Amending my coverage
Plan members are responsible for ensuring that their coverage meets their needs and their Positive Enrolment information is up to date.?
Coverage amendments include switching between Single or Family-level coverage, increasing or decreasing your level of coverage under the Hospital Provision, or converting your coverage from Supplementary to Comprehensive (or vice versa). You can make these types of amendments by submitting your changes to Compensation using the PSHCP Employee Application Form or to your Pension Office using the PSHCP Pensioner Application Form. Plan members who have access to Compensation Web Applications have the option of making these changes online. Certain waiting periods may apply before your change in coverage takes effect.
To update your Positive Enrolment information with Sun Life, you can submit a Positive Enrolment Change Form to Sun Life by mail. If you have registered for an online account with Sun Life, you can update your Positive Enrolment information online through Sun Life's Plan Member Services website at www.sunlife.ca/pshcp.
Updating your contact information
You must inform Sun Life of changes to your contact information (such as your mailing address and telephone number). You may do so by indicating your new contact information on your next claim form, or by completing the PSHCP Positive Enrolment Change Form, which can be done by mail or through the online form available on Sun Life's Plan Member Services website at www.sunlife.ca/pshcp.
Coordination of benefits information
Coordination of benefits is a provision that determines the sequence of coverage for Plan members who are entitled to coverage under one or more other private health care benefits plan(s). It also applies to cases where both spouses are members of the PSHCP.
To maximize the benefits of this provision, you must inform Sun Life if you are covered under another private health care plan, and indicate what that coverage entails (e.g. drug coverage or medical coverage or both). You can provide this information during Positive Enrolment.
If you wish to add, amend, or remove coordination of benefits information after you have completed positive enrolment, simply complete the Positive Enrolment Change Form and submit this to Sun Life.
Single to Family coverage (or vice versa)
If you have Single coverage and wish to add a dependant, you will need to complete a PSHCP application form to amend your coverage and submit it to Compensation or your Pension Office (depending on your employment status). Check the box that says “Applicant with dependants”; your contribution rates will increase from Single to Family-level coverage. You can also switch from Single to Family-level coverage through your Compensation Web Applications, if this is available to you. After you have increased your level of coverage, you must then complete a Positive Enrolment form to provide your dependant’s information to Sun Life.
If your application is submitted within 60 days of acquiring your new dependant, coverage will be effective as of the date you acquired the dependant.
If the application to amend your coverage is received after 60 days of acquiring your dependant, coverage will take effect on the first day of the fourth month the application is received by Compensation or your Pension Office.
If you wish to add or remove a dependant but wish to maintain Family coverage, simply complete the PSHCP Positive Enrolment Change Form and submit it to Sun Life.
If you no longer have any eligible dependants, you must submit the PSHCP Application Form to amend your coverage from Family to Single, and submit it to Compensation or your Pension Office, and complete a Positive Enrolment Change Form to inform Sun Life that you no longer have any dependants under the Plan. Your Plan contribution rates will be modified to reflect Single coverage.
Please also refer to the Member Booklet for more information on commencement, amendment, and termination of coverage.
Amending your Hospital Provision coverage
All members of the PSHCP are required to select a level of coverage under the Hospital Provision, which provides reimbursement for hospital room and board charges other than standard ward charges for each day of confinement. The level of coverage you choose will determine the maximum amount that can be reimbursed to you (subject to reasonable and customary charges), and may also have an impact on your monthly PSHCP contributions.
There are three levels of coverage, indicating the maximum amount a member may be reimbursed for each day of hospital confinement:
- Level I: $60
- Level II: $140
- Level III: $220
For example, if you have Level II coverage and wish to stay in a private room, you may be reimbursed up to $140 per day for accommodation expenses above the standard ward charges for your hospital stay.
To amend your level of coverage under the Hospital Provision and authorize the deduction of your PSHCP contributions, you must submit a PSHCP application form to Compensation or your Pension Office, or make the change online through your Compensation Web Applications. You are not required to submit this type of amendment to Sun Life.