Public Service Health Care Plan (PSHCP)
The Public Service Health Care Plan (PSHCP) provides health benefits to federal employees and their families and is administered by Canada Life. Coverage has been extended to all plan members living with type 1 diabetes.
Who qualifies for coverage?
All PSHCP plan members or their family members living with Type 1 diabetes are eligible for coverage for Dexcom CGM.
Eligible plan members are no longer required to be using an insulin pump prior to qualifying for coverage.
How much coverage do eligible PSHCP plan members have for Dexcom CGM?
Coverage is to a maximum of $3,000 in a calendar year, paid at 80% (or $2,400) for Dexcom CGM supplies.
Dexcom receivers are also covered for up to $700 over 5 years at 80% (or $560) and must be submitted using the manual claim process.
How do I get coverage?
To initiate coverage, plan members or their family members living with T1D will need to first purchase Dexcom CGM supplies 100% out-of-pocket and complete a manual claim. For this initial claim, you will need four items:
- A purchase receipt for Dexcom CGM supplies.
- A signed and completed PSHCP health care claim form.
- A prescription for Dexcom CGM from your doctor.
- A document (letter) from your doctor that confirms your T1D diagnosis.
Once this first manual claim is paid, you will be approved and able to use your drug card at your pharmacy. All subsequent purchases at your pharmacy will be directly billed to your plan.
How do I order my CGM supplies?
You should purchase your Dexcom CGM supplies at your pharmacy of choice using their drug card.
You will need to pay 100% out-of-pocket for your initial purchase and submit your claim to Canada Life manually online at www.canadalife.com/pshcp. However once approved, your subsequent purchases at pharmacy will be directly billed to your plan.
See above FAQ on obtaining coverage to ensure you meet all the requirements for approval.
Who can provide the required Type 1 diabetes diagnosis?
A prescribing physician must confirm your Type 1 diabetes diagnosis, which can be written on a prescription or provided as a medical letter.
How long will I be covered?
Once your first manual claim is reimbursed to you, you are approved for coverage going forward.
Does this change anything for existing PSHCP plan members using Dexcom CGM?
Existing PSHCP plan members with prior authorization (approval) for Dexcom CGM should not anticipate any denial of claims. It is important to note that coverage has changed to a maximum of $3,000 in a calendar year, paid at 80% (or $2,400).
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Have Insurance Questions?
We are here to help. A Dexcom Account Specialist can assist you in determining your benefits for CGM coverage. Get started by filling out our online form or call us toll-free at 1-844-832-1810.