PSHCP - Frustration abounds as public service health plan gets switched to Canada Life

[Blackadder1916]

If it hadn't been for noticing this CBC article, I would probably have remained blissfully(?) ignorant until my prescription claims started to be declined.

https://www.cbc.ca/news/canada/ottawa/canada-life-overwhelmed-call-volume-public-servants-1.6900064

Frustration abounds as public service health plan gets switched to Canada Life​

Complaints include long wait times, concerns about coverage

Dorène Hartling estimates she's called Canada Life close to two dozen times over the last week, each time failing to speak to an agent no matter what time of the day she rings.

Almost immediately, she gets the same message.

"Our service representatives are temporarily unavailable due to higher than normal call volumes."

With a big sigh, Hartling has one word to describe how she feels: "frustration."

She's not alone. On July 1, the country's largest health-care plan switched providers to Canada Life Assurance Company, bringing more than 1.7 million federal public servants, retirees and their dependents with them.

Meanwhile, the dental plan for retirees will transition to Canada Life on July 1 next year.

For Hartling, her husband Stephen, and many others, the transition has been anything but smooth.

Stress, frustration
CBC received a number of complaints from current and retired public servants and veterans in the weeks before and after the Canada Day switch.

They ranged from long wait times — upwards of an hour in many cases — trying to get through to someone on the phone, only to get an automated message telling them that no one is available and that they can't leave a voicemail.

Others have expressed concerns about not hearing back from anyone over email and not having access to their digital drug and dental benefit cards.

Even as recently as Friday, CBC was hearing from members who were still having problems reaching anyone by phone.

It's all led to worries that members might have to pay out-of-pocket for pricey prescriptions.

"There's a lot of public servants that are retired that are living, you know, on the edge. And without their public service health-care coverage, it's a significant financial strain," said Hartling, who also has an $1,800-a-month medication, among others, she needs to fill soon.

She's been trying to reach Canada Life on the phone because she's unsure if her prescriptions will go through and be covered, given the big transition. Her pharmacist has told her it's been hit-and-miss, she said.

"That would basically leave us strapped on a monthly basis, especially if this doesn't get resolved," she said.

"We're not going to go broke in the first week, but if we start having to cash out RRSPs ... there's a financial burden to that too."

In a statement to CBC, Canada Life said it's adding a "significant number" of staff to help meet the higher demand. The company said it hopes to get to a point where calls are answered in under one minute.

"We expect to make significant progress toward this over the next few weeks," the statement said.

"We apologize for any inconvenience this has caused and appreciate members' patience during this transition period."

The company also acknowledged there was a temporary outage of their website on Tuesday, which was resolved the same day.

'Another Phoenix issue'

CBC also reached out to the Treasury Board of Canada Secretariat (TBS) and Treasury Board President Mona Fortier.

In a statement, TBS said the government has been in contact with Canada Life about wait times.

"Canada Life is taking immediate steps to address the high volume of calls being received, including increasing the number of call centre agents. Plan members can expect to see progressive improvements," TBS wrote.

"Plan members continue to be covered by their plans and claims are being processed."

The Public Service Alliance of Canada, which represents the majority of public servants, released a message to members Friday saying the employer has an obligation to ensure the transition is seamless and must resolve issues "as quickly as possible."

But Stephen Hartling has doubts.

"It's sort of looking like it might turn into another Phoenix issue," Hartling said, likening the switch to the problematic pay system the federal government introduced in 2016. "Just a large government project that went awry right off the bat."

I'll admit that I was somewhat remiss in not paying attention when the switch to Canada Life was announced, however I have an excuse - I prefer paper to digital. The insurance companies prefer digital communication even when you have indicated paper; so any announcements they've sent me, any of the regular newsletters, any links to switch to the new company all went (unaware to me) to an email address that I hadn't used for several years. The communications that matter (or, up till now, thought had been the only ones that mattered), namely the scarce claims that I've sent in (actually only one in the last two years, for specs, (all my rx are submitted direct by the pharm) go by post and the payment comes by cheque. I provide banking info to very few agencies.

Anyway, the above story came to my attention by chance. I only opened it because it said "PSHCP". And that started a scramble over the past two days to see what I needed to do and complete in order that my regular prescriptions can be claimed - I had planned to call in my normal 3 month refill today since I have about a week's worth to go.

And thus I encountered many of the same "frustrations" detailed in the CBC article, primarily getting contact with a live human at Canada Life. If you call in you get the expected recording, press through the options for language and the menu to speak to a representative only to receive a message that due to call volume there are no representatives available so call at a later time and that you can go to their website to do "positive enrolment". If you go to their website and try to do positive enrolment, you are informed that you have to have a "unique link" that was emailed to you to do so; to solve that problem of not receiving that "link" they suggest (on their website) to contact them to speak to a representative about PSHCP or go to their website to do positive enrolment (a never ending circle of frustration). There was also the option of completing the positive enrolment by paper and mailing it in.

