Pshcp bulletin

Number 15 Publications Mail Agreement No. 40048697 May 2003
Smoking cessation aids
Smoking cessation aids, known as nicotine replacement therapy products, are a covered
expense under the drug provision of the Plan. As specified in the Members’ booklet, the Plan will
reimburse the reasonable and customary charges of these products, subject to a $1,000.00
maximum lifetime eligible expense per participant, if they are prescribed by a physician or
dentist and are dispensed by a pharmacist.

What’s covered?
• the oral prescription drug Zyban (Bupropion HCI), • nicotine patches, pads and inhalers such as Habitrol, Nicoderm, Nicotrol, Transdermal and Prostep, and Nicorette and Nicorette Plus Gum.
What’s not covered?
• nutritional or herbal products such as Smoke Control Spray, Butt Out and Smoke Away; • cigarette modification such as E-Z Quit , Nicolite and cigarette filters; • Habit Regulator Electronic Smoking Control Aid; • counselling by someone other than a registered psychologist (services of a psychologist are adjudicated under the Medical Practitioners Benefit); • acupuncture by someone other than a physician (acupuncture performed by a physician is adjudicated under the Medical Practitioners Benefit); • educational/teaching aids such as video and audio tapes, books and magazines, on-line Since 2001, nicotine replacement products are available without a prescription at mostpharmacies and have been sold in many retail outlets. Even though the pharmacist consultedwith you at the time of purchase to ensure your health safety, prescriptions were not required andcash receipts were accepted as proof of purchase when submitting your claims to the Planadministrator. However, the PSHCP specifies that these products must be prescribed by aphysician or dentist and dispensed by a pharmacist if you wish to submit a claim forreimbursement. Please note that effective September 1, 2003, eligible nicotine products will only be
reimbursed if they are prescribed by a physician or dentist and dispensed by a

Claim filing deadline for 2002 expenses: June 30, 2003
Please remember that claims for 2002 expenses must be submitted no later than June 30, 2003.
If you are mailing your claim, it must be mailed and postmarked no later than June 30 for theclaim to be accepted. Working with your Call Centre
The PSHCP Trust makes every effort to ensure that members and their families have access to adedicated, specialized, and effective call centre to provide benefit, coverage and claims statusinformation. The service performance of our call centre is closely monitored and, when required,necessary changes have been implemented. Over the years, the plan administrator hasextended service hours, increased the number of telephone lines, and introduced an automatedclaims status inquiry system known as the Interactive Voice Response (IVR). For a number of reasons, the number of calls to the Administrator has continued to increase. Toprovide you with additional insight into the operations of the call centre, we are pleased to sharewith you the following information: • The PSHCP call centre is staffed from 7:00 a.m. to 8:00 p.m. EST, Monday to Friday; • Thirty-five fully trained employees are dedicated solely to the PSHCP and the PDSP • In 2002, the PSHCP call centre representatives received 432,662 phone calls; • An additional 129,556 calls were directed to the IVR for a total of 562,218 calls during the • This is an average of 46,852 per month, or 2,343 calls per day. • During peak claim periods such as January 2003, the call centre received 59,534 Our performance target with regards to wait times for members is under two minutes. However,certain circumstances beyond our control sometime increase these wait times and we ask foryour patience and cooperation.
While we continually try to find ways of improving the efficiency of our call centre, we believe you
can help us. For example, if you want to inquire about the status of your claim, the Trust
suggests that you wait at least three weeks from the date you mailed your claim before
calling the Administrator. This period takes into account the timeframe for mailing and expected
claim turnaround times. Alternately, you can find out the status of your claim by going to the
Group Claims Information website hosted by Sun Life at
Although the call centre is staffed appropriately to handle inbound volumes at all times of the day,we encourage members to stagger the times at which they call. If you find it difficult to reach arepresentative at a particular time, we suggest that you call earlier or later in the day. Rememberthat the call centre is open from 7 a.m. to 8 p.m.
We also encourage plan members who have questions about their PSHCP benefit coverage toconsult either the paper copy of the booklet or conveniently access it on the Internet. Please notethat the booklets are available on the PHSCP website at PSHCP….at your fingertips
Since February 2003, PSHCP…at your fingertips (een available to
members virtually anywhere in the world, any time of day, every day of the year. The Trust’s web
site is especially a great tool for new members. You can find all the details of the Plan and more.
For example, under Plan Details members can find valuable information on what the plan covers
and doesn’t cover, how to file a claim, the deadline for filing claims, the group plan number and
much more. The interface is clean and very easy to use. We are confident that you will find the
information you are looking for and more.
Change of address
Sun Life Financial’s Health & Dental Claims office in the National Capital Region has moved from
its St. Laurent address to the Clarica Centre located at 99 Bank Street. Please note that the
mailing address and telephone numbers remain the same.
We ask that you continue to send
your claims to the mailing address (P.O. Box) indicated on your claim form. However, a drop box
for your claims has been installed on the lower level (B1) of the Clarica Centre for your
Speaking of change of addresses, members are reminded that it is important to inform either your
personnel office or pension office, whether you are an active employee or a pensioner, of any
change of address. We also require that you indicate any change of address when submitting a
claim to the Plan Administrator. Please note that this information should not be sent to the
PSHCP Trust.

The PSHCP Bulletin is produced by the Public Service Health Care Plan (PSHCP) Trust to provide you with benefit and administrative information


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