Frustration mounts among public servants over unpaid benefits claims

Two months after the federal government switched insurance providers, many public servants say they are seeing an increase in out of pocket expenses instead of better benefits coverage.

“Since Canada Life has had that contract there have been nothing but problems, including onboarding people,” Chris Aylward, president of the Public Service Alliance of Canada, said.

On July 1, an estimated 1.5 million federal employees covered under the Public Service Health Care Plan (PSHCP) moved from Sun Life Financial to Canada Life Assurance Company. The move, negotiated and announced last year, promised members better benefits and greater coverage for mental health services.

But dozens of members tell CTV National News since the switch, their claims are going unprocessed and their calls are going unanswered due to what has been described as overwhelmed call centres.

Public servant Michelle Favreau told CTV National News the problems are a source of anxiety.

“Every time I submit a claim I’m not sure it will go through or who to contact,” Favreau said.

Favreau says she has called Canada Life dozens of times but has had trouble getting anyone on the phone.

“We are paying for a service and we are not getting the service,” Favreau said.

As of Aug. 30, Canada Life says virtually all plan members have now enrolled and more than 3 million claims have been processed and paid. However, the insurance provider acknowledges it continues to experience “exceptionally high call volumes.”

“We appreciate the patience of public service plan members who are reaching out to us,” Canada Life spokesperson Kim Foregtta wrote in an email to CTV National News. “Our dedicated team is answering 25,000 contacts a week and with the actions we’ve taken to address call volumes, we expect to see a return to normal in the coming weeks.”

On its website, Canada Life says it has increased staff at the PSHCP Members Contact Centre, temporarily extended operating hours and accelerated the enrollment process to make it easier to access benefits coverage and to get claims approved. The website says the call centre is open Monday to Friday from 8 a.m. to 5 p.m. local time.

Despite some improvements, the union estimates there are likely thousands, if not tens of thousands of members experiencing problems with enrollment and claim reimbursement.

“It’s very frustrating,” Aylward said. “They didn’t do it right and now members are suffering because of that.”

Anne Cavan is one of those members. She recently paid thousands of dollars for cataract surgery and has yet to be reimbursed. Cavan admits the surgery itself happened before the government switched providers but she says she was assured the surgery would still be covered.

“Canada Life still hasn’t come through,” she said. “You try and contact Canada Life and they are just inundated with claims. You call their help line and you get voicemail and it hangs up on you.”

The dozens of current and retired public servants who spoke to CTV National News say they are extremely frustrated over the switch. Many said they are skipping essential therapy appointments, searching for cheaper drugs that aren’t as good for their medical conditions or are borrowing money from family to pay for their medication.

One long-time public servant, who did not want to be named for fear of reprisal from her department, told CTV National News she is spending about $600 a month—or roughly half her monthly EI payments—on therapy to help manage what she called work related burnout. Sun Life, she said, covered the appointments, but Canada Life argues her Quebec therapist does not qualify under the negotiated mental health benefits.

“It’s like russian roulette, you file a claim and have no idea if it will be reimbursed,” the woman told CTV News. “It’s taken me years to find someone that I have a good dynamic with and I don’t want to start from scratch.”

Aylward says he does not believe Canada Life or the Treasury Board Secretariat are taking the problems seriously enough.

“Yes, it’s a very large plan but it’s not like this snuck up,” said Aylward. “Canada Life had lots of time to prepare.”

A Facebook page setup for affected public servants has more than 5,800 members.