IAM 2.19.1

Section: PSHCP - CASE SUBMISSION

Subsection: HOW TO SUBMIT A CASE

DESCRIPTION

As mentioned in section IAM 2.1 of the Insurance Administration Manual (IAM), the Federal Public Service Health Care Plan (PSHCP) Administration Authority meets periodically to deal with problems arising out of the administration of the Plan with particular regard to difficulties and disputes over individual claims.

PROCEDURES

1. Every PSHCP member has the right to request that the Federal PSHCP Administration Authority reconsider a coverage or claims decision under the Plan.
2. When submitting a case to the Federal PSHCP Administration Authority, the member must send a letter in which he explains the reason for appealing. He must also include all the relevant facts related to the original claim, the reasons for disputing Sun Life Financial's decision and also any supporting documentation.

   Note: An appeal must be submitted in writing within one year of the Administrator's mailing of an Explanation of Benefits regarding the claim.

   The written appeals must be addressed to:

   Federal PSHCP Administration Authority
   | PO Box 2245, Station D
   | Ottawa ON K1P 5W4

Last Update: June 2011

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