1.    Registered dietician

New benefit

$300 per calendar year

No prescription required

2.    Occupational therapist

New benefit

$300 per calendar year

No prescription required

3.    Lactation consultant

New benefit

$300 per calendar year

No prescription required

4.    Acupuncturist

New benefit

$500 per calendar year

No prescription required

5.    Nurse practitioner

New benefit

n/a

To alleviate the pressure on physicians and to enable access for those without family doctors, nurse practitioners can now prescribe medical supplies and prescription drugs, if authorized by their province or territorial government

6.    Batteries for hearing aids

New benefit

$200 per calendar year

• This benefit is in addition to the existing benefit that covered batteries with an initial hearing aid purchase.
• This benefit can also be used to cover replacement hearing aid batteries

7.    Injectable lubricants for joint pain and arthritis

New benefit

$600 per calendar year

• Prescription required to ensure medical necessity
• This benefit does not cover injectable lubricants used for cosmetic purposes

8.    Needles and syringes for injectable drugs

New benefit

$200 per calendar year

Prescription required to ensure medical necessity (valid for 3 years)

9.    Gender Affirmation

New benefit

$75,000 per lifetime

• This industry-leading benefit provides coverage for gender-affirming care not covered by an individual’s province or territory
• A Gender Affirmation Application form must be submitted to Canada Life prior to incurring expenses for services

10.       Continuous Glucose Monitor Supplies

New benefit

$3,000 per calendar year

Valid for Type 1 diabetics only

11.       Diabetic Monitors

New benefit

$700 every five years

• Prescription required
• Removal of blood testing requirement to expand access to coverage.
• Valid for Type 1 diabetics only

12.       Diabetic testing supplies

New benefit

$3,000 per calendar year

Valid for Type 1 and Type 2 diabetics

13.       Psychological services

$2,000 per calendar year

$5,000 per calendar year

• No prescription required
• In addition to existing coverage for psychologists, coverage has expanded to include psychotherapists, social workers, and registered counsellors

14.       Psychotherapists

$2,000 per calendar year

$5,000 per calendar year

• No prescription required
• In addition to existing coverage for psychologists, coverage has expanded to include psychotherapists, social workers, and registered counsellors

15.       Social workers

$2,000 per calendar year

$5,000 per calendar year

• No prescription required
• In addition to existing coverage for psychologists, coverage has expanded to include psychotherapists, social workers, and registered counsellors

16.       Registered counsellors

$2,000 per calendar year

$5,000 per calendar year

• No prescription required
• In addition to existing coverage for psychologists, coverage has expanded to include psychotherapists, social workers, and registered counsellors

17.        Physiotherapist

Up to $500, then a member-paid corridor from $500 to $1,000, then unlimited after $1,000 in claims submitted

$1,500 per calendar year

• Prescription not required
• To enable access for 99% of plan members, the member paid corridor between $500 and $1,000 was removed to provide continuous coverage
• The Treasury Board (TB) President approved utilization of the entire annual amount of $1,500, per plan participant, from July 1 to December 31, 2023, reimbursed at 80%

18.        Flexibility

Up to $500, then a member-paid corridor from $500 to $1,000, then unlimited after $1,000 in claims submitted

$1,500 per calendar year

• Prescription not required
• To enable access for 99% of plan members, the member paid corridor between $500 and $1,000 was removed to provide continuous coverage
• The TB President approved utilization of the entire annual amount of $1,500, per plan participant, from July 1 to December 31, 2023, reimbursed at 80%

19.       Massage therapist

$300 per calendar year

$500 per calendar year

Prescription not required

20.        Osteopath

$300 per calendar year

$500 per calendar year

Prescription not required

21.        Naturopath

$300 per calendar year

$500 per calendar year

Prescription not required

22.       Podiatrist or chiropodist

$300 per calendar year

$500 per calendar year

• Prescription not required
• Coverage has expanded to enable access for plan members who receive services of a podiatrist/chiropodist/ licensed nurse in a community nursing station

23.       Nursing services

$15,000 per calendar year

$20,000 per calendar year

Must be medically necessary and provided by a licensed nurse in the personal residence of the plan participant

24.       Electrologist

Limited to $20 per visit, with no annual maximum

$1,200 per calendar year

• Reimbursement is no longer limited to $20 per visit
• New annual maximum of $1,200
• Prescription required unless plan participant is undergoing gender affirming care

