The Hospital Provision is available under Supplementary Coverage and Comprehensive Coverage. This provision provides reimbursement for the reasonable and customary charges, up to specified amounts, for the cost of hospital room and board charges other than standard ward charges (i.e. semi-private or private accommodation).
There are three levels of coverage, indicating the maximum amount a member may be reimbursed for each day of hospital confinement:
- Level I: $90
- Level II: $170
- Level III: $250
Every Plan member must choose a level of hospital coverage.
It is important to note that the Hospital Provision does not provide coverage for services rendered in a hospital, and does not cover standard ward charges.
If you would like to change your level of coverage under the Hospital Provision, you must submit a PSHCP application form to the designated officer of your personnel or pension office indicating that you wish to make an amendment.
No benefit is payable for:
- Expenses incurred under any of the conditions listed under General Exclusions and Limitations in the Plan Directive;
- Co-insurance charges or similar charges for hospital care which are in excess of charges payable by a provincial or territorial government health or hospital insurance plan, except charges as provided under the terms of the Hospital Provision. However, co-insurance charges for a chronic care hospital for a patient who is confined to a chronic care hospital, and has made at least one claim for such charges before September 1, 1992 and makes a further claim for the same period of confinement, are eligible;
- Personal charges such as televisions and telephones;
- Expenses incurred when a patient is occupying an acute care Hospital bed but has been medically discharged and no longer requires acute care.