PSHCP - Frustration abounds as public service health plan gets switched to Canada Life

[CountDC]

Is that the overage on the dispensing fee or the 80% of the generic cost only? There is no coverage difference between SL & CL, they are merely plan administrators. The new deal that the unions and TB reached really didn't do folks that have lots of ongoing prescriptions any favours with the cap on dispensing and the generic use clause which seems to be why the cost to the members is increasing which is not really a CL issue.

Don't know what it is other than it has gone up significantly.

 

[dapaterson]

I have filed one claim online, just over a week ago. Process seemed to go smoothly.

Just logged in to check on the status of the single, solitary claim I have filed, and see that there are two identical claims now listed as pending.

 

[SeaKingTacco]

I have filed one claim online, just over a week ago. Process seemed to go smoothly.

Just logged in to check on the status of the single, solitary claim I have filed, and see that there are two identical claims now listed as pending.

Score?

 

[Chargersfan]

Canada life is total garbage. Prepare to be disappointed.

 

[Happy Guy]

I have had issues with Canada Life since the transition, from positive enrolling to submitting claims. Fortunately for me since I was medically released, the medication that I need to help me with the health problems that are responsible for my retirement/release, are paid for by VAC. I am still having problems connecting with Canada Life to sort out my other claims.

Very frustrating.

 

[dimsum]

Canada life is total garbage. Prepare to be disappointed.

The crazy part is Canada Life is the easier of the two companies to deal with if you are OUTCAN. MSH International (the company who manages the OUTCAN healthcare) is far, far, far, far, far worse.

Everything is based on reimbursement, which is fun in the US when procedures are not cheap.

 

[lenaitch]

I don't know if this is the right place, but it seems the problems with Canada Life has drawn some attention. Not that it will likely make you feel any better, but our benefits used to be covered by Great-West Life and life was good. They 'merged' with Canada Life and London Life under the Canada Life banner and life is not so good anymore.

It may end up being little more than a wagging finger and stern look that qualifies as government action.

https://www.cbc.ca/news/canada/ottawa/canada-life-benefits-public-service-change-problems-1.7184925

 

[dimsum]

I don't know if this is the right place, but it seems the problems with Canada Life has drawn some attention. Not that it will likely make you feel any better, but our benefits used to be covered by Great-West Life and life was good. They 'merged' with Canada Life and London Life under the Canada Life banner and life is not so good anymore.

It may end up being little more than a wagging finger and stern look that qualifies as government action.

https://www.cbc.ca/news/canada/ottawa/canada-life-benefits-public-service-change-problems-1.7184925

…and the only reason why this is even a thing is because GAC and other civilians are having these issues too. If it was just CAF members posted overseas, there would be crickets.

 

[SeaKingTacco]

I feel bad for the OUTCAN folks who are having issues, but I have to say that, as a datapoint of one, I my turn around times have been quicker with Canada Life. Mind you, my claims are pretty vanilla…

 

[lenaitch]

I feel bad for the OUTCAN folks who are having issues, but I have to say that, as a datapoint of one, I my turn around times have been quicker with Canada Life. Mind you, my claims are pretty vanilla…

So are mine, and I find claims are pretty timely, but predetermination assessments are delayed. Previously under GWL, they would be assessed in a day or two. I'm in the middle of getting a crown put in and it took CL three weeks to assess the intended claim, and that's twice it has happened.

To your point, a datapoint of one to be sure, but it is a lively topic of discussion within our Association.

 

[dimsum]

I feel bad for the OUTCAN folks who are having issues, but I have to say that, as a datapoint of one, I may turn around times have been quicker with Canada Life. Mind you, my claims are pretty vanilla…

The OUTCAN folks have to deal with MSH, which is the issue. Canada Life has been fine for my spouse.

I know of someone who had to pay upfront (still waiting on reimbursement) in the US for the birth of their child. It’s been a few months.

Let’s just say the price they had to pay was absolutely shocking and I have no idea how people without huge amounts of insurance can afford literally having a baby there. Hell, I’m not sure how they’re financially afloat even with the allowances, after that invoice.

