Federal officials say they’ve been let down by their new health insurance plan

Since the transfer of public health insurance to Canada Life, some retired public servants are concerned about having to pay higher bills following changes in coverage for physical therapy and certain drugs.

Louise Sullivan puts a splint on her husband’s knee, then holds his arm as he tries to walk from the living room to the kitchen and back again. Michael Fairhead is visibly exhausted. Her too.

These Ottawa federal retirees, both in their 60s, led active lives and traveled the world before Michael Fairhead lost most of the right side of his body to a stroke eight years ago.

Mrs Sullivan believes that without years of intensive physical therapy, he would not have been able to retain even the little mobility he has left. However, the frequency of these sessions is now likely to be significantly reduced. Recently, the Government of Canada has made a number of changes to the country’s main health insurance plan, the Public Service Health Care Plan (PSHCP).

Without a physical therapist, his body will atrophyshe explains. What really worries me is that he will get to the point where he won’t be able to do anything on his own and I will have to do all the things he can do now.

Mrs Sullivan and M. Fairhead are among the 1.7 million federal government workers and retirees, along with their dependents, who have seen their insurance provider go away The life of the sun on Canada Life on 1^eh July last year. This has resulted in changes to what services and drugs are covered, how claims are approved, and how to contact an agent to discuss a problem or question.

Coverage changes are decided before switching to Canada Life

The Treasury Board Secretariat (TBS), which oversees the working relationship between the federal government and the public sector, explains that changes in PSHCPincluding claim limits, coverage conditions and eligibility, was approved in fall 2022, independent of the move to Canada Life.

These changes came into effect after Canada Life won a tender to administer this plan.

Anyway, CBC met with dozens of members who say they are disappointed and angry with both the government and the health insurance coverage provider.

There are people behind all these numbers and all the decisions that are made. Real people have had their lives affected in a very profound way and I personally find it appalling.

In the case of Mr. Fairhead, coverage for his physiotherapy was previously almost unlimited. Now it’s capped at $1,500 a year.

According to Ms. Sullivanthe physiotherapy expenses for Mr. Fairhead cost over $14,000 last year.

Therefore, physiotherapy sessions had to be reduced from three days a week to no more than once a week. Mrs Sullivan intending to assist his spouse in performing all his exercises. However, she knows that she will not be able to do it as well as a physiotherapist.

My biggest fear is that he will get to the point where he will be so sore and stiff that he won’t even want to get out of bed. It will destroy meshe says.

Confusion over drug coverage

In addition to health coverage limits, the new plan mandates the choice of generic drugs.

Beverly Cormier, 59, recently switched medications to reduce inflammation from his rheumatoid arthritis. With her husband’s plan, the first month was 80% covered The life of the sun. But when it came time to rebuild, the manufacturer, Pfizerinformed him that his request for reimbursement had been rejected by Canada Life.

It’s really hard to explain to people that one day you feel fine, the next day you can barely move and that this drug really made things better in a very short time.she explains.

His medication costs $1700 a month.

Ms. Cormier was only able to take it for a month before the terms of her health insurance changed.

Her husband, Standard Cormier, a veteran who worked for the military for 27 years, retired to find another job.

The impossibility of reaching a Canada Life agent after being turned down twice for his medication has compounded his irritation.

Canada Life has since reimbursed the drug after CBC contacted the office of the Chair of the Treasury Board Secretariat (TBS), Mona Fortier, to ask her about this issue. THAT TBS indicated to CBC that the use of this drug requires prior authorization to be reimbursed.

When it comes to your medication and you’re in pain, you just want someone to answer youcomments Beverly Cormier.

Because of the delay in getting her medication approved, Mrs. Cormier had to endure a lot of pain. For 10 days she was deprived of her medication, which increased the inflammation.

I feel like we fell through the cracks.

Susan judges, 52, is also eligible for this plan because her husband is a veteran. She had to pay hundreds of dollars out of pocket for medication before issues with her health insurance coverage were resolved earlier this month.

At the time of the regime change, Ms. judges called Canada Life four to five times a day. However, it took him several weeks before the insurance company got back to him.

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To this day, she still has to wait weeks for a refund of the $300 she demanded because of ongoing problems enrolling her and her husband in the insurance plan. Sometimes he has to make this choice: buy food or his medicine?

I have reached the maximum amount on my credit cards to pay for the small amount of medication I currently haveshe says.

More statements

These numerous cases of concern and frustration, the president of the National Association of Federal Retirees, Roy Goodallis a witness.

This situation is terrible. I wouldn’t want to be in the shoes of the people going through thishe comments.

He says his association plans to raise the issue of capping physiotherapy coverage with the government when they review coverage in two years.

According to him, there is an increasing number of statements from people who are upset about not being able to get in touch with an agent and having to do much of the process of registering or requesting a refund online when they are not very familiar with digital technology.

I understand that many people are stressed, angry and frustrated that they cannot reach anyonehe continues.

Canada Life asks for your patience

Canada Life is advocating patience as it tries to manage wait times to speak with an agent.

She explains that the high volume of calls is related to the fact that many people need help signing up for the plan. However, she adds that she is working with the government to help members get their benefits faster and has increased call center capacity to reduce waiting times.

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The company encourages service recipients to contact pharmacies with their new benefit card information to reduce the number of denied claims.

Several beneficiaries, according to TBS

THAT TBS, for its part, says that thanks to these changes, more people have access to federal insurance.

In the meantime, he says he will continue to put pressure on Canada Life to find solutions that meet the requirements.

The Treasury Board Secretariat points out that prescription drugs are still reimbursed at 80%, but that a new cap of $8 on dispensing fees and the requirement to choose generics allows benefits to be extended to other areas, including mental health, mobility equipment and laser eye surgery.

The same logic applies to the portion of the plan devoted to physical therapy: by imposing an annual cap of $1,500, TBS says it was able to remove a hurdle that previously made some lower fee claims ineligible.

THAT TBS says he also tried to reach plan members in a variety of ways before the transition, including through the retiree’s annual statement and social media.

Mrs Sullivan understands that this change could give more people access to the plan, but she feels that older people with chronic conditions are being left behind.

For most people this is not a problem, but our population is aging. Older people often have problems: they break things more often, and ten sessions will not help them recovershe claims.

CBC contacted conservative and New Democrat health critics.

New Democrat Member of Parliament for hamilton-Center, Matthew Greenthere is deputy labor critic, called the decision aalarming and D’unacceptable.

According to information from CBC News