e-4785 (Health)

The Public Service Health Care Plan (PSHCP) is the largest employer sponsored plan in Canada, covering 1.7 million employees, retirees, veterans and eligible dependants. On July 1, 2023, Canada Life began administering the PSHCP and, while there were some issues at the onset, many solutions have been implemented which have led to significant improvements and a more positive member experience.

The Government of Canada is aware of the challenges experienced by some PSHCP members related to the services provided by Canada Life and MSH International. MSH is the sub-contractor to Canada Life that provides emergency travel and comprehensive coverage services to members of the PSHCP who are posted abroad or travelling. The Government continues to monitor the situation very closely and works with Canada Life to address issues and implement solutions quickly.

Service Standards, Wait Times and Claims Issues

In response to the transition issues, Canada Life implemented its customer service action plan in November 2023, which resulted in the hiring of additional staff, leading to significant improvements to call centre wait times as well as the claim reimbursement turnaround time for services provided within Canada. In fact, since the winter 2024, call wait times for services within Canada have been, on average, less than 20 seconds. Most claims submitted digitally by members or their service providers are processed within one business day, while claims submitted by paper are normally processed in approximately 6 business days. Furthermore, Canada Life introduced an urgent needs escalation process for priority cases in fall 2023 to expedite claims for urgent, life-sustaining products or services and to support claims from plan members dealing with financial hardship or a disability. Since July 2023, Canada Life has informed us they have responded to over one million calls and inquiries and have reimbursed more than 26 million PSHCP benefit claims. 

With respect to the demographics of the PSHCP, there are approximately 1.7 million plan members (769,470 members and 929,357 dependants) with supplementary coverage. In addition, there are 21,645 members who specifically have comprehensive coverage (13,505 members and 8,140 dependants), which represents plan members posted outside of Canada and retirees living outside of Canada. All members with supplementary coverage also have access to MSH’s emergency travel assistance, when travelling out-of-province or out-of-country, when required (i.e. for personal reasons).

MSH has experienced challenges in the delivery of the comprehensive and emergency travel assistance services.  In response, Canada Life worked with MSH International to introduce a similar action plan, investing in additional staff to answer calls and process claims. As of June 2024, Canada Life informed the government that average MSH call centre wait times were usually under 2 minutes. Canada Life and MSH have also prioritized escalations and the adjudication of high-cost claims. Members can now consult an online dashboard to view current contact centre and claim processing wait times, and an updated MSH Portal provides an enhanced member experience by including a simplified registration page, a detailed claims information page, and the ability to view explanation of benefits information without having to call the MSH contact centre. The Portal also now allows members to submit claims digitally enabling faster turnaround times.

With respect to claims data, ten years of claims history, including annual and lifetime maximums for members and their covered dependants, was securely transferred from Sun Life to Canada Life. Should there be exceptional circumstances in which benefit balances and claims history were not transferred, members can contact the Canada Life contact centre for assistance.

Should a member disagree with a decision rendered by Canada Life, as was the case with Sun Life as the previous PSHCP administrator, an appeals process is available to all plan members. Plan members can escalate a claim with Canada Life twice before a final level of appeal with the PSHCP Administration Authority, a not-for-profit corporation responsible for overseeing Canada Life’s administration.

Rest assured, the Treasury Board of Canada Secretariat and Public Services and Procurement Canada executives continue to meet with Canada Life leadership daily to ensure that issues are addressed quickly and to collaborate with Canada Life on implementing solutions.

Changes to PSHCP Coverage

Separate from the transition to Canada Life, on July 1, 2023, several changes to benefits under the PSHCP came into effect. These changes were negotiated collaboratively and in good faith between bargaining agents, retiree representatives, and the Employer at the PSHCP Partners Committee. Concurrently with other changes, over 50 significant benefit enhancements were introduced, spanning various areas of improvement, including vision care, mental health, massage therapy, and new benefits for dietitian services, occupational therapy, and lactation consultants.

Part of the objective for the recent changes to the PSHCP was to ensure the longevity and sustainability of the PSHCP. To modernize, at no incremental cost to taxpayers, and better align the PSHCP with best practices in the employer-sponsored health care plan industry, changes to the PSHCP included the introduction of market-tested measures. These strategies encourage plan members or their eligible dependants to have a discussion with their medical professionals about treatment options and are aimed at reducing the rate of growth of PSHCP costs and will also ensure value for services obtained by members. The intention of the changes is to promote less invasive and less expensive, but equally effective, treatments where medically appropriate.

PSHCP members with questions about coverage are encouraged to contact Canada Life for information about supplementary coverage and contact MSH for information about comprehensive coverage. Conversely, members can visit the fully mobile accessible Canada Life website.