Since I thought that I may have a chance to get connected if I called early enough (they say their lines are open 0800 to 1700 hrs in each time zone), I got up early this morning to correspond to Newfie time. Did not work. Even at zero dark newfie, the message was still that no one was available due to call volume. After a couple of hours of redialing at regular intervals, I tried a different track. Instead of selecting to speak to a rep, I used the option they have for medical/dental offices calling about/on behalf of a patient (press 3). At last, something other that "no rep available" - now I was in a queue with an expected wait time of 20 to 30 minutes. A human being finally came on line about 35 minutes later. Thankfully, she was very pleasant and helpful and didn't penalize me for not being "a medical office". I explained my dilemma, she took my info and confirmed that I was in the PSHCP system (which had been migrated from Sun Life) but I still had to do "positive enrolment". When I explained the difficulty with "unique link", it was then that I became aware that all previous correspondence had been sent to my former, now defunct email address. Even when she tried to do it from her end, she encountered the same problem. When I asked her about paper enrolment, she said the timeline from receipt of the paper form to enrolment would be between 8 to 12 weeks. To change the email address (and get a link resent) would require me to do "positive enrolment" before they could do that.

Fortunately, with a little finagling and sleight of hand I was able to recover and access my former email address. Along with a few years worth of useless, unimportant correspondence and other assorted junk was a link (that would have expired tomorrow). I was able to complete the enrolment on-line today. Though I will take responsibility for the small part my digital idiosyncrasies may have played, much more blame must be laid on the insurance companies (both Sun Life and Canada Life) as well as whatever arm of government is responsible for PSHCP. And now, forewarned, I await the same switch of the Pensioners' Dental Care Plan next year to Canada Life.

Anyone else encounter difficulties with this switch? This has only been enrolment, I wondering now how efficient they will be with claims processing.

 

[Weinie]

If it hadn't been for noticing this CBC article, I would probably have remained blissfully(?) ignorant until my prescription claims started to be declined.

https://www.cbc.ca/news/canada/ottawa/canada-life-overwhelmed-call-volume-public-servants-1.6900064

I'll admit that I was somewhat remiss in not paying attention when the switch to Canada Life was announced, however I have an excuse - I prefer paper to digital. The insurance companies prefer digital communication even when you have indicated paper; so any announcements they've sent me, any of the regular newsletters, any links to switch to the new company all went (unaware to me) to an email address that I hadn't used for several years. The communications that matter (or, up till now, thought had been the only ones that mattered), namely the scarce claims that I've sent in (actually only one in the last two years, for specs, (all my rx are submitted direct by the pharm) go by post and the payment comes by cheque. I provide banking info to very few agencies.

Anyway, the above story came to my attention by chance. I only opened it because it said "PSHCP". And that started a scramble over the past two days to see what I needed to do and complete in order that my regular prescriptions can be claimed - I had planned to call in my normal 3 month refill today since I have about a week's worth to go.

And thus I encountered many of the same "frustrations" detailed in the CBC article, primarily getting contact with a live human at Canada Life. If you call in you get the expected recording, press through the options for language and the menu to speak to a representative only to receive a message that due to call volume there are no representatives available so call at a later time and that you can go to their website to do "positive enrolment". If you go to their website and try to do positive enrolment, you are informed that you have to have a "unique link" that was emailed to you to do so; to solve that problem of not receiving that "link" they suggest (on their website) to contact them to speak to a representative about PSHCP or go to their website to do positive enrolment (a never ending circle of frustration). There was also the option of completing the positive enrolment by paper and mailing it in.

Since I thought that I may have a chance to get connected if I called early enough (they say their lines are open 0800 to 1700 hrs in each time zone), I got up early this morning to correspond to Newfie time. Did not work. Even at zero dark newfie, the message was still that no one was available due to call volume. After a couple of hours of redialing at regular intervals, I tried a different track. Instead of selecting to speak to a rep, I used the option they have for medical/dental offices calling about/on behalf of a patient (press 3). At last, something other that "no rep available" - now I was in a queue with an expected wait time of 20 to 30 minutes. A human being finally came on line about 35 minutes later. Thankfully, she was very pleasant and helpful and didn't penalize me for not being "a medical office". I explained my dilemma, she took my info and confirmed that I was in the PSHCP system (which had been migrated from Sun Life) but I still had to do "positive enrolment". When I explained the difficulty with "unique link", it was then that I became aware that all previous correspondence had been sent to my former, now defunct email address. Even when she tried to do it from her end, she encountered the same problem. When I asked her about paper enrolment, she said the timeline from receipt of the paper form to enrolment would be between 8 to 12 weeks. To change the email address (and get a link resent) would require me to do "positive enrolment" before they could do that.

