CF H Svcs HQ Det Washington has been made aware that MSH International (the new OUTCAN PSHCP admin) has indicated that direct billing services are no longer available to comprehensive policy holders. The broader solution to this issue is outside of CAF jurisdiction. However, this issue impacts the OUTCAN Global Affairs Canada community as well and the issue has been communicated through DGCB to Treasury.

US Defense Health Agency and TRICARE Operations leadership has since indicated that in accordance with TRICARE Reimbursement Manual 6010.64-M, Chap 4, Sect 4, Para 15.0, the PSHCP is now considered a secondary insurer. Only those insurance policies purchased privately by your families here in the US, or provided by a dependant’s US employer, fall under the category of Primary “Other Health Insurer” (OHI). 

Subsequently, the US OUTCAN Health Services Team offers the following guidance for families receiving TRICARE benefits (see attached guides): 

• At the earliest opportunity contact or visit your nearest Military Treatment Facility (MTF) Patient Administration Office or DEERS Office. Advise them that as of 1 July, your family no longer has access to any OHI. Ask that it be removed. A letter you may provide clarifying the reason is attached in the guides listed as the fourth bullet-point. 

• Moving forward, disregard any guidance to add an OHI to your TRICARE or DEERs profile, there’s no need to declare one. 

• Regardless of whether dependants are referred out from the MTF or self-refer to access care from civ providers, utilize TRICARE as your primary insurance. 

• ENGLISH GUIDE | FRENCH GUIDE

The only times you should need to claim through the PSHCP/MSH International are the following:

• When accessing services which are covered benefits under PSHCP but not TRICARE.

• When accessing services for which TRICARE has a cap or requires a copay (MSH will accept claims for copays or “cost shares”, provided the services fall within the PSHCP entitlements).

• Any time dependants are admitted to hospital, it remains the case that TRICARE does not cover inpatient care for foreign military dependants, so in these cases your families will need to claim though Canada Life/MSH.

• There is no change to entitlements under MFSIs for amounts claimable against the crown or the process for doing so. For qualified expenses, we will still require proof of payment and the Explanation of Benefits from BOTH TRICARE and MSH International.

As before, in the event that an expense must be claimed through MSH International, and the expense of paying upfront is excessively burdensome (<$300), medical advances are available.

Unfortunately, we have no real ability to influence or directly troubleshoot issues with Canada Life or MSH International, and any ongoing problems with registration need to be addressed with them directly. As always, feel free to reach out with any other questions or concerns to the team.

~ Your US OUTCAN Health Services Team