Bulletins & FAQs

• TriWest Eligibility and Care Denial Issues
  We want to make all personnel aware that we are currently tracking several issues where TriWest has incorrectly indicated that members and families are ineligible or have been denied care, despite eligibility. 
  
  To ensure these issues are managed promptly and accurately, please follow the steps below if you encounter any such problems:

  • Contact your local Beneficiary Counselling and Assistance Coordinator (BCAC) first. They are best equipped to assist with these matters at the local level. 
  • Notify our team as soon as the issues arises. We are actively tracking the number and nature of TriWest issues to address them effectively. 
    • Point of Contact: SO Health Admin - Capt Rook / Email: teigen.rook@forces.gc.ca
  • If the issue persists after contacting your local BCAC, escalate to our team directly. We will provide further assistance and support. 
  • Please do NOT contact TRICARE or TriWest directly. The representatives you speak with do not have access to specific information or solutions related to foreign military. 

  We appreciate your cooperation in following these steps to ensure that all members and their families receive the care they are entitled to. Your timely reporting allows us to track and resolve issues more effectively.
  
  - Your US OUTCAN HS Team
• TRIWEST Update - 12 June 2025

  Bulletin No. 2502
  Attn: US OUTCAN CAF Members Supported by TRIWEST
  
  Ongoing issues related to the change in service provider for the TRICARE West Region continue to be worked on by DHA, TRICARE, and TRIWEST. While we still do not have a timeline for when some of these issues can be solved, TRICARE continues to try and develop solutions to ease the burden on beneficiaries. We understand that many are still frustrated and having issues with care denials, usually at the point of service. There are some updates on the tricare.mil/west site that we want to highlight to hopefully reduce this.

  • For CAF Members who are seen as TRICARE Prime beneficiaries, DHA has issued a referral approval waiver in the West Region (attached here). It is currently approved through 30 June 2025, but I do expect it to be extended. Bring a copy of this with you to your specialty care appointments. Please refer to the website above, as updates on the waiver’s expiration will be posted there.

  • For CAF Members who have a referral to a specialist that is valid into 2025, please review the expiration date. You can continue to see that provider until the referral expires or until 30 Sep 2025, whichever comes first. 

  • The West Region Provider Directory is now available. For your families who are seen as TRICARE Select beneficiaries, please double-check that any upcoming referrals or booked appointments are with in-network providers on the directory. If not, there will be additional out-of-pocket costs associated with those visits. As always, those costs can be claimed to MSH International, including your TRIWEST Explanation of Benefits.

   
  Lastly, TRICARE has updated their co-payment and cost-share 2025 Costs and Fees. Please ensure you and your families are aware of these fees. For any military members that end up with a co-pay or cost-share, this would predominantly apply to CAF Members that are SSEP or LWOP and have applied dependant benefits through TRICARE; they can claim any of those associated fees through the HS Team. For your families, those payments can be claimed through MSH International.
   
  If you have any questions about this, please reach out to us at cdlsw-medicaladmin-elfcw-adminmedical@forces.gc.ca. We are tracking updates and will try to keep all informed to the best of our ability.
  
  Your US OUTCAN HS Team
  www.cfmws.ca/us-healthcare

• PSHCP Administrator Dispute Escalation

  CAF Members posted OUTCAN USA continue to experience issues encountered with PSHCP; specifically from the administrators of Canada Life and MSH International, resulting in customer service deficiencies, delayed or denied claims and other systemic issues. Escalation via PSHCP Administration Authority remains an option, though the CAF has continued to find avenues to escalate your issues and have them addressed in a timely manner. We continue to advocate specifically for DND, our members and their families.
   

  If you have been experiencing issues that have not been resolved by interacting directly with MSH International or Canada Life, there is now a process to identify this issue directly to the DND Plan Manager. Examples of reasons to escalate include but are not limited to;

  • Claims denied in contravention of the PSHCP Directive;
  • Claims processing times in excess of 90 days without explanation;
  • Improper reimbursement;
  • Personal or Banking Information errors not resolvable by MSH/ Canada Life Customer Service;
  • Entitlement or coverage errors not amendable by CAF HR; or
  • Portal access issues not resolvable by MSH International/ Canada Life Customer Service.

  
  To begin the process, please DOWNLOAD, complete, and submit the PSHCP Administrator Dispute Escalation form. Note that the submit button on the form will function correctly only after it has been downloaded. Some issues may fall within CAF Pay and Admin or Health Services Support to resolve. If you are unsure whether this may be the case, please reach out to us. This process will result in your file being reviewed from all perspectives; we recommend that claim numbers, dates, all correspondence, as well as phone calls, be reported and identified. This will be the highest level of review we have been able to source and therefore ask that you are as detailed and specific as possible to better enable the Plan Manager to resolve your problems as quickly and efficiently as possible.

  
  - Your US OUTCAN HS Team

• Should I claim via MSH or Tricare?

  Bulletin No. 2201
  
  CAF members are not participants in the Public Service Health Care Plan (PSHCP), so should never claim any medical expenses through MSH International. CAF members, for the most part, are covered by TRICARE.
  
