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Overview

The Benefits At-a-Glance summarizes the coverage available to you under the PSGIP. It does not describe all the benefit details. Certain limitations and conditions apply. See the exclusion sections for each benefit for more information. Coverage shown is per insured person and per calendar year, unless otherwise stated.

If you are a retiree of CUPE Locals 1145, 1770, 1775 and 3620, City of Charlottetown, Innovation PEI, Island Waste Management Corporation (IWMC) or WCB of PEI, coverage is available for health, travel and dental benefits only.

Health

Supplements your provincial health coverage.

Reimbursement* Option 1 Option 2 Option 3 Option 4
Prescription drugs
(mandatory generic substitution)
  • 80% of the first $150 per eligible drug expense, and 100% thereafter
  • You pay an annual** deductible before drug coverage begins:
    $300 single
    $600 family***
  • 80% of the first $150 per eligible drug expense, and 100% thereafter
  • You pay the first $50 per eligible drug expense, and 100% thereafter
  • Coverage for vaccines only:
    80%, to a $500 lifetime maximum per person

Reimbursement is based on your prescription drug coverage option:

  • $500 lifetime maximum per person for vaccines
  • $300 lifetime maximum for smoking cessation products (limited to 50% reimbursement)
  • $250 maximum per calendar year for sexual dysfunction medications
  • Pay-direct drug card (reimbursement is processed at point-of-sale, where available)
Hospital accommodations
  • No private or semi-private coverage under Options 1, 2 & 3
  • Ward coverage provided under the provincial plan
  • 100% of the difference between a ward and semi-private room
  • 80% of the difference between a semi-private and private room
Paramedical practitioners
80%
  • 20-visit maximum per calendar year for physiotherapist
  • $240 maximum per calendar year for massage therapists and occupational therapists
  • $12 per visit, to a maximum of 20 visits per practitioner per calendar year for chiropodists or podiatrists (plus cost of laboratory tests and x-rays), chiropractors and osteopaths
Eye exams 80%
One eye exam every 2 calendar years
(every calendar year for children age 18 and under)
Eye glasses or contact lenses 80%
$80 maximum once every 2 calendar years
(every calendar year for children age 18 and under)
Private-duty nursing 80%
$8,000 maximum per calendar year
Medical supplies and prosthetics 80%
Other eligible expenses 80% (except for ambulance services)
  • Accidental dental
Treatment must be completed within 12 months of the accident
  • Ambulance services
100% of the first $50 of eligible expenses per calendar year, and 80% thereafter
  • External insulin pumps
 1 pump every 5 calendar years, to a maximum of $5,200
  • Hearing aids
$900 maximum per ear every 5 calendar years
  • Orthotics and orthopedic shoes
$240 combined maximum every calendar year
  • Benefit year is from April 1 to March 31
  • $600 family refers to $300 for yourself and another $300 for all of your eligible dependents combined

Travel

Supplements your provincial health coverage.

Reimbursement 100%
Emergency out-of-province /
country health care

$1 million maximum per emergency

Coverage for the first 180 days of a trip

Medical conditions must be stable

(must be covered under provincial plan)
Travel assistance 24/7 services
1 866 530-6024 (in Canada and the US) /
Collect: (905) 816-1901

Dental

Provides coverage for a variety of dental procedures.

Reimbursement Plan A Plan B
Preventative services
(e.g., oral exams, cleaning and scaling of teeth, fillings and x-rays)
 80%
Recall exams once every
5 months
 80%
Recall exams once every
5 months
Maintenance  services
(e.g., oral surgery and periodontic and endodontic care)
 80% 80%
Major restorative services
(e.g., dentures, crowns and bridges)
 No coverage 50%
$500 maximum per calendar year
Dental fee guide Current year fee guides for general practitioners

Basic Life and AD&D Insurance

(for retirees of Civil Service and Health PEI only)

Provides financial security if you or a dependent dies or suffers a severe injury as a result of an accident.

Coverage Retiree Life and Basic Dependent Life* Basic AD&D**
Retirees of Civil Service $5,000
(retired at or after age 55 with 10 years of service and eligible for a pension)
 $5,000
(retired at or after age 55 with 2 years of service)
Retirees of Health PEI $5,000
(retired at or after age 55 with 2 years of service)
 –
For your spouse*** $4,000****
(optional coverage)
 -
For your children $3,500**** per child
(optional coverage)
 -
  • If you retired from the Civil Service before June 1, 1997, with a pension from the Pension Plan, and you pass away before age 65, you are covered for your basic life insurance in effect prior to your retirement.
  • If you retired from the Civil Service before June 1, 1997, coverage for basic AD&D insurance is equal to 2 X your pre-retirement earnings, up to age 65 ($5,000 afterward).
  • Coverage is equal to $3,500 if you were a permanent, full-time UPSE employee who transferred from the Civil Service to the Health Sector on August 1, 1995, and remained an UPSE employee.
  • If you retired from Health PEI, this basic coverage will end on the first day of the month following your 65th birthday. If you retired from the Civil Service, it will continue for life.

Optional Life and AD&D Insurance

(for retirees of Civil Service and Health PEI only)

Provides additional financial security to enhance your basic coverage.

Coverage Optional Life Optional AD&D
For you Your amount in effect before retirement, up to a maximum of $300,000 Your amount in effect before retirement, up to a maximum of $300,000
For your spouse Your spouse’s amount in effect before retirement, up to a maximum of $300,000 50% of your optional AD&D coverage
(60% if you have no children)
For your children $10,000 per child 15% of your optional AD&D coverage if you have a spouse (20% otherwise)
$20,000 maximum per child
Termination of coverage Age 65 Age 65