Changes in new health plan for federal workers pose problems

Beneficiaries left frustrated as new health plan brings changes to physiotherapy and drug coverage

Changes in new health plan for federal workers pose problems

Following the series of changes that the government made to the Public Service Health Care Plan (PSHCP), dozens of beneficiaries expressed their frustrations about both the government and Canada Life Assurance Company (Canada Life), CBC News said in a report.

1.7 million federal workers, retires, and dependents of the PSHCP had their insurance provider switched from Sun Life to Canada Life last July 1. This brought changes regarding services and drug coverage applicable to them.

Louise Sullivan, a retired federal public servant, counted on the coverage for the intensive physiotherapy her husband, Michael Fairhead, needed after losing function in most of the right side of his body following a stroke 8 years ago.

Before, the plan covered 80% of the claim up to $500 and over $1,000. In the previous year, Fairhead’s physiotherapy was over $14,000. With the changes in the health plan, she had to cut down on her husband’s physiotherapy from thrice a week to only one day as the coverage was capped at $1,500 annually. 

On the other hand, Beverley Cormier, a dependent of her husband’s plan, had to switch to a new medication for the flare-ups caused by her rheumatoid arthritis. This was because the new health plan opted for beneficiaries to choose generic drugs. Before, Sun Life covered 80% for her medicine by Pfizer but as of late, she found out that it was declined by Canada Life.

Cormier and her husband, Norm Cormier, a veteran who served the military for 27 years, were also frustrated about being unable to contact an agent at Canada Life after they were denied twice for the medication.

Susan Judges, another dependent, had a similar problem as she had trouble contacting the company regarding the problems with her plan. It took weeks before she got a response, causing her to pay hundreds of dollars out of her own pocket for medication. While eventually getting a reimbursement of $300, she still had to make the decision of either paying for food or her medicine.

Canada Life said that the higher call volume was caused by those who needed help in enrolling in the plan but assured that they were working with the government to help members access their benefits with ease and reduce call wait times. They also urged members to contact pharmacies with their Canada Life benefit card information in order to lower the number of rejected claims.

The Treasury Board Secretariat (TBS) said that some of the changes in the plan such as the $8 cap on pharmacy dispensing fees, the switch to generic drugs, and the $1,500 annual cap to the physiotherapy portion of the plan were to expand benefits in areas such as mental health, mobility devices, and laser eye surgery.

Sullivan felt that the changes may make things applicable to others but will leave seniors with chronic conditions behind.

"There are faces behind all of these numbers and decisions that they make, and that real people are having their life affected to a very deep degree and I personally think it's appalling," she said.