  CAF dependants, however, are PSHCP participants, so they may need to claim medical expenses through MSH International. Remember, in Canada, family members have access to supplemental coverage (it supplements provincial plans) from the PSHCP which is now administered by Canada Life. In the US, dependants are switched to comprehensive coverage (must be done when a member arrives at post) and MSH International administers it.
  
  Rules of Thumb:

  • CAF members must use military MTFs (covered by TRICARE) unless pre-authorized by CAFMLO or 1-800-TRICARE (1-800-874-2273) to use external services or obtain care on the economy (some CAF members do not have access to MTFs).
  • Dependants: Strongly advised to use military MTFs if you have access – TRICARE is the Primary Insurer if TRICARE approves the medical expense, with residual amounts (co-pays/cost-shares) being claimed afterward through MSH International. Dependants who do not have access to MTFs or TRICARE will typically use the PSHCP as their primary insurance (unless they have access to other health insurance). 

  - Your US OUTCAN HS Team

• Plan Number for MSH International Registration
  For folks having difficulty registering with MSH International, a few OUTCAN families have provided guidance based on their experiences surrounding problems with the Plan Number. 
  
  Spousal and dependant Plan Numbers are based on the member's date of birth.

  Member's Birth Month	Plan Number
  January, February, March	52111
  April, May, June	52112
  July, August, September	52113
  October, November, December	52114

  
  
  
  
  
  
  
  Canada Life Member Certificate Number
  As a spouse or dependant, your Canada Life Health Plan Certificate Number may only show one of the 5-digit numbers listed above whereas the CAF Member's Plan Certificate Number will be up to 10 digits long, starting with an alphabetical letter - e.g., E000796638.
  
  Plan Number for MSH International Registration
  To successfully register with MSH International, you have to add a zero (0) in front of the spousal or dependant plan number and remove the alphabetical letter, replacing it with a zero (0), from the member's number. Please see the example below -

  • Spousal or Dependant Plan Number: 52111
  • Member's Plan Number: E000796638
  • Plan Number for MSH International: 052111-0000796638
• Steps for Submitting a Claim to Canada Life / MSH International
  
  
   
• Vacation Coverage Outside of the US
  Firstly, all routine medical care should be completed prior to travel – any medical care sought on vacation should generally be urgent/emergency care for acute illness/injury.
  
  CAF members have access to Emergency Medical Care Coverage while traveling via Blue Cross (Tricare will not cover medical care received outside CONUS/Alaska/Hawaii/Thule) – instructions can be found at the Medavie Blue Cross site: https://www.medaviebc.ca/en/members/welcome as well as on the back of your Blue Cross card. In Canada or US, attempts should be made to utilize military MTFs (if appropriate to the situation).
  
  Families of CAF members posted to the US must be enrolled in Comprehensive coverage with the Public Service Health Care Plan (PSHCP) as administered by MSH International – this is their coverage no matter where they are in the world (even when they return to Canada for leisure travel!!). If Emergency Travel Assistance is required, call 1-833-774-2700 (in North America) or call collect 1-365-337-7427 in all other countries. 
  
  Rules of Thumb:

  1. Families newly posted to the US may want to verify positive enrolment with Comprehensive coverage by contacting Canada Life. If you are not positively enrolled with Comprehensive coverage within 10 weeks of arriving in the US, contact your OR to determine if you need to resubmit the required documentation. Regardless of the status of your positive enrolment, you are AUTOMATICALLY covered the month you departed from Canada, but submitting claims may be more difficult without confirming enrolment.
  2. A consultation with your primary care provider/travel medicine clinic is routinely recommended in advance of international travel.

  
  - Your US OUTCAN HS Team (Bulletin #2202 - Updated Jan'24)
• Medical Coverage for Adult Dependants
  Kids off to school? Some things you need to consider with respect to coverage. 

  • Tricare Eligibility: For those with access to Tricare coverage, children only have “dependent status” (thus eligibility for Tricare) until age 21; the day they turn 21, they are ineligible for Tricare unless attending an approved institution of higher learning (i.e., college, university, etc.) – in this case, they are eligible until age 23. Please see more information/conditions here. 
  • PSHCP Eligibility: PSHCP is similar, with eligibility until the day a child turns 21. However, PSHCP eligibility is extended for those attending an accredited secondary institution and who are under the age of 25. Eligibility criteria are found here.

  
  Many have children who head back to Canada for school – coverage is as above.
  
  Dependents headed back to Canada to attend school are covered by the PSHCP.  However, they lose access to Comprehensive coverage after 3 months of being in Canada to attend school. Therefore, children headed back to Canada need to enroll in a Provincial insurance plan and then positively enrolled in PSHCP Supplementary coverage. From the PSHCP Directive: "Any dependant who resides in Canada other than on a temporary basis (i.e., for more than three months) is ineligible for Comprehensive Coverage and must entrol in a provincial/territorial health insurance plan. However, the dependant will have Supplementary Coverage if eligible and if the member is paying family contributions for Comprehensive Coverage." 
  
