Subject: Public Service Health Care Plan (PSHCP) Weekly Coverage File Submitted to Sun Life
February 3, 2012
1.1. The purpose of this directive is to clarify to compensation advisors the administrative changes since the launch of the Public Service Health Care Plan (PSHCP) weekly coverage file sent to Sun Life Assurance Company of Canada (Sun Life).
Note: Throughout this directive, it will refer to the Compensation Web Applications (CWA); however, compensation advisors without CWA access must input the transactions using the Regional Pay System (RPS).
2. Related Documents
2.1. This directive should be read in conjunction with the following compensation directives from the Compensation Web site and the Information Notice from the Treasury Board Secretariat (TBS) Web site. When the information contained in this directive differs in regard to the procedural administration of the PSHCP, the information reported in this directive supersedes all others.
2.2. ARCHIVED CD 2010-006 - Launch of the Public Service Health Care Plan (PSHCP) Self-Service Web Application, Changes to PSHCP Input Screens in the On-Line Pay System, and Changes to the Format and Issuance of PSHCP Certificate Numbers Effective May 3, 2010 dated April 12, 2010, and revised July 8, 2011;
ARCHIVED CD 2008-019 - Two New Recovery Codes for Public Service Health Care Plan (PSHCP) Deficiencies to be Used for an Authorized Leave Without Pay (LWOP) Period dated October 28, 2008, and revised April 24, 2009;
ARCHIVED CD 2006-022 - Changes to the Public Service Health Care Plan (PSHCP) Effective April 1, 2006 dated September 27, 2006, and revised October 2, 2006;
ARCHIVED CD 2003-004 - Contribution Payments from Employees on Leave Without Pay (LWOP) in Respect to Insurance Plans dated April 10, 2003, and revised March 4, 2004; and
3.1. TBS requested that Public Works and Government Services Canada (PWGSC) change the data and the frequency of PSHCP members' information being reported to Sun Life.
3.2. Complying with TBS' request, PWGSC developed the weekly coverage file that is sent to Sun Life every Tuesday morning, to replace the monthly remittance file. The coverage file is produced by using information contained in CWA and in RPS.
4.1. The coverage file contains the following data information:
- From RPS
- Date of birth,
- Department code,
- Pay list,
- Pay office, and
- Status (employee, pensioner, survivor, etc.).
- From CWA
- Certificate number,
- Coverage start date,
- Coverage end date,
- Coverage type (single or family),
- Hospital level (I, II, or III), and
- Coverage category (supplementary or comprehensive).
4.1.1. Sun Life's systems are unable to process more than one data element change per member, per weekly coverage file. Therefore, compensation advisors will have to be careful not to process more than one transaction in CWA and/or in RPS to be transmitted in the same weekly coverage file.
Note: In order to be included in the weekly coverage file, the change must be finalized in both CWA and/or RPS before Tuesday morning, if not the change will be included in the next weekly coverage file.
4.2. Period of Leave Without Pay
4.2.1. If an employee was on leave without pay (LWOP) before March 2011 and a Contribution Remittance for Period of Leave Without Pay form (PWGSC-TPSGC 2278 - Contribution Remittance For Period of Leave Without Pay (PSHCP) This information is only accessible to federal government employees, and only to federal departments and agencies.) was not sent to the Financial and Payroll Accounting Division (FPAD), the compensation advisors will have to contact Sun Life to reactivate the coverage manually.
4.2.2. As of May 2011, when the compensation advisor receives a written notification from an employee that he wishes to suspend his PSHCP coverage, the compensation advisor must process a "deduction stop" in CWA. When the employee returns to work, the compensation advisor will reinstate the coverage via CWA with a new coverage start date. The compensation advisor must also advise returning employees that they must re-submit their positive enrolment information on-line at Sun Life Web site or by submitting a paper application. The enrolment form can be obtained by contacting Sun Life at 613-247-5100 in the National Capital Region, or at 1-888-757-7427 in all other regions.
Important: The compensation advisor must manually change the effective date of coverage that CWA will populate for a returning member who declined coverage during a period of LWOP, because a 3-month waiting period is automatically imposed by the system.
4.2.3. Only a change to the type of coverage transaction (from single to family or vice-versa) can be processed when the account is in LWOP status.
4.3. Seasonal Employees
4.3.1. A written notice to cancel PSHCP coverage is not required for seasonal employees. If the seasonal employee does not make his payment within the allotted time (see the Insurance Administration Manual (IAM) (IAM 2.13.5), the compensation advisor will have to stop the coverage in CWA and reinstate the coverage when the employee returns to work. The compensation advisor must also advise the returning employee that he must re-submit his positive enrolment information in the same manner as described in section 4.2.2. of this directive.
4.4. Transfer In (TIN) and Transfer Out (TOU)
4.4.1. Compensation advisors must verify that there is no overlap or lapse of coverage when a TIN/TOU is processed between two different pay offices (PO).
Example: An employee is transferred from PO 36 STC to PO 62 SVC effective January 19, 2011. The transfer is not processed in the RPS until May 5, 2011.
CWA will automatically generate a deduction stop transaction when a TOU transaction is created. While the employee may have started in his new position in January, but because the pay account was not transferred until May, the coverage stop date reported to Sun Life will be the last day of the month following the date the TOU was processed. In this example, the TOU is processed in May and therefore, the coverage end date reported to Sun Life will be June 30, 2011.
The compensation advisors from SVC must then process a coverage start date in CWA of July 1, 2011.
Note: The compensation advisor must be very careful to distinguish between the deduction effective date in RPS and the coverage start date in CWA to ensure double deductions are not taken.
4.5. Dual Employment
4.5.1. When an employee is on LWOP and accepts a position in another department, it is the responsibility of the home department to ensure that the proper PSHCP contribution is collected and remitted in order to maintain coverage. The home department should not process any transaction in CWA.
Important: The contributions, received by the home department during periods of dual employment, should only include the employee share (single rate).
For special cases of extended dual employment periods, special arrangements can be negotiated between the two departments.
4.5.2. If the employee decides not to maintain his PSHCP coverage (opt out) at anytime during his LWOP, the home department needs to report a coverage stop date in CWA. If the employee accepts a position in another department and qualifies for the PSHCP, then the host department must reinstate coverage in CWA. The procedures stated in section 4.2.2. of this directive apply.
4.6. Lay-off - Work Force Adjustment Directive (WFAD)
4.6.1. A member who opts to continue coverage following a WFAD decision, the compensation advisor must complete form PWGSC-TPSGC 2278 - Contribution Remittance For Period of Leave Without Pay (PSHCP) This information is only accessible to federal government employees, and only to federal departments and agencies. and send it to FPAD with the payment. A transaction in CWA will report a coverage end date of the last day of the month following the month of discharge. As a result, the compensation advisor must contact Sun Life and request the reported coverage end date be manually adjusted to reflect the period requested by the member, which can be up to one year.
4.7.1. Special considerations are given to pregnant members who cease to be employed or to the pregnant survivor of a deceased member who wish to continue their coverage. In these situations, the coverage can be maintained until the end of the pregnancy if the required contributions are made. See IAM 2.14.4 for more details. The compensation advisors must follow the same process as described in section 4.5.1. of this directive.
5.1. Any inquiries on the information contained in this document should be addressed to your PWGSC Compensation Services Office.
Reference(s): CJA 9224-14-3 9242-5-2
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