Did You Know?
Understanding Coverage Eligibility
The PSHCP provides coverage for the purchase or rental of hospital beds in certain circumstances. The Plan covers 80% of the reasonable and customary expenses of an eligible hospital bed if it is:
- manufactured specifically for medical use;
- for use in the patient’s private residence,
- approved by the Administrator for cost-effectiveness and clinical value; and,
- designated as medically necessary.
Only one hospital bed purchase is eligible for reimbursement per covered person under the Plan in their lifetime.
The Plan does not consider costs for adjustable beds, such as those sold in retail or furniture stores, as these do not meet the requirements stated above. Adjustable beds, such as Ultramatic, Craftmatic, or Simmons Beautyrest models, are marketed for comfort and lifestyle use. These beds often include features like remote controls, massage options, or luxury materials and lack clinical-grade components required for long-term medical care.
To qualify for a hospital bed under the Plan, the patient must have a medical condition that clearly necessitates its use. Long-term conditions such as cystic fibrosis, muscular dystrophy, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Parkinson’s disease, and severe pressure sores (decubitus ulcers) are some examples of conditions that may be considered eligible. Short-term conditions may also qualify, such as recovery from surgery or a broken limb that requires prolonged bed rest.
Clinical Features of an Eligible Hospital Bed
To be eligible for reimbursement under the PSHCP, a hospital bed must be manufactured specifically for medical use and designed to support patient care. These beds include several features that distinguish them from standard or adjustable beds sold in retail or furniture stores, such as:
- Height Adjustability: The entire bed can be raised or lowered to assist with safe patient transfers and to support caregivers in providing care.
- Head and Foot Elevation: The head and/or foot of the bed can be elevated independently to support medical needs such as circulation, breathing, or pressure relief.
- Side Rails: Built-in rails can be raised or lowered as needed to help prevent falls and assist the patient with repositioning.
- Lockable Wheels: The bed is mounted on wheels to allow for easy movement within the home, with locking mechanisms to ensure stability during use.
- Mattress Retainers or Stoppers: These hold a therapeutic mattress securely in place, preventing shifting or sliding during use.
- Manual or Electric Controls: Hospital beds may include either hand cranks or electronic controls to adjust bed positioning based on medical needs.
- Sturdy Frame Construction: Typically made of metal, hospital beds are built for durability and are designed to support long-term use and various medical attachments.
- Accessory Compatibility: Many hospital beds can be fitted with optional medical accessories, such as IV poles or trapeze bars, to provide further support for care at home.
Beds that do not have these clinical-grade features, such as retail adjustable beds with massage functions, memory foam, or luxury upholstery, are not eligible under the PSHCP, even if they may provide enhanced comfort to the patient.
Required Documentation
To determine eligibility, members must submit to the Plan Administrator (Canada Life) a physician’s prescription for the hospital bed, along with a completed Durable Equipment Application Form, which includes the patient’s medical condition and justification for the equipment. The physician or nurse practitioner must clearly outline the diagnosis and the necessity of the equipment on the form.
Please note that any fees charged by a physician or nurse practitioner for completing the form or providing any additional supporting documentation are not reimbursable under the PSHCP.
Coverage for therapeutic mattresses
Therapeutic mattresses are eligible under the PSHCP when certain criteria are met, and coverage is limited to one every five years. The intent of this provision is to provide coverage for medically necessary therapeutic mattresses, such as those prescribed for the treatment of pressure ulcers and skin breakdown caused by prolonged bed rest or for burn victims.
A therapeutic mattress is a medical-grade mattress specifically designed to help manage or prevent pressure-related injuries and is typically used in conjunction with a hospital bed. These mattresses often feature alternating pressure zones, low-air-loss systems, or high-density foam construction to redistribute weight and reduce pressure on vulnerable areas of the body.
There is no benefit under the Plan for a mattress that is not manufactured specifically for medical use, such as an orthopedic or comfort mattress.
Renting vs. Purchasing
Members have the option to rent or purchase a hospital bed. Coverage is based on reasonable and customary rates, and reimbursement is provided up to the lesser of the purchase/rental cost or the reasonable and customary amount.
Any amount previously paid for rentals or repairs will be deducted from the amount eligible for reimbursement.
Submitting an Estimate
It is highly recommended that members submit an estimate prior to renting or purchasing a hospital bed and therapeutic mattress. The estimate should include:
- A completed Durable Equipment Form completed by the member’s physician or nurse practitioner
- A detailed quote from the supplier outlining a breakdown of costs and the device’s specifications
To validate the coverage available under the PSHCP, please contact Canada Life’s PSHCP Member Contact Centre at 1-855-415-4414 (toll-free from anywhere in North America).
Members with Comprehensive coverage should contact MSH International’s Comprehensive Coverage Contact Centre at 1-833-774-2700 (toll-free from Canada or the United States) or 1-365-337-7427 (call collect from outside of Canada and the United States)