On June 3, the Standing Committee on Government Operations and Estimates (OGGO) released their much-anticipated report on the transition of the Public Service Health Care plan (PSHCP) from Sun Life to Canada Life. The report comes nearly a year after the changeover, which saw the largest health insurance plan in the country serving more than 1.7 million federal public servants, retirees, and their dependents, failed to adhere to the service standards that public servants expect and are owed.

The report (opens in new tab) outlined nine recommendations that, if implemented, will improve on the delivery of the plan, with the main takeaways being:

• Compensation for financial loss: The report emphasizes the importance of ensuring that employees who have suffered financial losses due to Canada Life’s unjustified delays or denials of claims are fully compensated for these losses.
• The need for transparency and accountability: It is recommended that the government make available to employees the service standards outlined in its contract with Canada Life and provide regular updates on Canada Life’s adherence to these standards and any penalties levied against Canada Life for failing to meet them.
• Review of coverage caps: The government is urged to revisit the existing caps on coverage for physiotherapy services. This includes aligning them with previous coverage and distinguishing between short- and long-term needs.

How we’re taking action

At ACFO-ACAF, we will continue to hold Treasury Board (TBS) accountable through multiple avenues, including:

• The policy grievance that we submitted on March 18, 2023, regarding the Employer’s failure to implement seamless and uninterrupted benefits under the Public Service Health Care Plan (PSHCP) Directive following its transition from Sunlife to Canada Life and its adverse effects on members;
• Our participation in the PSHCP Partners Committee (opens in new tab) and PSHCP technical sub-committee where implementation issues are raised and recommendations are made by bargaining agents, including, putting pressure on TBS to divulge how and when they will implement the committee’s recommendations.

Individual recourse and damages

Issues with coverage or claims denied by Canada Life 

The quickest way to resolve any issues related to the denial of a claim or coverage under the Plan, or if you received a lesser reimbursement than expected, is to submit an appeal with the PSHCP Administrative Authority. PSHCP appeals are heard on a quarterly basis by the Administration Authority. The process can be found here (opens in a new tab).

Filing an individual grievance

Filing an individual grievance may be appropriate in limited situations where severe hardship was experienced as a result of issues from the health care plan changeover, including but not limited to:  

• Canada Life failing to process a claim or provide reimbursement within a reasonable time and you incurred interest on a credit card as a result; 
• you were unable to reach Canada Life in a timely manner to obtain assistance, and as a result, treatment was delayed and caused negative health implications; 
• you were unable to submit a claim because of Canada Life’s conduct in some way and this caused negative financial or health implications; 
• you experienced other issues that are directly attributable to Canada Life which caused negative financial or health implications; and
• you had to delay care for a condition related to your age, disability, or other protected human rights ground under the Canada Human Rights Act.

If you would like to file a grievance to seek individual damages for the hardship you have experienced or are experiencing, please contact labourrelations@acfo-acaf.com with the details of your case to determine if this is the appropriate course of action.