CGM Coverage with Public Service Health Care Plan (PSHCP)
PSHCP is administered by Canada Life
Does PSHCP provide Dexcom CGM coverage?
Yes, both Dexcom G6 and G7 are covered by PSHCP. The Public Service Health Care Plan (PSHCP) provides health benefits to federal employees and their families and is administered by Canada Life. Coverage has been extended to all plan members living with type 1 diabetes.
Do I need a prescription to qualify for coverage?
A prescribing physician must confirm your Type 1 diabetes diagnosis, which can be written on a prescription or provided as a medical letter.
How do I get coverage?
To initiate coverage, plan members or their family members living with T1D will need to first purchase Dexcom CGM supplies 100% out-of-pocket and complete a manual claim. For this initial claim, you will need four items:
- A purchase receipt for Dexcom CGM supplies.
- A signed and completed PSHCP health care claim form.
- A prescription for Dexcom CGM from your doctor.
- A document (letter) from your doctor that confirms your T1D diagnosis.
The manual claim can then be submitted online at www.canadalife.com/pshcp.
Once this first manual claim is paid, you will be approved and able to use your drug card at your pharmacy. All subsequent purchases at your pharmacy will be directly billed to your plan.
How long will I be covered?
Once your first manual claim is reimbursed to you, you are approved for coverage going forward.
How much coverage do eligible PSHCP plan members have for Dexcom CGM?
Coverage is to a maximum of $3,000 in a calendar year, paid at 80% (or $2,400) for Dexcom CGM supplies.
Dexcom receivers are also covered for up to $700 over 5 years at 80% (or $560) and must be submitted using the manual claim process.
Where can I get my Dexcom CGM supplies?
You should purchase your Dexcom CGM supplies at your pharmacy of choice using their drug card.
You will need to pay 100% out-of-pocket for your initial purchase and submit your claim to Canada Life manually online at www.canadalife.com/pshcp . However once approved, your subsequent purchases at pharmacy will be directly billed to your plan.
See above FAQ on obtaining coverage to ensure you meet all the requirements for approval.
Will I have any out-of-pocket costs?
In some cases you may have out-of-pocket costs when purchasing at your pharmacy. If you find you do have a co-pay amount, the Dexcom G7 Patient Benefit Program assists in reducing or even eliminating up to 20% of out-of-pocket costs.* Download a copy of the program certificate below, which can be redeemed at your pharmacy with a valid Dexcom G7 prescription.
Do you have questions?
Our team is here to help! One of our Insurance Specialists can assist you in determining your coverage for Dexcom CGM. Get started by filling out our online form or call us at 1-844-832-1810.
*Based on reasonable upcharge, mark-up and customary pharmacy dispensing fee.
† Best available information as of June 14, 2024. Subject to change.
† Best available information as of June 14, 2024. Subject to change.