Medical Benefits for Military Families

Military families are accustomed to facing unique challenges that come with the territory when your loved one serves in the Canadian Armed Forces (CAF), access to healthcare and insurance not being the least of them. Though families are not covered in the same manner military members themselves are, the government of Canada has designed the Public Service Health Care Plan to meet the needs of families that provincial plans may not.

Naturally, when it comes to healthcare the first place to turn to is the healthcare plan provided by each province. But this plan doesn’t include a lot of everyday medical needs, and that’s where the Public Service Health Care Plan comes in. The Public Service Health Care Plan or PSHCP is a private and voluntary health care plan supported by the government of Canada that serves all public servants and government employees including members of the CAF. The plan reimburses its members for any medical costs incurred that are not covered under provincial health plans. The PSHCP provides the same coverage from province to province as long as an individual has provincial healthcare.

Military members are only allowed to access the plan if they have families. Spouses, children and dependent step-children are eligible under this plan. Children are covered up to the age of 21 unless they are full-time students, in which case they are covered up to the age of 25. The plan also makes exceptions for children with mental impairments to be covered for life if they cannot work.

Mirroring other private healthcare plans, the PSHCP is designed to cover two broad categories: extended health care provisions and hospital provisions. Extended health care provisions reimburse members for everyday medical procedures such as vision, dental, medications, some lab work and physiotherapy. However, not every aspect of extended health care is on an annual basis. For instance, vision care is based on a two- year cycle and covers eye exams and glasses or contacts up to a maximum of $275.

Hospital provisions, on the other hand, are based on the daily charges of a hospital stay and allows for semi-private or private rooms. Level I, which is automatically included with a standard plan, is based on a maximum daily charge of $60 that a hospital would charge. Level II is $140 and level III is 220.

The Public Service Dental Care Plan is branch of the PSHCP to cover standard dental procedures. Monthly charges for a family are $69, but options are available to cover a spouse and employee or children and employee that are $46 monthly. The plan covers dental exam, routine cleaning, some x-rays, some minor and major restorative procedures such as a root canal, some oral surgery procedures and even some orthodontic services. Members are reimbursed at 90 per cent. The eligibility of families is the same as the general plan.

To join the plan, military members are required to fill out forms that are available online. Once families become members, the government pays for the full cost of the basic plan which is extended healthcare and level I of the hospital benefits. For level II, members must pay $3.53 monthly for family coverage. Level III costs are $10.34 annually for family coverage.

The Public Service Health Care Plan is undergoing some significant changes, some of which are already in effect while others will come in to affect next year. Starting this past October vision care was expanded to include laser surgery benefits for a lifetime maximum of $1,000. The coverage, replacement and servicing of aerotherapeutics devices is now $300 annually. There has also been an increase in coverage for psychological services from $1,000 to $2,000 annually.

Starting this January, the annual deductible will be eliminated. Previously plan members had to pay an annual deductible of $60 for single member coverage and $100 for family plans.

Fortunately, members on an OutCAN posting are still covered under PSHCP with a few minor changes including a provision for hospital benefits outside of Canada. Members are also covered for a maximum of $500 Canadian when travelling outside of the country in case of an emergency.

Of course, finding appropriate insurance is only half of the equation. Many families have difficulties connecting with healthcare physicians after being posted to a new city. To help solve this problem, under the supervision of Military Family Services, the Military Family Resource Centre-National Capital Region has partnered with the Academy of Medicine Ottawa launched a pilot project entitled Operation Family Doctor. Operation Family Doc, started in 2012, has a 100 per cent success rate in Ottawa and 81 per cent success rate in Quebec so far.

“I create partnerships with family doctors I approach them and ask if they would be interested in taking military families, how many can you take, how often can you take them and do you have cap? Every single clinic I have a different relationship with for what their intake is. And so, we match a family to where they need to go,” explained Robyn Curry Director of Operation Family Doctor.

Families are matched to doctors based on their location and other preferences such as language and gender.

The program, as of now, is in the early stages of possibly going nationwide someday.

“We are very interested in trying to spread this initiative to other family resource centre just to ease the burden of families when they arrive. We’re taking measured steps because every community is different, and community capacities differ from region to region. We are trying to look at this one base at a time. We are pretty optimistic that this will spread across the country,” said Colonel Russell Mann Director of Military Family Services.

Military Family Services (MFS) is also looking into other options to help families access healthcare easier when posted to a new area. For example, though nearly every province has agreed to waive the 90 day wait to access healthcare, it is still difficult for families to gain the information necessary to access healthcare. MFS is now focusing on communication products for families and education of people working in the health services in each province to provide families with the appropriate tools.

“The well-being of military families is a priority for the Canadian Armed Forces.  DND and the CAF recognize that CAF families access health care which falls under provincial responsibility and as such have engaged provincial ministries of health to foster understanding and awareness about unique military family considerations in order to influence policy and legislative changes. As a result, all 10 provinces have agreed to waive the 90-day wait period for military families to receive provincial coverage, and the Northwest Territories have agreed, in principle, to waiving the 90-day period.” said Col. Mann.

To see further updates to the PSHCP, click here.

**This article was originally published in the Winter 2015 issue**