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1. Home
2. Politics
WHO HOLDS THE BLAME FOR PROBLEMS WITH THE PUBLIC SERVICE HEALTH CARE PLAN?
On July 1, Canada Life took over administration of the Public Service Health
Care Plan, which serves 1.7 million federal workers, retirees and their
dependents. Previously approved changes to the benefits plan also came into
effect that same date.
Photo: (CBC)
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RCI
Posted: October 30, 2023 7:39 PM
Unions say provider change, benefit plan are all prerogative of employer
The unions representing public servants say the federal government should have
done more to ensure a smoother transition when the country's largest health care
plan switched to Canada Life last summer.
Around 1.7 million federal workers, retirees and their dependents saw their
insurance provider switch (new window) from Sun Life on July 1.
With it came changes to what services and drugs are covered, how they're
approved and what happens when they need to talk to an agent.
CBC has heard hundreds of stories (new window) from people now having
problems with long wait times, failing to get through to an agent or being
denied a claim without explanation.
* BEGGING FOR BENEFITSHealth-care plan switch to Canada Life leaves people
frustrated, stressed (new window)
The Public Service Alliance of Canada (PSAC) compares the switch to the adoption
of the Phoenix pay system (new window), which left workers underpaid, overpaid
or not paid at all.
They can't pay their employees properly and now they've completely buggered up
their benefits. That's just totally unacceptable, said Chris Aylward, PSAC's
national president.
We were expecting delays with the simple transition from one provider to another
because of the size of the plan. We certainly were not anticipating the number
of problems or the scope of the problems.
PSAC National President Chris Aylward during a press conference in Ottawa, May
3, 2023
Photo: Radio-Canada
The Professional Institute of the Public Service of Canada (PIPSC) said
responsibility ultimately rests with the federal government, which procured the
contract and is solely responsible for the benefit plan.
Unions do not have the ability to grieve issues with benefits.
We don't have any levers or mechanisms to make Canada Life meet its obligations.
The employer holds the contract with Canada Life. They have the service
standards and it's for them to make sure they are delivering on the contract,
said Jennifer Carr, national president of PIPSC.
* BEGGING FOR BENEFITSTheir daughter nearly drowned. Now they're going into
debt paying for her care (new window)
PSAC and PIPSC, along with smaller federal worker unions, sit on a committee
that negotiates changes to the benefit plan with representatives of the Treasury
Board of Canada Secretariat (TBS).
That process is separate from collective bargaining and doesn't involve a vote
by union members.
BENEFIT PLAN CHANGES
The Treasury Board, which oversees labour relations between the federal
government and the public sector, said changes made to the plan, including claim
limits and coverage terms and eligibility, were approved in the fall of 2022.
The changes were independent of the switch to Canada Life, which won a tender to
administer the plan, and took over as the plan's administrator the same day the
changes came into effect.
Changes to the Public Service Health Care Plan involve several coverage
increases (new window), though it does introduce new limits related to drug
coverage — including a cap on dispensing fees and a requirement for a
pre-authorization for high cost medications — and physiotherapy (new window).
* Gender-affirming care boosted in new federal worker health plan (new window)
* New health plan for federal workers has some members feeling like they 'fell
through the cracks' (new window)
Other than those changes, many plan members said they were told their coverage
would remain the same and the transition would be seamless.
24/7 CALL CENTRE AMONG UNION SUGGESTIONS
Union leaders say the biggest problem is still the lack of staff and long delays
to get through to an agent at Canada Life, along with claims being denied.
Another public sector union, the Canadian Association of Professional Employees,
said it would have liked to see a trial period or running of parallel systems
before Canada Life was given the sole responsibility to administer the plan.
PSAC said it recommended a 24/7 call centre well before the July 1 switchover, a
request that still hasn't been answered. However, Canada Life did announce it
would be expanding its call centre and hiring more agents after months of
complaints from plan members.
* BEGGING FOR BENEFITSWoman's health 'sliding backwards' after drug coverage
pulled (new window)
* BEGGING FOR BENEFITSShe ended up in hospital after her life-sustaining
formula coverage was slashed (new window)
For its part, PIPSC said it's concerned delays that were evident in the early
positive enrolment period weren't adequately addressed.
Carr said unions should have been brought into the process earlier.
There's lots of lessons that could have been learned [from Phoenix]. If unions
are at the table and we have a say, it's a lot easier, she said.
She added that the government should not use average call centre wait times as
the main measure of the quality of Canada Life's service. Instead, she said they
should also measure the number of claims that have been denied and the time it
takes to pay out claims.
'UNACCEPTABLE' DELAYS
Treasury Board President Anita Anand, who replaced Ottawa-Vanier MP Mona
Fortier in the role in late July, said she is speaking directly with Canada Life
leadership about the unacceptable delays.
Anand, who was minister of public services and procurement in the Phoenix
aftermath, said the government has learned lessons from Phoenix.
The Government of Canada … was very much on top of the contractual obligations
that Canada Life has with the Government of Canada, as well as the way in which
some of the unpredictable difficulties were going to be addressed as soon as
possible, she said in a press conference last week.
Treasury Board President Anita Anand says she is pressing Canada Life's
leadership on the long wait times plan members are experiencing for both
reaching a call centre agent and being reimbursed for claims.
Photo: (Adrian Wyld/The Canadian Press)
In a statement to CBC, the Treasury Board said they are having daily discussions
with Canada Life to better understand members' situations and provide additional
guidance where required.
It also said anyone who has had a claim denied can appeal it to the PSHCP
Administration Authority (new window).
The more than half-a-billion dollar contract was awarded to Canada Life after an
open, fair, and transparent competitive procurement process, Public Services and
Procurement Canada (PSPC) wrote in an email.
It said the contract allows for a six-month adaptation period, along with an
opportunity to make required changes and the company's service-levels are being
monitored.
Both the Government of Canada and Canada Life are focused on resolving ongoing
challenges experienced by some members, PSPC wrote.
SMALLER CHANGE THAN PHOENIX
While the problems with the switchover to Canada Life have been likened to
Phoenix, University of Ottawa professor Stephane Tywoniak, an expert in
government procurement, said the scope of the change is much smaller.
Here we only have a change of provider for essentially the same service, he
said. I believe changing health service coverage is a routine operation in many
businesses.
Though he provided the caveat that his expertise isn't in insurance
administration, he noted Phoenix included the centralization of staff,
recalculation of compensation and an entirely new information technology
product.
A Canada Life office in Toronto.
Photo: Radio-Canada / Don Pittis
In a statement, a Canada Life spokesperson said the company recognizes some
people are experiencing difficulty accessing their benefits, leading to high
call volumes and wait times.
The spokesperson said the company is aware that in some cases, exceptional
coverage over and above the plan design was granted to individuals.
For that reason, the company said it has established a special team of claims
examiners to review declined claims and ensure those who were granted exceptions
previously continue to receive coverage for the medications and treatments they
need.
Canada Life said it is implementing a customer service action plan and is
prioritizing claims to ensure those experience financial hardship and urgent
needs are processed first.
Matthew Kupfer (new window) · CBC News
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