Question Period Note: Public Service Health Care Plan

Beginning on July 1, 2023, when Canada transitioned the administration of claims processing from Sun Life to Canada Life, some Public Service Health Care Plan members have experienced difficulties obtaining assistance via the call centre.

• Canada Life has been working collaboratively with Canada and has committed to implementing measures to improve member services
• Senior officials continue to meet on a regular basis with Canada Life to discuss and monitor ongoing call-centre support issues

If pressed on impact of it job cuts at Canada Life:

• PSPC will work with TBS to ensure that the recent announcement by Canada Life related to its IT support does not impact service to our health plan members
• We encourage Canada Life to provide comprehensive support and resources to ensure that affected workers are taken care of during their transition

If pressed on improvements to the service levels:

• To improve services, Canada Life has increased staff at its call centre, as well as extended its daily call centre hours, including opening on weekends
• Canada Life has increased communication with individual pharmacies and their head offices
• Canada Life implemented temporary changes to the positive enrolment process, allowing for easier claim reimbursement for a cohort of members who failed to complete their enrollment
• Canada Life continues to update online communications to help answer frequently asked questions
• Canada Life has implemented an escalation process to assist members with urgent claims inquiries
• The measures implemented to date have lead to significant improvements in call centre service levels including a consistent decrease in average wait time which are now meeting or exceeding the service standard of 70% of calls answered in 20 seconds or less

If pressed on services for members abroad:

• Canada Life is continuing its efforts to improve service delivery to out of country members either through the PSHCP Emergency Travel Assistance Services or Comprehensive Coverage
• These services continue to fall below service standards and officials are working diligently with Canada Life to find solutions 
• Canada Life has developed an Action Plan to improve services;  the proposed measures should help Canada Life address the current backlog sooner than anticipated

If pressed on the MSH data breach:

• Following a ransomware breach, MSH claims processing operations resumed on February 26, 2024, when the situation was under control
• Both Canada and Canada Life were assured that the servers were cleansed
• MSH is currently doing further data analysis to determine what or if any personal information was jeopardized. Once data analysis is completed, members will be advised of the outcome

If pressed on the Canada Life attack:

• Any members affected by this incident will be notified and provided the information needed so that appropriate mitigation measures can be taken
• On April 18, 2024, Canada Life implemented mandatory 2-Factor Authentication to their platform, with an opt-out option

If pressed on financial consequences:

• As part of its regular contract management responsibilities, PSPC is taking steps under the terms of the contract to address service delivery issues faced by Canada Life in order to ensure that Public Service Health Care Plan members receive the services that they deserve
• We are unable to disclose any financial information at this time

The source of member frustration can largely be attributed to an apparent deficiency in responding to larger than expected call volumes, which continues to be much higher than historical norms and modeling projections.

The higher call volumes have been the result of a combination of plan changes, user error (positive enrollment not completed properly or completely), and errors with pharmacies (some did not use proper codes, even if individuals completed their positive enrollment).

• The contract was awarded to Canada Life on November 30, 2021, for the provision of claims processing services in support of the Public Service Health Care Plan
• The estimated value of the contract is $514.45 million
• The contract was comprised of a 20-month start-up phase (implementation period), an operations phase of 8 years, plus four 1-year option periods
• The operations phase began on July 1, 2023
• The Public Service Health Care Plan covers more than 1.7 million Canadians (federal public servants, federal public servant pensioners, and their eligible dependents), with total annual expenditures of approximately $1.46 billion
• The Public Service Health Care Plan provides reimbursement for a range of health-related goods and services that are not provided through private insurance plans, provincial or territorial insured health, social or other publicly funded programs
• The Treasury Board of Canada Secretariat implemented a series of plan design changes (e.g., mandatory generic drugs, changes to physiotherapy) that coincided with the launch of the Canada Life contract operations
• The PSHCP also provides coverage to out of country members either through the PSHCP Emergency Travel Assistance Services or Comprehensive Coverage. These services are provided by Canada Life through their subcontractor, MSH International (Canada) Ltd. (MSH)
• On February 9, 2024, a ransomware breach was discovered by MSH. MSH immediately paused their claims processing operations. Operations resumed February 26, 2024
• Between March 17 and March 19, 2024, a privacy breach, known as a password-spraying attack was detected by Canada Life on their platform. On April 11, 2024, Canada Life confirmed there were 50 member accounts compromised
• On April 7, 2024, the London Free Press reported that Canada Life will be outsourcing its technology department to HCLTech. The move will see 200 jobs cut across the country including 35 in London, Ontario
• On April 25, 2024, Radio-Canada reported that Canada had imposed financial “sanctions” on Canada Life. The CBC reported on April 26, 2024, that PSPC, “is taking steps to address startup delays faced by Canada Life and has begun to apply financial consequence mechanisms under the contract