June 24, 2024

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Public servants, dependants abroad waiting on health insurance claims

6 min read

The administration of the Public Service Health Care Plan for more than 1.7 million public servants, retirees and dependants transferred to Canada Life from Sun Life Financial Inc. last July 1.

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Some public servants and their dependants living and travelling abroad are out thousands of dollars as problems with their health insurance provider persist.

Karen Patrick, a Canadian Armed Forces military spouse living in Turkey, says she is waiting for reimbursement of nearly $7,000 worth of medical claims dating back to September 2023.

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“Those of us living outside of Canada, working for the government, we’re scared of getting sick,” Patrick said.

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For months, Patrick was locked out of the system’s online portal. When she could access the site to make claims online, she could only upload three items at a time, so she opted to make her claims by registered mail instead. Patrick said she had also been largely unsuccessful in reaching customer support.

“I’ve tried calling them. I’ve been on hold for I don’t know how long,” Patrick said, noting she had received some emails from MSH International saying the company was working on her files. “We’re paying for a service that we’re getting no return from.”

A subcontractor to Canada Life, MSH International began administering coverage to public servants and their dependants travelling and living abroad on July 1.

The administration of the Public Service Health Care Plan for more than 1.7 million public servants, retirees and dependants transferred to Canada Life from Sun Life Financial Inc. following a multi-year tendering process.

In February, the Public Service Alliance of Canada filed a grievance against the federal government for its conduct in transferring the administration of the health-benefits plan. The government has said it’s committed to dealing with ongoing issues faced by members.

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Patrick and her husband have lived in Turkey for more than three years and say they never had issues when the plan was under Sun Life/Allianz Global Assistance.

Due to a lack of trust in the system, Patrick has put on hold some foot surgeries valued at $13,000 U.S.

She added that, while the military had offered to advance funds, that was “a double-edged sword” as members would be on the hook with the government if claims were denied.

“People are incurring huge financial debt over this. Our kids are back in Canada and they’re under this plan,” Patrick said, adding that she received daily messages from people about their issues with MSH.

Kened Sadiku, a spokesperson for National Defence, confirmed that advances are being offered to CAF members and their dependants working abroad, “no advances were recovered until members were appropriately reimbursed by MSH.”

“CAF members were only redirected to Canada Life for advances once Canada Life was equipped with its own system to address these issues,” Sadiku said, adding that members facing challenges should speak to their Chain of Command.

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In an update to PSHCP members earlier in March, MSH said “the member experience has not met the expected level of service for which we strive.”

The company said it was “working hard” to reduce contact-centre wait times, to ensure urgent cases were escalated appropriately and to improve claims processing times, noting that, at the time of the transition, there had been a significant number of claims needing attention, with the backlog becoming even worse due to a cyber incident earlier this year.

In an email earlier in March, MSH spokesperson Pamela Kwiatkowski said calls were being answered in less than 20 minutes on average, with urgent or emergency calls being answered in under five minutes on average. She said wait times continued to drop as more agents were being hired and trained.

Adhering to the PSHCP Plan Directive, Kwiatkowski said members were not just receiving “at least the same level of benefits” as in the past, but there had been “enhanced” with an increase in benefits.

Amanda Kennard
Retired public servant Amanda Kennard is waiting for more than $10,000 U.S. in health insurance claims to be reimbursed. Photo by Handout /ott

Amanda Kennard, a retired public servant living in South Carolina, said she had about $10,000 U.S. in outstanding claims. Facing difficulties reaching customer support, Kennard said she had spent several hours on hold, once waiting on the line for seven hours.

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“I pressed the call back option and they would phone back at like two in the morning, three in the morning,” said Kennard, who worked for the public safety department for 18 years. “If they did call back during the day, I would answer and they would just hang up.”

Between July and November, Kennard said she was only able to get through to an agent a few times. In November, she received a reimbursement of just over $5,800 for claims she had made. While she has since received some small, sporadic payments, she says they have amounted to much less than what she is owed.

“I had to go through so much stress, so much hell,” Kennard said, adding she pays $200 a month for the health insurance plan. “Now I’m back in the same position.”

Kennard said her claims were related to “regular care” like physiotherapy, medications and hospital visits.

“The U.S., as you know, is very expensive,” Kennard said, noting she was asked to make claims via email in July as the online portal was not working, with a company representative later telling her that most of those claims were not received. “It’s not hard to build up $10,000 worth of claims. That can be one visit to the hospital.”

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Kennard said she had noticed that some medications were no longer covered under the new plan.

“If something in the States is a prescription, but not in Canada, they don’t cover it,” she said, adding that, fortunately, her husband had another health insurance plan to access medications. “That’s really weird. I can’t really force pharmacists to give it to me.”

Going forward, Kennard said she was concerned about making claims and piling up charges on her credit card.

“I just don’t know what to do. I feel like I’ve tried everything,” said Kennard, who has reached out to higher-ups at MSH, Canada Life and the federal government. “I feel somebody’s working out of the garage running this company.”

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