25.       Speech language pathologist and audiologist

$750 per calendar year

$750 per calendar year

In addition to existing coverage for speech language pathologists, coverage has expanded to enable access to the services of an audiologist

26.       Prescription eyeglasses, contact lenses (purchase and repairs)

$275 every two years

$400 every two years

n/a

27.       Laser eye surgery

$1,000 per lifetime

$2,000 per lifetime

n/a

28.       Smoking cessation drugs

$1,000 per lifetime

$2,000 per lifetime

n/a

29.       Wigs

$1,000 every five years

$1,500 every five years

n/a

30.       Orthopedic shoes

$150 per calendar year

$250 per calendar year

Prescription required from a physician or nurse practitioner or podiatrist

31.       Aerotherapeutics supplies

$300 per calendar year

$500 per calendar year

In addition to supplies, this benefit also includes coverage for repairs

32.       Hearing aids

$1,000 every five years

$1,500 every five years

n/a

33.    Insulin jet injector

$760 every three years

$1,000 every three years

n/a

34.          Walkers and wheelchairs

Subject to Reasonable and Customary charges every five years

Subject to Reasonable and Customary charges every five years

• Coverage expanded to enable access for plan members who require a walker or wheelchair outside of a private residence
• Coverage expanded to enable access to reimbursement for expenses incurred within the same 5-year period, less the amount reimbursed for the previously claimed chair

35.          Medical monitoring devices

Subject to Reasonable and Customary charges every five years

Subject to Reasonable and Customary charges every five years

In addition to existing coverage for apnea and enuresis monitors, coverage expanded to enable access for: oxygen saturation meters, pulse oximeters, saturometers, blood pressure monitors, coagulation monitors, and heart monitors

36.       Level I

$60 per day

$90 per day

n/a

37.       Level II

$140 per day

$170 per day

n/a

38.       Level III

$220 per day

$250 per day

n/a

39.       Emergency benefit while travelling

$500,000 every trip

$1 million every trip

Out-of-province coverage for 40 consecutive days, excluding any time out of the province for business on official travel status

40.       Family Assistance Benefits

$2,500 per travel emergency

$5,000 per travel emergency

Coverage for meals and accommodations increased from $150 to $200 each day, per plan participant, reimbursed at 100%

41.       Meals & Accommodations

$150 per day

$200 per day

Coverage for meals and accommodations increased from $150 to $200 each day, per plan participant, reimbursed at 100%

42.       Pensioner relief provision

Members who retired before April 1, 2015, are eligible

Members who retired after April 1, 2015, until March 31, 2025, are eligible

To support low-income retired members who are either in receipt of a Guaranteed Income Supplement (GIS) or have a net/combined income lower than the GIS thresholds, the relief provision was amended to include plan members who retire after April 1, 2015, until March 31, 2025

43.       Mandatory Generic Substitution

n/a

• Plan members with existing brand name prescriptions prior to July 1, 2023, continue to be reimbursed at 80% of the cost of the brand name drug until December 31, 2023
• As of January 1, 2024, plan members will be reimbursed 80% of the lowest-cost generic drug
• Plan members can continue taking the brand name drug, but will need to pay the difference between 80% of the lowest-cost generic and the brand name drug out-of-pocket

• Generic drugs are identical to their brand name drug counterparts as they contain the same pharmaceutical ingredients
• Exceptions are granted based on medical necessity; plan members granted an exception will receive reimbursement for 80% of the cost of the brand name drug

44.       Legacy coverage

n/a

• Plan members with existing brand name prescriptions prior to July 1, 2023, continue to be reimbursed at 80% of the cost of the brand name drug until December 31, 2023
• As of January 1, 2024, plan members will be reimbursed 80% of the lowest-cost generic drug
• Plan members can continue taking the brand name drug, but will need to pay the difference between 80% of the lowest-cost generic and the brand name drug out-of-pocket

• Generic drugs are identical to their brand name drug counterparts as they contain the same pharmaceutical ingredients
• Exceptions are granted based on medical necessity; plan members granted an exception will receive reimbursement for 80% of the cost of the brand name drug

