The transition of the federal government’s Public Service Health Care Plan from Sun Life Financial to Canada Life Assurance Company has been nothing short of chaotic, according to public servants who say they’re struggling to access coverage, make claims and connect with customer-service agents.
Tanya King, an Ottawa-based drag queen and trans woman who has been working for the federal government for three and a half years, says she has been trying to contact Canada Life for three weeks about how to access coverage for gender-affirming care that’s now included in the plan.
Public servants covered by the Public Service Health Care Plan (PSHCP) are entitled to a new benefit of $75,000, reimbursed at 80 per cent, for certain gender-affirming procedures not covered by provincial/territorial health plans and performed in Canada. In order to be considered for coverage, a member has to complete an application form with a physician or nurse practitioner.
Until last week, King said she was unable to receive the document from Canada Life or find it on the company website despite multiple attempts to reach customer support. While the document is now available online, King says she still needs to reach an agent to discuss her coverage and complete all necessary forms, but the company’s phone lines are clogged due to high call volume.
“I’m at risk right now losing coverages for my compound hormone medication,” King said, noting she expected to have to pay out of pocket for her prescription refills when her medication ran out in early August. She said she also needed the document signed in order to start the process of finding a surgeon to perform facial feminization surgery and vocal feminization surgery needed for her transition.
“There’s a significant risk if I stop because I have an ongoing history of debilitating depression and suicidal ideation. The last time I stopped hormone medication, that’s what happened. So there’s there’s a lot at stake.”
The PSHCP is an optional health care plan providing coverage to 1.7 million federal public service employees, federal retirees and eligible dependants.
On July 1, the administration of the plan moved to Canada Life, with 87.9 per cent of plan members — 95.8 per cent of employees and 78.3 per cent of retired plan members — having completed their enrolment as of July 12, the Treasury Board of Canada Secretariat says.
There has been no change to administration of dental plans.
Robin Stagg, a public servant who works for the Department of National Defence in Toronto, says he has been unable to access his medical benefits since making the switch to Canada Life.
Though Stagg completed his enrolment in mid-April and received confirmation from a representative that it had been successful, come July 1, he could not see his benefits after logging into the insurance company’s website.
While an agent assured him during a phone call that a simple email issue was the problem, Stagg still faced the same challenge more than 10 days later. Now Stagg says he can’t even reach an agent due to the high volume of calls.
“I feel very discouraged and right now, am even somewhat anxious about my medical coverage,” Stagg said in an interview last week, noting he had also tried to send Canada Life a message through its app, but had yet to hear back. “At this point, I have tried everything possible to make contact with Canada Life to find a solution except to research their location, go there in person and ask to speak to someone.”
Stagg says he’s already expecting to have to pay out of pocket for upcoming prescriptions. He added he was anxious that, if an emergency were to happen, at this point he would have to pay for medical care out of pocket as well with no way of knowing how long reimbursement would take.
“Thankfully, I am not traveling until October, but, if not sorted by then, I will need to buy a separate medical travel insurance as there is no way that I can risk being out of Canada without coverage,” Stagg said. “My stress level is increasing with this especially because of the frustration of not having anyone to speak with and not due to any lack of effort on my end.”
A spokesperson for Canada Life said the company had experienced “higher than normal” call volumes and longer wait times within its call centre, apologizing for the inconvenience this had caused. The spokesperson noted that Canada Life had processed more than 500,000 claims for PSHCP members since the beginning of July.
“We have a plan in place to address this and we expect to see notable improvements in the coming weeks,” the spokesperson said, adding the company was planning to open increase contact centre opening hours and to add trained and security-cleared staff to the centre to support the PSHCP.
“As we do that, we’re also adjusting some of our internal processes to reduce the duration of calls and reinforcing self-serve options where possible and appropriate for members and healthcare providers so they can get the help they need without waiting on the phone,” the spokesperson said. “We’re continuing to work with pharmacies over the coming days and weeks to ensure this is are addressed and are already starting to see a decrease in rejections.”
Grant Wilkinson, a federal retiree who worked for the government for more than 33 years, said in an interview last Friday that he was out $1,600 as he waited to be refunded for a claim he made while the PSHCP was still administered by Sun Life.
On June 22, Wilkinson said he received a covered service costing about $1,600 every eight weeks. The next day, he filed a claim with Sun Life, as he had done for months.
“Usually within a day or two, I would get something from Sun Life saying, ‘Your claim has been processed,’” Wilkinson said, adding that, when he didn’t get a response from the company within a week, he phoned Sun Life and was reassured his claim was received and would be processed before the end of June. “Then this morning, I got the email that I’m used to getting from Sun Life saying the claim has been processed. I went on and it had been processed all right, but they had refunded nothing of my $1,600.”
Wilkinson was made aware that the claim had been turned over to Canada Life for review and processing. However, when he contacted the new administrator, he was told they could not pay for the claim.
“I seem to be caught in the middle here. I’ve got two insurance companies saying, ‘Not our problem,’” Wilkinson said. “How long do I wait before I have to accept the fact that they’re not going to process it?”
Barb Couperus, a spokesperson for the Treasury Board of Canada Secretariat, said the Government of Canada was pressing the issue of wait times with Canada Life through meetings and daily calls to senior executives.
“The wait times that public servants are experiencing are unacceptable,” Couperus said. “Canada Life is taking immediate steps to address the high volume of calls being received, including increasing the number of trained and security-cleared call centre agents. Plan members can expect to see progressive improvements throughout July and beyond.”
Couperus said the government was aware that public servants had been facing issues submitting claims through Canada Life’s online system, noting the insurance company was working to address the issue.
“PSCHP members’ coverage remains in place — members who have not completed positive enrolment can be reimbursed for health expenses after their enrolment is completed and confirmed by Canada Life,” Couperus said, adding that the government “appreciates patience” during this time. “Claims are being processed as per the plan.”
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