Public Service Health Care Plan Bulletin Number 15

May 14, 2003

Public Service Health Care Plan Bulletin Number 15

The attached bulletin has been produced by the Public Service Health Care Plan (PSHCP) Trust. Would you please distribute the bulletin to employees.

Smoking cessation aids

Smoking cessation aids, known as nicotine replacement therapy products, are a covered expense under the drug provision of the Plan. As specified in the Members' booklet, the Plan will reimburse the reasonable and customary charges of these products, subject to a $1,000.00 maximum lifetime eligible expense per participant, if they are prescribed by a physician or dentist and are dispensed by a pharmacist.

What's covered?

• the oral prescription drug Zyban (Bupropion HCI),
• nicotine patches, pads and inhalers such as Habitrol, Nicoderm, Nicotrol, Transdermal and Prostep, and Nicorette and Nicorette Plus Gum.

What's not covered?

• nutritional or herbal products such as Smoke Control Spray, Butt Out and Smoke Away;
• cigarette modification such as E-Z Quit , Nicolite and cigarette filters;
• Habit Regulator Electronic Smoking Control Aid;
• hypnosis;
• counselling by someone other than a registered psychologist (services of a psychologist are adjudicated under the Medical Practitioners Benefit);
• laser treatment;
• acupuncture by someone other than a physician (acupuncture performed by a physician is adjudicated under the Medical Practitioners Benefit);
• smoking cessation programs;
• educational/teaching aids such as video and audio tapes, books and magazines, on-line programs.

Since 2001, nicotine replacement products are available without a prescription at most pharmacies and have been sold in many retail outlets. Even though the pharmacist consulted with you at the time of purchase to ensure your health safety, prescriptions were not required and cash receipts were accepted as proof of purchase when submitting your claims to the Plan administrator. However, the PSHCP specifies that these products must be prescribed by a physician or dentist and dispensed by a pharmacist if you wish to submit a claim for reimbursement.

Please note that effective September 1, 2003, eligible nicotine products will only be reimbursed if they are prescribed by a physician or dentist and dispensed by a pharmacist.

Claim filing deadline for 2002 expenses: June 30, 2003

Please remember that claims for 2002 expenses must be submitted no later than June 30, 2003. If you are mailing your claim, it must be mailed and postmarked no later than June 30 for the claim to be accepted.

Working with your Call Centre

The PSHCP Trust makes every effort to ensure that members and their families have access to a dedicated, specialized, and effective call centre to provide benefit, coverage and claims status information. The service performance of our call centre is closely monitored and, when required, necessary changes have been implemented. Over the years, the plan administrator has extended service hours, increased the number of telephone lines, and introduced an automated claims status inquiry system known as the Interactive Voice Response (IVR).

For a number of reasons, the number of calls to the Administrator has continued to increase. To provide you with additional insight into the operations of the call centre, we are pleased to share with you the following information:

• The PSHCP call centre is staffed from 7:00 a.m. to 8:00 p.m. EST, Monday to Friday;
• Thirty-five fully trained employees are dedicated solely to the PSHCP and the PDSP members;
• In 2002, the PSHCP call centre representatives received 432,662 phone calls;
• An additional 129,556 calls were directed to the IVR for a total of 562,218 calls during the year.
• This is an average of 46,852 per month, or 2,343 calls per day.
• During peak claim periods such as January 2003, the call centre received 59,534 telephone calls.

Our performance target with regards to wait times for members is under two minutes. However, certain circumstances beyond our control sometime increase these wait times and we ask for your patience and cooperation.

While we continually try to find ways of improving the efficiency of our call centre, we believe you can help us. For example, if you want to inquire about the status of your claim, the Trust suggests that you wait at least three weeks from the date you mailed your claim before calling the Administrator. This period takes into account the timeframe for mailing and expected claim turnaround times. Alternately, you can find out the status of your claim by going to the Group Claims Information website hosted by Sun Life at www.sunlife.ca/member.

Although the call centre is staffed appropriately to handle inbound volumes at all times of the day, we encourage members to stagger the times at which they call. If you find it difficult to reach a representative at a particular time, we suggest that you call earlier or later in the day. Remember that the call centre is open from 7 a.m. to 8 p.m.

We also encourage plan members who have questions about their PSHCP benefit coverage to consult either the paper copy of the booklet or conveniently access it on the Internet. Please note that the booklets are available on the PHSCP website at www.pshcptrust.ca.

PSHCP....at your fingertips

Since February 2003, PSHCP...at your fingertips (www.pshcptrust.ca) has been available to members virtually anywhere in the world, any time of day, every day of the year. The Trust's web site is especially a great tool for new members. You can find all the details of the Plan and more. For example, under Plan Details members can find valuable information on what the plan covers and doesn't cover, how to file a claim, the deadline for filing claims, the group plan number and much more. The interface is clean and very easy to use. We are confident that you will find the information you are looking for and more.

Change of address

Sun Life Financial's Health & Dental Claims office in the National Capital Region has moved from its St. Laurent address to the Clarica Centre located at 99 Bank Street. Please note that the mailing address and telephone numbers remain the same. We ask that you continue to send your claims to the mailing address (P.O. Box) indicated on your claim form. However, a drop box for your claims has been installed on the lower level (B1) of the Clarica Centre for your convenience.

Speaking of change of addresses, members are reminded that it is important to inform either your personnel office or pension office, whether you are an active employee or a pensioner, of any change of address. We also require that you indicate any change of address when submitting a claim to the Plan Administrator. Please note that this information should not be sent to the PSHCP Trust.