45.       Medical flexibility

n/a

• Plan members with existing brand name prescriptions prior to July 1, 2023, continue to be reimbursed at 80% of the cost of the brand name drug until December 31, 2023
• As of January 1, 2024, plan members will be reimbursed 80% of the lowest-cost generic drug
• Plan members can continue taking the brand name drug, but will need to pay the difference between 80% of the lowest-cost generic and the brand name drug out-of-pocket

• Generic drugs are identical to their brand name drug counterparts as they contain the same pharmaceutical ingredients
• Exceptions are granted based on medical necessity; plan members granted an exception will receive reimbursement for 80% of the cost of the brand name drug

46.        Prior Authorization

n/a

The prior authorization program applies to a sub-set of specific prescription drugs that require special handling, and was implemented to ensure that plan members are receiving reasonable treatment

Plan members with existing prescriptions prior to July 1, 2023, will continue receiving reimbursement for their treatment without having to submit a prior authorization request

47.       Legacy coverage

n/a

The prior authorization program applies to a sub-set of specific prescription drugs that require special handling, and was implemented to ensure that plan members are receiving reasonable treatment

Plan members with existing prescriptions prior to July 1, 2023, will continue receiving reimbursement for their treatment without having to submit a prior authorization request

48.       Originator biologics

n/a

• The prior authorization program also applies to biologic drugs;
• If there is a biosimilar drug available for a given treatment, a plan member may be contacted with transition details

Exceptions will be granted based on medical necessity

49.       Medical flexibility

n/a

• The prior authorization program also applies to biologic drugs;
• If there is a biosimilar drug available for a given treatment, a plan member may be contacted with transition details

Exceptions will be granted based on medical necessity

50.       Compound drugs

Eligible for reimbursement

Compound drugs now require one active ingredient with a Drug Identification Number (DIN) that is covered under the PSHCP to be eligible for reimbursement

• During the legacy period, plan members with existing compound drug prescriptions without an active ingredient with a DIN, will continue receiving reimbursement
• Until January 1, 2024, members who were reimbursed for a compound drug, regardless of ingredient, between January 1, 2023, and June 30, 2023, can have a subsequent compound drug (for that same compound drug) reimbursed without the need for one active ingredient to have a DIN

51.       Legacy coverage

Eligible for reimbursement

Compound drugs now require one active ingredient with a Drug Identification Number (DIN) that is covered under the PSHCP to be eligible for reimbursement

• During the legacy period, plan members with existing compound drug prescriptions without an active ingredient with a DIN, will continue receiving reimbursement
• Until January 1, 2024, members who were reimbursed for a compound drug, regardless of ingredient, between January 1, 2023, and June 30, 2023, can have a subsequent compound drug (for that same compound drug) reimbursed without the need for one active ingredient to have a DIN

52.   Catastrophic Drug Coverage

Eligible drug expenses will be reimbursed 100% when out-of-pocket drug expenses exceed $3,000 in a calendar year, per plan participant

Eligible drug expenses will be reimbursed 100% when out-of-pocket drug expenses exceed $3,500 in a calendar year, per plan participant

n/a

53.       Pharmacy Dispensing Frequency Limit

n/a

Pharmacist dispensing fees will now be reimbursed up to a maximum of five times per year, per plan participant, for maintenance drugs

• Exceptions will be granted based on medical necessity
• Due to provincial pharmaceutical regulations, exceptions are in place for plan members residing in Saskatchewan and Quebec

54.       Medical flexibility

n/a

Pharmacist dispensing fees will now be reimbursed up to a maximum of five times per year, per plan participant, for maintenance drugs

• Exceptions will be granted based on medical necessity
• Due to provincial pharmaceutical regulations, exceptions are in place for plan members residing in Saskatchewan and Quebec

55.   Pharmacy Dispensing Fee Cap

n/a

Pharmacist dispensing fees will now be covered up to a maximum of $8, per plan participant, reimbursed at 80%

• The dispensing fee cap does not apply to biologic or compound drugs
• Exceptions will be granted based on medical necessity
• Due to provincial pharmaceutical regulations, an exception is in place for plan members residing in Quebec

56.       Medical flexibility

n/a

Pharmacist dispensing fees will now be covered up to a maximum of $8, per plan participant, reimbursed at 80%

• The dispensing fee cap does not apply to biologic or compound drugs
• Exceptions will be granted based on medical necessity
• Due to provincial pharmaceutical regulations, an exception is in place for plan members residing in Quebec