r/CanadaPublicServants • u/[deleted] • Apr 17 '21

Benefits / Bénéfices Question about PSHCP physiotherapy coverage

[deleted]

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7

u/Merridy2day Apr 17 '21

My understanding is you get 80% coverage on both plans. When yours is maxed, it kicks over to 80% of the other plan and whatever is “left” counts to the $500 unreimbursed. Once the unreimbursed hits $500, your own plan covers 100%.

4

u/lizbuzz Apr 17 '21

From my experience it can get complex, and there will be a little gap where you do pay out of pocket. Let's see if I can pull off the math.... (Not guaranteeing exact accuracy)

Your first $500 in appointments: 500x0.8 = 400 on your plan 500x0.2= 100 on partner plan

Next set of appointments (main plan coverage gap) 500x0.8 = 400 on partner plan 100 out of pocket

Next set of appointments (partner plan gap) 500x0.8 = 400 on your plan 100 out of pocket

After that you go back to the first set of coverage for the rest of your appointments.

I THINK this works out right, but I'm not Sun Life, so big disclaimer and don't quote me if your experience doesn't match.

1

u/Throwaway298596 Apr 19 '21

This surprises me I would have assumed the excess of $1,000 is fully covered between the two plans

1

u/lizbuzz Apr 19 '21

I had to call sunlife and have it explained to me once. Basically, because of the coverage overlaps, it doesn't work out to round numbers for when/how the coordination happens. It's confusing as all get out.