Dependant Medical Care
While posted to Colorado Springs, family members may choose to use local civilian medical facilities or Military treatment facilities.
Civilian Treatment Facilities
Should you choose to use a civilian facility there are two options available to make payment for services. The facility may be able to invoice the Public Service Health Care Plan service provider Allianz directly or you may be required to pay the invoice and then you will submit a claim to Allianz. Check with the civilian provider prior to making any commitment to services.
Allianz Global Assistance 1-800-363-1835
P.O. Box 71987
Public Service Health Care Plan(PSHCP) – Dependants
To ensure continuity of dependant health care needs, serving CAF members who are posted to the US with dependants must obtain Comprehensive Coverage provided under the Public Service Health Care Plan (PSHCP). The PSHCP Comprehensive Coverage provides for CAF dependants, inpatient, outpatient visits and hospital needs commensurate with the benefits offered by the Ontario Hospital Insurance Plan (OHIP). It is highly encouraged that CAF members and dependants become conversant with the PSHCP benefit plan booklet – specifically with respect to information related to medical / hospital coverage, description of benefits, maximum allowable expenses and exclusions / limitations.
Claim Procedures – PSHCP
CAF and family members should note that accessing and paying for health care may not be as simple as they have experienced in Canada. Many US providers will request cash-up-front or payment before any claim is finalized. For assistance in processing health care claims contact CFSU(CS). However, it is important to understand and recognize that the interaction between medical (and dental) insurance companies and the member remains the responsibility of the CAF member.
Military Treatment Facilities (MTF)
Once the CAF member has registered with the Tri-West Health Care Defense Enrolment Eligibility Reporting System (DEERS) database access to most MTFs will be authorized. The CAF member will register during in-clearances. MTFs may be available to both CAF members and their families for routine matters. It is recommended to contact the MTF directly on specific matters. Additionally, Fort Carson has available emergency rooms but if this is not practical due to the emergency, members are highly recommended to proceed to the closest civilian emergency room or to call 911.
Family members are advised that, while they have access to US MTFs, serving military members receive priority treatment. Therefore, at times a dependant’s appointment or procedure may be postponed in order to accommodate a higher priority requirement. Notwithstanding this, MTFs still provide an economical method to receive medical care and services. These services are limited to outpatient services only (that is, when you are not admitted to a hospital, for example a doctor’s office/clinic, pharmacy visits) and are usually provided without charge, including prescription medications. These services may be used in concert with PSHCP entitlements, thus extending options for health care to family members.
For dependant family members, optical services in the US can be costly and the supplementary benefit of the PSHCP can provide partial relief from the cost. It is recommended that if glasses or contacts are required for family members, consideration should also be given to obtaining them prior to departing Canada, where costs are generally lower.
For dependant family members, prescription medications can be two to three times higher in cost compared to Canada. Family members requiring chronic medications may find this aspect a bit of a financial burden, and although options exist to relieve CAF families of this, this issue should be carefully considered during the screening process. In addition, members and their families should note that some medications might not be available in the US, which may necessitate changing the prescription upon the recommendation of the US physician – again, something that should be fully explored during the screening process. Whenever possible CAF members and their dependants will receive free prescriptions at Military Treatment Facilities (MTF) if the medication is available but some cases may see dependants being denied care and prescriptions for pre-existing medical conditions. All prescriptions whether given by a provider at a MTF or given by a civilian provider should be filled at the Peterson Commissary Pharmacy. Have your provider call the Peterson AFB Pharmacy at 719 556-0055 to obtain a fax number to fax the prescription directly or personally bring in your prescription. Prescriptions filled at the Peterson AFB Pharmacy are free of charge. Having the Peterson AFB Pharmacy fill the prescription instead of a commercial pharmacy will alleviate the need to submit claims to PSHCP Allianz. Claims which may not be covered or not 100% covered.
Peterson AFB Commissary Pharmacy 719 556-0055
Dependant Dental Care
The Canadian Forces Dental Care Plan (CFDCP) benefits will follow the family to the US. With the higher average cost of US dental care, the need for CAF members to submit a treatment plan (to Great West Life) before any significant work is committed is paramount. This would apply to treatments such as orthodontic work.
Great West Life
Foreign Benefits Payments
P.O. Box 6000
1- 800-957-9777 (English) or 1-800-704-4007 (French).
CF Dental Care Plan
With respect to the submission of dental claims, the CFSU(CS) will be able to guide you through the process. However, it is important to understand and recognize that the interaction between dental (and medical) insurance companies and the member remains the responsibility of the CAF member.
Medical / Dental Advances
CAF members who incur health care or dental care expenses in excess of C$200 may obtain an advance of public funds to temporarily offset their out-of-pocket expenses. Under exceptional circumstances, a member may apply for an advance of less than $200 by submitting a substantiated memorandum through their Chain of Command. Any advances issued are to be repaid immediately upon receiving reimbursement from PSHCP/CFDCP, or six months from the date the advance was issued, whichever is earlier. While this represents a means by which to assist CAF members and their families with high medical/dental costs, it must be recognized that these monies are issued as an Advance and must be repaid – regardless of how much coverage the insurance carrier provides.
To obtain a medical/dental advance, the member must complete and submit a request (available from CFSU(CS) for a Medical/Dental Advance along with a cost estimate from the medical/dental provider. Although some local physicians/hospitals will send invoices directly toAllianz/Great West Life, CAF members may be required to pay the health care facility or physician directly (that is, with the advance) and following this, submit all “paid’ invoices to Allianz or Great West Life for reimbursement. Once payment is received from Allianz there may be items identified as R70 that can then be claimed through the CFSU (CS).
While the US health care system can be confusing and sometimes more administratively complex than experienced in Canada, familiarity with our CAF medical and dental plans will only serve to ease the transition into these systems. All CAF members and their families can be assured that CFSU(CS) will provide as much assistance as possible to help answer any questions you may have.