  If your child is attending a university anywhere other than in Canada, and you are still in the USA with access to Comprehensive coverage, then that child has Comprehensive coverage under the PSHCP as well (but may lose Tricare coverage if not in the USA).  See “Families with both Supplementary and Comprehensive Coverage” on the PSHCP Directive site for other iterations of this policy: here. 
  
  While we are not insurance experts, we do our best to assist understanding policies in place during your posting to the USA. If there are any questions regarding coverage, please contact your local BCAC (Tricare questions) or Allianz (PSHCP questions) directly. 
  
  - Your US OUTCAN HS Team (Bulletin #2302)
• Navigating Dental & Vision

  Dental - All dental care for spouses and children must be arranged with a local dental provider. The coverage your family has will be the same as in Canada with Canada Life (formerly known as Great West Life). Make sure to check with the dental provider to see if they will direct bill for you! Check out the FAQ below for more details.

  • Dental Care FAQ
  • Dental Plan Booklet

  ---

  Vision - For family members, optical services in the US can be costly. Your insurance coverage remains the same as in Canada; however, while OUTCAN it's billed through MSH International. Since the cost of vision care in the US is generally higher, the out-of-pocket expenses will be higher for the family. It is recommended that if glasses or contacts are required for the family, consideration should be given to obtaining them prior to departing Canada.
  
  Public Service Health Care Plan 

• Immunization Requirements for Children

  Immunization records must be obtained from your family doctor in Canada for any dependent child who will accompany you and will be attending a US school. Ensure the record shows the day, month, and year the immunization was given. You are also encouraged to contact your applicable school district in the US during your HHT to determine what immunizations are required. 

  CAF members, spouses and children are also able to get vaccinations at any US Base Hospital that offers them. There is no cost for these as they are done through TRICARE. If there is not a US Military Hospital installation in your area, then any doctor or pharmacy can be used, but you will be using Allianz for your insurance provider. Allianz will cover 80% of the cost of immunizations and the additional 20% can be submitted to CDLS(W) for reimbursement.  

  Immunizations are done differently in the US.

  Here are some of the State Vaccination Requirements.

  • State and local vaccination requirements for daycare and school entry are important tools for maintaining high vaccination coverage rates, and in turn, lower rates of vaccine-preventable diseases (VPDs).
  • These laws often apply not only to children attending public schools but also to those attending private schools and day care facilities. States may also require immunization of healthcare workers and of patients and residents of healthcare facilities.
  • All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons. State laws also establish mechanisms for enforcement of school vaccination requirements and exemptions.
  • Find Vaccination Requirements for your state and school district

  When travelling on an HHT, it is recommended that you bring your children’s immunization records with you. They are required for new school registration.

  Your child may be required to have specific immunizations to attend school or daycare at your new US location that is not on the provincial timeline of the Canadian province that you reside in. If that is the case, you may not be able to receive an immunization at a public/community health unit.  Unfortunately, they are required to follow the provincial immunization timeline and not make any changes or exceptions. There are 2 options to get your child the immunizations required for your new post:

  1. Make an appointment with your child’s family doctor and ask if they can order in the required immunization and arrange to administration. If this is possible, the immunization will be billed as a prescription through your healthcare insurance and the administration may be scheduled at their office or through a pharmacy. 
  2. Wait until you arrive at your new US location and get the immunizations there.  It is recommended that CAF families utilize their local base hospitals/MTFs for immunizations. There are no fees and record keeping will be stored in one place.  

  
  Check out our Immunizations FAQ for more information! 
• Having a Baby in the US

  Having a baby in the US may be a complicated process. Your child(ren) born in the US will automatically have dual citizenship. But it will require some extra paperwork.

  So where do you start to get your child(ren) Canadian Citizenship? They are already Canadian! You only have to get proof of that, which is called a Canadian Citizenship Certificate.

  • Having a Baby in the US FAQ
  • Car Seat Regulations FAQ (US & Canada)
  • Application for a Citizenship Certificate for Adults and Minors (Proof of Citizenship)
• Returning to Canada
  Heading back to Canada this APS? Some things to remember with respect to medical records. 
  
  Medical Records

  • CAF Members: Please visit your MTF and request a copy of your entire US medical record (you will most likely have to place a separate request for your Behavioural Health file) representing your entire posting to the USA; these can either be sent to MS Pela (natalia.pela@forces.gc.ca) for entry into CFHIS or hand delivered to the medical records section at your next unit. 
  • Dependants: Should request their medical records as above and retain them for delivery to the nex care-providers in Canada. 

  Dental Records

  • OUTCAN Pers: The HS team has no ability to enter dental records into CFHIS (Dental Officers use a different electronic record to maintain your dental files). Dental records should be requested from your US dental providers for delivery to your Canadian dental providers upon return to Canada. 

  
  IMPORTANT** The HS team regularly receives requests from personnel who have returned to Canada who neglected to do this and it is impacting future care/Release/VAC plans. It can be administratively challenging to recover this information once you have returned to Canada, so it is highly recommended that you add this to your list of departure administration. 
  
  - Your US OUTCAN HS Team (Bulletin #2303)