Thank you very much.
Good morning everyone.
My name is Seth Sazant. I'm a pension and benefits officer and negotiator with the Public Service Alliance of Canada. I'm appearing on behalf of our national president, Chris Aylward. With me is my colleague, Sasha Hart, who is the PSAC general counsel.
Thank you, Mr. Chair, for the opportunity to speak on this very important matter.
Of our 225,000 members, the majority work for the federal government, where the benefits are provided through the public service health care plan. In addition, hundreds of thousands of retirees who are former PSAC members are members of the same plan. While we negotiated the terms of the plan itself, it's the employer's obligation to administer and to provide those benefits. On July 1, 2023, Canada Life took over the administration of the plan. Since that time, to say that things have been a total mess is an understatement.
The ability of our members to contact Canada Life for routine issues, questions and reimbursement for regular services has appeared to improve. However, many problems remain. We believe that there need to be discussions on ways to make things right for what has gone on and to fix the existing problems. Phoenix was bad enough. Our members have dealt with not getting paid properly or on time for years. Now accessing their benefits has become incredibly difficult. The employer has repeatedly fallen down on providing the basics of compensation for our members.
I would ask the committee members to consider some of the following situations. Each one is a real life situation of a PSAC member or retiree who has contacted us asking for help.
One member who suffers from a neurological disease was unable to complete positive enrolment and couldn't get in touch with Canada Life to fix the issue. As a result, they discontinued their pharmacotherapy, suffered from multiple seizures and were hospitalized. A cancer patient who requires biological therapy medication that costs $5,000 a month had their claim seamlessly covered with Sun Life, but then it was denied by Canada Life. They ran out of medication because they couldn't reach anyone at Canada Life and they couldn't afford the out-of-pocket costs. Another member's spouse requires medication that cost $2,300 per month. It was covered without issue previously. Canada Life then halted their coverage and months of unresponsiveness led to over $8,000 in out-of-pocket expenses.
I would ask you to put yourself in these people's shoes and imagine the stress and difficulty. These members should have been focused on fighting their diseases, but instead they were needlessly spending time agonizing over how to get their medicines covered. For some this meant a decline in their health.
For months, members who called Canada Life had at best a fifty-fifty chance of even getting into the queue to wait on hold. The other 50% would simply hear a message saying to call back later. For months, the average wait time for those who were lucky to get through was over half an hour. The contract that the government has signed with Canada Life stipulates that over 70% of calls should be answered in 20 seconds or less.
We also saw problems with insufficiently trained agents offering incorrect or misleading information and very slow processing times for claims. Again, the contract stipulates that 95% of claims that are submitted electronically should be processed in five days, but routinely there was a five-week delay.
If Canada Life cannot adhere to the service standards in their contract, they must provide fee credits back to the Government of Canada. They were given a six-month grace period where such credits did not apply. We're still puzzled about why this was allowed to happen. Canada Life forced our members into terrible situations without even coming close to the expected service standards. These standards remain unmet as far as we know, but we haven't been provided with the figures that we need to verify this.
All that said, we're seeing two continued major problems with the administration of this plan.
The first relates to international claims. For members who are posted abroad working in Canada's embassies, consulates, military bases or for anyone who is travelling, the entire system is actually currently down and has been for two weeks. This is a result of a cybersecurity incident. However, even before this complete shutdown, service for members outside of Canada has been a major issue with an enormous backlog of unprocessed claims. There are currently more than 3,500 claims that are over 60 days old waiting to be adjudicated and paid.
The second major problem relates to a process of prior authorization for drugs. This is a new process where people who take certain drugs—usually due to their high cost—must navigate system approvals before any coverage.... This system is failing our members and causing serious health issues for many. I'd be happy to elaborate further if there are questions.
Again, certain problems are definitely getting better, but many problems remain and there isn't an easy fix here. Fundamentally, we believe our members need to be made whole for their pain and suffering, which includes those who have suffered adverse health consequences and those who have suffered financially.
Thank you very much for your time.
