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IAM 2.7.2

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Section: PSHCP - JOINING THE PLAN - EMPLOYEES

Subsection: EFFECTIVE DATE OF DEDUCTIONS AND COVERAGE

RULE

If an application to join the Public Service Health Care Plan (PSHCP) is received by the compensation advisor:

Within 60 days of the employee's date of eligibility, coverage is effective on the first day of the month following the month in which the application is received. Deduction starts in the month the application is received. Contributions are payable one month in advance of the effective date of coverage.

After 60 days of the employee's date of eligibility, coverage is effective the first day of the fourth month following the date the application is received. There is a 3-month waiting period. Deduction starts in the third month following the date the application is received.

EXAMPLE

An employee's date of eligibility is June 4. His application is received August 15, (after 60 days of the employee's date of eligibility). A 3-month waiting period will apply (September, October and November).

Coverage is effective December 1st.

Deduction starts in November.

COMMENTS

  1. An employee may not apply to join the Plan while on leave without pay (LWOP) or on seasonal lay-off.
  2. If an employee is on LWOP or on seasonal lay-off when coverage would normally become effective, coverage only becomes effective the first of the month following his return to duty.
  3. | If an employee's eligibility date changes following a retroactive change of his employee status, coverage will be effective the first of the month following the date of the instrument of change, as long as the employee's application form is received by the compensation advisor within 60 days from the date of the instrument of change. Contributions are payable one month in advance of the effective date of coverage. (If the employee's application is received by the compensation advisor after 60 days from the date of the instrument of change, a 3-month waiting period will apply).

EXCEPTIONS

The following are exceptions to the rule:

  1. Former Member of the Canadian Forces (CF) or the Royal Canadian Mounted Police (RCMP)

    | Upon joining the Public Service, a member of the CF or RCMP who has dependants covered under the PSHCP may apply for coverage under the Plan as a public service employee. If the member applies within 60 days of the date of his cessation of coverage under the CF or RCMP medical provisions, coverage under the PSHCP will be effective the day the member ceases to be covered under the CF or RCMP medical provisions. Deduction will start the month the member becomes a member of the PSHCP as a public service employee. Should a member also wish to amend his level of Hospital Provision (HP) at this time, he may do so without a waiting period.

    If the member applies after 60 days of the date of cessation of coverage as a CF or RCMP member, coverage under the PSHCP will be effective the first day of the fourth month following the date the application is received by the compensation advisor. Deduction will start in the third month following the date the appplication is received by the compensation advisor.

    Note: A person who was a member of the Plan either as an employee, a pensioner, a member of the CF or the RCMP immediately before his appointment to a term of six months or less, does not have to complete another qualifying period; he remains a member of the Plan.

    Example: An individual is released from the CF on February 14 and joins the Public Service effective February 15. A PSHCP contribution is deducted from his CF pay in January and his coverage ceases upon the date of release. This individual applies for PSHCP coverage on February 22. Therefore, his PSHCP coverage is effective February 15, and deduction starts in February.

  2. Transfer of Coverage

    A person who is covered as a dependant under the PSHCP and who applies for his own coverage under the PSHCP within 60 days of ceasing to be covered as a dependant, including while on LWOP, is not subject to the 3-month waiting period. Coverage as a member is effective on the day coverage as a dependant ceases. However, if the member wishes to increase the level of HP he had as a dependant, the increased coverage will be subject to a 3-month waiting period.

    Example: An employee is covered as a dependant and has Level II under the HP. When he applies for his own coverage, he requests the Level III under the HP. Level III coverage will be subject to a waiting period. Therefore, the HP Level III will be effective the first of the fourth month following the month the application is received by the compensation advisor. The contributions are payable one month in advance of the effective date of coverage. In the meantime, the employee can be covered for the Level II coverage without being subject to a waiting period as explained above.

    | Note: The rule of transfer of coverage applies for a dependant that wishes to join the PSHCP as a member to take advantage of the coordination of benefits or in a case of a divorce as the dependant would no longer be covered under the PSHCP.

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  3. Comprehensive Coverage for Employees Posted Outside Canada

    | An employee posted abroad is required to have Comprehensive Coverage under the PSHCP for the month of departure from Canada. Therefore, his coverage and that of his eligible dependants (refer to Section IAM 2.4.5) begins effective from the date his provincial health insurance coverage expires, regardless of when his application is received by the compensation advisor or whether he was already a member of the Plan.

    | Coverage for Pensioners, Employees on Educational LWOP or on International Assignment

    | If an application to transfer from Supplementary to Comprehensive Coverage is received by the designated officer within 60 days of ceasing to be covered by a provincial/territorial health insurance plan, coverage is effective the first of the month following the date of receipt. However, if an application is received more than 60 days after ceasing to be covered under a provincial/territorial health insurance plan, a 3-month waiting period will apply.

    | When transferring from Comprehensive to Supplementary Coverage, the Supplementary Coverage cannot commence until the date the coverage commences under a provincial/territorial health insurance plan.

    Contributions must be paid one month in advance of the effective date of the coverage.

  4. Re-application

    A member who cancels his coverage and then later decides to re-apply for the PSHCP (without a break in service, i.e. cessation of employment), will be subject to a three-month waiting period, regardless of when he re-applies for coverage. There is no grace period for re-application.

REFERENCE

Public Service Health Care Plan Directive - April 1, 2006

Last Update: February 2010