Committee asks government to compensate staff for Canada Life delays, claims denials

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The Standing Committee on Government Operations and Estimates (OGGO) tabled its report on the changeover of the Public Service Health Care Plan (PSHCP) from Sun Life Financial to the Canada Life Assurance Company on Monday.

The report, submitted by the committee chair and member of Parliament for Edmonton West, Kelly McCauley, outlined nine recommendations to the federal government, including compensating employees who have suffered financial loss and better communicating coverage changes to members.

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“Since the changeover from one administrator to the other, several issues have been reported by members and their dependants, such as the inability to get through to an agent when calling Canada Life and delays and denials in claims processing and payments,” the report read.

The administration of the plan for more than 1.7 million public servants, retirees and dependents transferred to Canada Life from Sun Life last July 1 following a “start-up period” of about 18 months and a multi-year tendering process.

The Government of Canada had previously announced several changes to the plan, also effective July 1, with officials reinforcing that “everything that was covered before” remained covered.

However, since the changes took effect, many plan members, both in Canada and abroad, have expressed concerns about challenges in accessing services, reaching customer support and getting claims reimbursed.

In February, the Public Service Alliance of Canada (PSAC) filed a grievance against the federal government for its conduct in transferring the administration of the health-benefits plan, with other groups, such as the Canadian Association of Professional Employees and Employees with Disabilities of the Public Service of Canada, also expressing concerns around issues like processing delays, administrative burdens to members and changes to coverage of physiotherapy.

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The government has said it’s committed to dealing with ongoing problems faced by members.

The committee’s study on the changeover began on Dec. 7 after member of Parliament for Beauport-Limoilou Julie Vignola brought forward a motion for a study in September, with a motion adopted in October. The group agreed to analyze the health plan’s transition, examining the quality of coverage, effectiveness, mechanisms used in awarding the contract and the measures that would be taken to correct the situation.

Two meetings were held as part of the study, with the committee receiving testimony from Canada Life, Public Services and Procurement Canada (PSPC), the Treasury Board of Canada Secretariat (TBS) and PSAC. The committee also received emails from plan members and written briefs.

This newspaper has reached out to TBS, PSPC and Canada Life for comment.

The committee’s recommendations include that the government involve employee representatives and retirees in the re-tendering process, with efforts made to involve people with disabilities and their caregivers; that it work with the administrator to improve communication with members on changes to coverage, considering people’s access to technology and that it begin monitoring the plan’s performance on the first day it comes into effect, with transition periods to include “monitoring milestones.” It said grace periods should not be provided to contractors with “no or few consequences for severe underperformance.”

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The committee also recommended the government provide its rationale behind transitioning to the plan and updating benefits on the same day; that it make the contract’s service standards available to employees, providing regular updates to stakeholders; that it review caps on coverage for physiotherapy services to bring it in line with previous coverage; that it develop separate processes for monitoring the timeliness and accuracy of “prior authorization decision-making and appeals” and claims that aren’t pre-authorized and that it ensure the company can provide services in English and French.

It also recommended that the government ensure employees who have suffered financial loss “as a result of Canada Life’s unjustified delays or denials of claims” are fully compensated.

A supplementary report was submitted by the Conservative party, which recommended the government consider age and medical discrimination when making decisions, that it have standards for contractors and subcontractors and that Canada Life cover “any losses attributed to the lack of timely benefits as they were responsible for the influx of new plan members.”

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The Bloc Québécois also submitted a supplementary report, arguing that the federal government “continues to demonstrate its inability to properly manage issues within its jurisdiction,” noting that there have been “management problems” with several other issues, like the Phoenix pay system. The party recommended the government “look for ways to pay its employees, to provide them with the health care they are entitled to and to properly manage its own files” rather than “encroach on the provinces.”

“Current federal management is a last-minute effort, done in response to newspaper articles,” the Bloc’s report stated. “There is a glaring lack of monitoring and supervision, as well as overall planning, which is necessary for the long-term management of a government.”

The OGGO committee requested that the government table “a comprehensive response” to its report.

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