Report urges better oversight of Canada Life, compensation for clients

The federal committee investigating the changeover of the public service health-care plan to Canada Life wants the government to fully compensate public employees for "unjustified delays or denials of claims," and to improve oversight.

After Canada Life took over administration of the federal health-care plan on July 1, 2023, members began to speak out about their negative experiences.

It's the largest health insurance plan in the country, serving more than 1.7 million federal public servants, retirees and their dependents.

Beauport–Limoilou MP Julie Vignola of the Bloc Québécois brought forward the motion to study the changeover last September. The committee on government operations and estimates began its review in December.

Its recommendations, published Monday, focus on Canada Life's ability to execute the plan, and how the government was monitoring it.

The committee's recommendations indicated Canada Life needed to improve communication with plan members, make plans for members who do not have internet access, and be able to communicate in French as well as in English.

One problem the committee highlighted was that Canada Life said on its dashboard its claim processing time was between one and five days. The report notes it actually had a backlog of 3,867 claims more than 16 days old, and 226 more than 30 days old.

The report also says the government needs to begin monitoring Canada Life's performance immediately, with no grace period, and provide regular updates on whether the company is adhering to its standards.

'Fully compensate' clients, report recommends

It adds the government should "fully compensate" employees who suffered financially due to "Canada Life's unjustified delays or denials of claims."

The report made nine recommendations in total. It noted that representatives of employees and retirees, and particularly people with disabilities, should be involved in future re-tendering processes.

Pamela M. White, former director of health data analysis for Statistics Canada, told the committee that in her opinion, "the contract did not require [Canada Life] to fully deliver the [plan] to 100 per cent of the 1.7 million members and dependents on July 1, 2023," the date of the changeover.

"It appears that there was no expectation of full delivery of the service until Jan. 1, 2024, when [government] monitoring would commence," she said.

The other recommendations focused on specific problems that plan members were experiencing, like coverage for physiotherapy, the need for prior authorization for drug claims, and the government's lack of communication with plan members about changes to coverage.

PSAC national executive vice-president Alex Silas said the report supports what the union has been saying in its policy grievance about Canada Life, and the delay times federal workers have been facing in accessing their claims.

"I think the report is favourable, but now the real work is going to be Treasury Board needing to implement these changes, and finally fixing Canada Life, and putting an end to the numerous problems that workers in the federal public service," he said.

The Treasury Board of Canada, which oversees federal government operations, said in a statement it's going to go over the recommendations and respond to the committee "in due course."

It said there have been improvements with these benefits since changes were made in November.

'Fighting back continually'

Former Health Canada employee Dominique Hansen-Vigier said Tuesday that being repaid for the money she's lost would be great, but other things have been lost that aren't so easy to recover: time and trust.

Hansen-Vigier, who was forced to retire in 2018 for medical reasons, said her injections to help with fibromyalgia were fully covered under Sun Life. Since the switch, she has had numerous issues getting the injections, and other medical expenses, covered by Canada Life.

"I have to fight back continually to get the money back," she said. "It's exhausting, the amount of emails that go back and forth, and having to speak to supervisors."

That's all time she can't get back, Hansen-Vigier said.

"Every time, I'm holding my breath," she said. "I don't understand. Don't they have a legal obligation to abide by the information they give us?"

Nathan Prier, president of the Canadian Association of Professional Employees (CAPE) said the union is especially glad to see that the report recommends compensating employees for their losses and the stress they endured.

"We've seen once again that this race to the bottom, in finding the cheapest provider, ends up costing the public a lot more when we have to pay out damages because basic employer responsibilities can't be met," he said.

Prier said CAPE is happy to see the government will be asked to explain why they changed what's covered on the same day they changed the administrator.

"This double change is right in the middle of a lot of the problems that were reported," he said. "We just can't see these kind of employer abuses continue without consequences, and we're glad that the committee seems to support that."

Prier said CAPE will work with MPs and members to ensure it's involved in future changes and to hold the government accountable.

Read the full report