Fortunately, with a little finagling and sleight of hand I was able to recover and access my former email address. Along with a few years worth of useless, unimportant correspondence and other assorted junk was a link (that would have expired tomorrow). I was able to complete the enrolment on-line today. Though I will take responsibility for the small part my digital idiosyncrasies may have played, much more blame must be laid on the insurance companies (both Sun Life and Canada Life) as well as whatever arm of government is responsible for PSHCP. And now, forewarned, I await the same switch of the Pensioners' Dental Care Plan next year to Canada Life.

Anyone else encounter difficulties with this switch? This has only been enrolment, I wondering now how efficient they will be with claims processing.

We went with the enhanced PSHCP package with Sun Life since we were being posted to Belgium. My wife has submitted claims, Canada Life says we are only covered for Canadian expenses. My wife lost her shit. We are still trying to unfuck this, as I have an invoice for surgery from about 45 days ago.
A pox on Canada Life.

 

[Remius]

I did the positive enrolment weeks ago with no issues. Got the card electronically. Was informed my pharmacy made the switch automatically. I haven’t tried making a claim yet but several of my colleagues are having issues with their profile not showing up or only seeing their dental portal.

 

[gryphonv]

Personally I had a horrible time getting it transferred. Had to jump through a lot of hoops with snail mail. If there was a problem with my application they would mail it back with little explanation, expecting me to fix it. No calls to inform me what was the issue.

A certain box not checked, or missed a signature. Etc.

But the fact they never once attempted to call me to clarify the issue and only rely on snail mail. So esentially 2+ weeks of delay each time mail is sent in one direction .

I say I spent roughly 12-20hrs(in total) of running around getting documents, trying to call them, getting mixed information when I did finally get ahold of someone (one told me my application was fine, only to get a letter 2 weeks later saying they needed something else) ETC.

The Ironic thing is VAC and the last insurance company had all the information required. A simple consent to release info should of sufficed for the transition.

I'm fairly savy, and managed to weed my way through this, but I wonder about our other members who are not so savy and are probably now sitting without coverage.

I haven't attempted to use the service yet, but I know the last provider it was very simple going online to submit claims and getting payment pretty much in a day or two back to my bank account (for things I had to prepay)

In the end from first receipt of the positive enrolment form. I spent roughly 2 months of back and forth to get it set up. Part of me wonders if this was part of the design to just get people to give up trying.

 

[Remius]

Personally I had a horrible time getting it transferred. Had to jump through a lot of hoops with snail mail. If there was a problem with my application they would mail it back with little explanation, expecting me to fix it. No calls to inform me what was the issue.

A certain box not checked, or missed a signature. Etc.

But the fact they never once attempted to call me to clarify the issue and only rely on snail mail. So esentially 2+ weeks of delay each time mail is sent in one direction .

I say I spent roughly 12-20hrs(in total) of running around getting documents, trying to call them, getting mixed information when I did finally get ahold of someone (one told me my application was fine, only to get a letter 2 weeks later saying they needed something else) ETC.

The Ironic thing is VAC and the last insurance company had all the information required. A simple consent to release info should of sufficed for the transition.

I'm fairly savy, and managed to weed my way through this, but I wonder about our other members who are not so savy and are probably now sitting without coverage.

I haven't attempted to use the service yet, but I know the last provider it was very simple going online to submit claims and getting payment pretty much in a day or two back to my bank account (for things I had to prepay)

In the end from first receipt of the positive enrolment form. I spent roughly 2 months of back and forth to get it set up. Part of me wonders if this was part of the design to just get people to give up trying.

My mother in law had similar issue using snail mail. Documents sent back with no real explanation.

 

[OldTanker]

I received a package in the mail several months ago that this change was coming. I registered online with no difficulty and received my new electronic card (and a printable hard copy) by email. I have submitted two claims so far but no results (although they warn it will take at least 10 business days to process - I expect it might take longer due to sorting out the process). I have no complaints about the actual process and for me I thought it was well handled. Lets see how long it takes to process my claims and what happens down the road.

 

[dimsum]

I did the positive enrolment weeks ago with no issues. Got the card electronically. Was informed my pharmacy made the switch automatically. I haven’t tried making a claim yet but several of my colleagues are having issues with their profile not showing up or only seeing their dental portal.

Some of it was dependent on what browser you used (phone vs laptop).

No idea why.

We went with the enhanced PSHCP package with Sun Life since we were being posted to Belgium. My wife has submitted claims, Canada Life says we are only covered for Canadian expenses. My wife lost her shit. We are still trying to unfuck this, as I have an invoice for surgery from about 45 days ago.
A pox on Canada Life.

I had heard anecdotally that it was because OUTCAN expenses are from another provider. In the US it's MSI (sp?).

But yeah, not a great transition.

