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 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 and the number of callers unable to reach an agent (0 for the period of November 11 to 16)

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 benefits) that coincided with the launch of the Canada Life contract