Public Service Health Care Plan (PSHCP)
Which insurer adjudicates claims for PSHCP?
Canada Life adjudicates claims for PSHCP. Please select Canada Life-PSHCP from the insurer drop-down menu.
Which carrier do I submit claims to for PSHCP?
Please submit claims to Canada Life by selecting Canada Life - PSHCP from the insurer drop-down menu when submitting a claim.
How do I contact the insurance company?
1-855-415-4414, Monday to Friday 8 a.m. to 5 p.m. caller’s local time.
What are the hours of adjudication?
From 6 a.m. to 12 a.m. eastern time, daily, 7 days per week.
Once an Acknowledgement is generated, what is the time frame for receiving a response?
Responses are returned within 5 business days.
Is payment to provider possible?
Yes, if you register for direct deposit and submit an eligible service through eClaims payment directly to you is possible.
However, if you submit a claim outside of regular hours of operation (6 to 12 a.m. eastern time daily) and request benefits assignment, Canada Life will issue the payment to the plan member directly.
This will be noted in the Acknowledgement message provided to you: Payment will be made to the plan member.
When you receive this message, we recommend that you collect the full amount from your patient. You can advise your patient that Canada Life has received and will assess the claim. An explanation of benefits and payment, if applicable, will be sent the plan member within 5 business days.
Payment: How will payment be handled for claims submitted using eClaims?
Canada Life will issue bundled payments, by direct deposit weekly or once per month by cheque.
Your bundled payment will include claims submitted under insurer Canada Life and Canada Life – PSHCP.
Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?
If your client/patient has both primary and secondary coverage with Canada Life, you will receive payment under the primary plan only. Please request payment for any unpaid balance from your client/patient.
When submitting the claim, you must complete both the primary and secondary coverage sections of your client/patient’s claim. Canada Life will provide you with an electronic confirmation of the amount paid under the primary coverage and will automatically coordinate the secondary claim manually. Payment for the secondary coverage will be paid to the plan member.
You will not receive an electronic response for the secondary claim; however, there is no need for the member to submit a paper claim to Canada Life for the secondary claim.
Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?
You can't submit claims for the same service twice in the same day for the same patient/client. Your patient/client must submit the claim to Canada Life. Canada Life will assess the claim and issue payment (if applicable) to your patient/client.
What do I enter in the Policy / Group and Member ID / Certificate fields? Where do I find this information for my patient?
Please see the sample card shown below:
What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?
Canada Life - PSHCP supports the following healthcare provider disciplines:
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Acupuncturists
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Chiropodists
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Chiropractors
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Dieticians
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Massage Therapists
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Naturopathic Doctors
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Occupational Therapists
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Opticians
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Optometrists
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Osteopaths
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Physiotherapists
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Podiatrists
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Psychologists
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Psychotherapists
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Social Workers
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Speech Language Pathologists
How do I learn more about the PSHCP plan?
You can find more information about the PSHCP by visiting:
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www.canada.gc.ca; or,
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The PSHCP plan directive www.njc-cnm.gc.ca/directive/d9/en
What is the audit arbitration period for the PSHCP?
A provider may respond to audit results within the 14-day arbitration period for provider audit processes. During the arbitration period, the payer will not accept additional documentation for claims that failed audit because of failure to produce documentation and overcharges.