
Plan Document
General
Purpose of the Public Service Health Care Plan
Management of the Public Service Health Care Plan
Definitions
Eligibility
I - Employees, Civilian Members of the RCMP
II - Members of the RCMP and of the CF Regular and Reserve Component
III - Pensioners
IV - Dependants
Commencement, Amendment and Termination of
Coverage
When an Application is Required
Effective Date of Coverage
When Joining the Plan
When Amending Coverage
When Transferring Coverage
When Continuing Coverage
Families with both Supplementary and Comprehensive Coverage
Termination of Coverage
Contributions
Employee Contributions Only
Employee and Employer Contributions
Retroactive Change in Coverage
Administrative Errors
Available Coverage
Supplementary Coverage
Comprehensive Coverage
Eligibility for Provisions
Plan Provisions
Claims
Appeals
Payment of Benefits
Deductible Amount
Co-Payment
Overpayments
Co-ordination of Benefits
Subrogation
General Exclusions and Limitations
Extended Health Provision
Extended Health Provision - Drug Benefit
Extended Health Provision - Vision Care Benefit
Extended Health Provision - Medical Practitioners Benefit
Extended Health Provision - Miscellaneous Expense Benefit
Extended Health Provision - Dental Benefit
Accidental Injury
Oral Surgical Procedures
Extended Health Provision - Out-of-Province
Benefit
Emergency Benefit While Travelling
Emergency Travel Assistance Services
Referral Benefit
Hospital Provision
Basic Health Care Provision
Hospital (Outside Canada) Provision
Summary of Maximum Eligible Expenses
Schedule I - Participating Employers
Schedule II - Employers Withdrawn from the PSHCP
Schedule III - Designated Persons, Boards and Agencies
Schedule IV - Recognised Ongoing Pension Benefits
Schedule V - Monthly Contribution Rates
Schedule VI - Full Employer-Paid Coverage
Schedule VII - Life-Sustaining Drugs
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