 

[Weinie]

The OUTCAN folks have to deal with MSH, which is the issue. Canada Life has been fine for my spouse.

I know of someone who had to pay upfront (still waiting on reimbursement) in the US for the birth of their child. It’s been a few months.

Let’s just say the price they had to pay was absolutely shocking and I have no idea how people without huge amounts of insurance can afford literally having a baby there. Hell, I’m not sure how they’re financially afloat even with the allowances, after that invoice.

We have resubmitted invoices, some of which are more than one year old. We are coming close to $10K in renumerations. Every time my spouse goes on their website, it shows one claim, which they f$%^ed up. The call center is impossible to reach. Extremely frustrating.

 

[captloadie]

I thought here might be as good a place as any to pose this question.

I was reading on REDDIT that members have been successfully listing their CAF Service Spouses as dependents on each others plans in order to receive benefits for items they are having done outside the CAF medical and dental systems. It was even possible to coordinate the coverage with Blue Cross, for items like glasses. Some individuals were adamant that this did not contravene any of the restrictions, as the policy states that CAF members cannot access "their own" plans for treatment, but is mute about accessing the plan as a dependent. Some even stated that they were told about this from medical/dental staff. It was would seem that those accessing this process are doing so for things like massage treatments, mental health, additional dental hygienist appts, more expensive glasses or prescription sunglasses etc. All things that might be in the grey area of whether they need to be included on ones med docs.

My initial instinct was to say nope, nadda, this is fraud. But as I looked into it a little more, other than going outside the CAF medical system for treatments (which I acknowledge is an issue in and of itself), is there anything unethical about this? And should it be something we are talking with the troops about more.

 

[dapaterson]

A CAF service spouse is a CAF member. Assuming they are not a class A reservist, they are not entitled to PSHCP or PSDCP coverage.

 

[MJP]

I thought here might be as good a place as any to pose this question.

I was reading on REDDIT that members have been successfully listing their CAF Service Spouses as dependents on each others plans in order to receive benefits for items they are having done outside the CAF medical and dental systems. It was even possible to coordinate the coverage with Blue Cross, for items like glasses. Some individuals were adamant that this did not contravene any of the restrictions, as the policy states that CAF members cannot access "their own" plans for treatment, but is mute about accessing the plan as a dependent. Some even stated that they were told about this from medical/dental staff. It was would seem that those accessing this process are doing so for things like massage treatments, mental health, additional dental hygienist appts, more expensive glasses or prescription sunglasses etc. All things that might be in the grey area of whether they need to be included on ones med docs.

My initial instinct was to say nope, nadda, this is fraud. But as I looked into it a little more, other than going outside the CAF medical system for treatments (which I acknowledge is an issue in and of itself), is there anything unethical about this? And should it be something we are talking with the troops about more.

I don't know, call me crazy but I don't really trust the rantings of one angry dude who is adamant it is totally legit.

 

[captloadie]

I don't know, call me crazy but I don't really trust the rantings of one angry dude who is adamant it is totally legit.

I get that. But even crazy angry folks can have legitimate points at times.

 

[captloadie]

A CAF service spouse is a CAF member. Assuming they are not a class A reservist, they are not entitled to PSHCP or PSDCP coverage.

But does the policy say that CAF members are not entitled to be dependents to a plan? That was the argument being made, and I honestly don't know. If one member is on LWOP for either an outcan posting, or mata/pata, don't they access the care then?

 

[dapaterson]

The PSHCP directive, para 1.2.2

 

[SupersonicMax]

The PSHCP directive, para 1.2.2

Well, it isn’t that cut and dry as they are also dependant of their spouse, who are eligible per 1.4.1. I interpret 1.2.2 as you can’t participate under your own plan.

"1.4.1 A member's dependant is eligible to participate in the Plan provided the dependant is legally married to the member or satisfies the eligibility criteria stipulated in the definition of "dependant child" or “common-law partner”."

 

[Navy_Pete]

Is anyone else having trouble with the dental coverage being rolled in? Mine is still only showing the drug and health benefits for dependents (and weirdly my birthday in the profile is actually my wife's).

GOing to submit a claim anyway, but jumped through their hoops already to add it on and still nothing almost a year later.