 

[dapaterson]

If it was 45 days ago, then it has to be claimed through the prior provider, as I understand it - expenses before 01 July can't be claimed with Canada Life.

 

[PuckChaser]

Completed positive enrollment in April. Accounts still not linked despite being tech savvy and following their full process.

Phoenix 2.0 must be right, but at least since it's not just CAF members getting screwed someone will want to fix it quickly.

 

[Rifleman62]

Registered electronically when transition commenced. No problem. Took the printed info from Canada Life to the pharmacy a month ago. Claim for my wife last week when smoothly.

 

[Haggis]

Our union's social media is full of horror stories of the Canada Life switch. Personally, I have not had a problem, but I've only made one purchase since the switch.

 

[lenaitch]

I feel your pain. Our benefits package was administered by Great-West until they merged/were bought out by Canada Life. The claims process is the same and fairly responsive, but if you need to actually get a hold of someone or get somebody to make a decision such a treatment plan or pre-approval for something, good luck.

 

[Navy_Pete]

When I did positive enrollment, found out they had my wife's DOB as mine, and a number of other issues. Finally got it sorted but fortunately haven't had to make any claims, as we're still trying to figure out some older Sunlife ones that didn't get processed.

Have heard of people having issues with prescription and all sorts of other claims, but don't expect much more then some kind of vague apology for 'normal transition pains', which is crap when they don't do direct billing, and people are out of pocket.

 

[SeaKingTacco]

I can’t figure out how to view or print my card. I click on the icon and nothing seems to happen.

 

[lenaitch]

I can’t figure out how to view or print my card. I click on the icon and nothing seems to happen.

Maybe you aren't really here (it's an existentialism thing).

 

[Colin Parkinson]

I can’t figure out how to view or print my card. I click on the icon and nothing seems to happen.

Perhaps you are a robot......

 

[CountDC]

I did the positive enrolment online and it said my card would be available 2 days later. it also said that as if 1 Jul I would be able to see my information on the site. Still no card or info on the site. I was lucky that while at the pharmacy I was able to find the certificate number on their site and have my claim processed. Used the contact us link and still no reply. Now the real good news (yeah, sarcastic) the amount I had to pay went from about $6 to $20.

 

[MJP]

I did the positive enrolment online and it said my card would be available 2 days later. it also said that as if 1 Jul I would be able to see my information on the site. Still no card or info on the site. I was lucky that while at the pharmacy I was able to find the certificate number on their site and have my claim processed. Used the contact us link and still no reply. Now the real good news (yeah, sarcastic) the amount I had to pay went from about $6 to $20.

Is that the overage on the dispensing fee or the 80% of the generic cost only? There is no coverage difference between SL & CL, they are merely plan administrators. The new deal that the unions and TB reached really didn't do folks that have lots of ongoing prescriptions any favours with the cap on dispensing and the generic use clause which seems to be why the cost to the members is increasing which is not really a CL issue.

 

[Rifleman62]

National Association of Federal Retirees - 18 Jul 23 Update on the PSHCP transition to Canada Life Dear members, As we know, many pensioners have faced serious challenges with the transition of the Public Service Health Care Plan (PSHCP) to Canada Life. Federal Retirees shared its expectations for a seamless transition for pensioners from the outset. However, many Association members have come forward with questions, concerns and frustrations. The situation intensified when Canada Life became the PSHCP provider on July 1. Several problems have been identified. There have been communication challenges as some members were not notified by Canada Life about the transition. We have also seen processing delays for paper enrolment forms, website challenges, some partners/spouses were not included in the transition, and members have faced difficulties and unexpected payments at the pharmacy. Members have encountered significant wait times at the Canada Life call centre or have been completely unable to reach an agent to correct problems or answer questions. This is unacceptable. In the past week, the national office has received over 700 calls and emails about Canada Life. Several branches have also reported an extremely high volume of calls. We appreciate those who have taken the time to share their experiences and ask for patience as we respond. Though, I must be clear; the PSHCP contract is between Treasury Board and Canada Life. It is their responsibility to ensure appropriate resourcing for a change that has been planned for some time. The quality of service at this stage of the transition is shameful. The Association has escalated its concerns with Canada Life’s service to Treasury Board. We have met with staff at the office of the Treasury Board president, and I have called for a meeting of the PSHCP Partners Committee to address these issues. We have been told that the Treasury Board president has spoken with the president of Canada Life to share concerns and hear directly what the company is doing to improve service. We have also been advised improvements are forthcoming. Federal Retirees will continue to call for corrective measures until we see significant improvements and pensioners have the quality of service they deserve. Sincerely, Roy Goodall President

 

[Blackadder1916]

. . . Now the real good news (yeah, sarcastic) the amount I had to pay went from about $6 to $20.

My first claim went in, no problem with my pharmacy submitting it. But, like you, my out of pocket cost went up from approx $10 to $30.