Public servants, retirees travelling and working overseas wait months for reimbursement

Some federal government employees posted or travelling overseas say they've had to wait months to be reimbursed for medical insurance claims that, oncerepaid, have been shorthundreds or thousands of dollars with little explanation.

On July 1, 2023, 1.7 millionfederal workers, retirees and their dependents saw their insurance provider switch from Sun Life to Canada Life. The change was supposed to be seamless, but it left many public servants scrambling for their benefits.

As part of the switch, Canada Life subcontracted MSHInternational to handle all overseas claims as of July 1, 2023,both for emergency travel medical coverage and comprehensive coverageforthose posted overseas by Global Affairs Canada (GAC).

"It's frustrating, it's stressful. It makes you second-guess the career path that you choose to represent Canada overseas," said Sonia Hooykaaswho works for GAC and has been posted in the U.K. since November 2020.

Hooykaas is covered under the comprehensive portion of the plan, which acts as a substitute for provincial health insurance.

She has to submit to MSH everything from the cost of regular checkupsto the multiple surgeries she and her daughter have undergone since last summer.

Since last July,Hooykaas has submitted$57,500 worth of eligible claims buthas only been paid around $35,000.

"So I'm more or less where I [was] before, only with a bunch of money that doesn't jive with all the paperwork that they gave me," she told CBC."It's a part-time job."

Before July, Hooykaas rarely encountered problems with Sun Life's international subcontractor, AllianzGlobal Assistance.

"At least with Allianzyou actually got somebody on the phone. There was a dedicated telephone number. I never waited for longer than fiveto 10 minutes on hold to talk to somebody," she told CBC.

But nine months afterthe switch"it's night and day," she said.

Scared to travel again

Roseline Roy has been retired from the federal public service for nearly a decade.

During a trip to a Greek island in October, she was with a grouphiking down a mountain when she slipped on a rock and broke her ankle.

She was taken to a local hospital where adoctor told her she'd suffereda double fracture and needed immediate surgery before returning home to Gatineau, Que.

Ittook Roy four days and numerous callsto reach an MSH agentwho she saidapproved the surgery after the fact.

The agentalso approved a business class ticket home so Roy could follow her doctor's orders to keepher leg elevated. MSH was tohave the hospital bill the insurance company directly.

Butthat didn't happen and Roywas forced to charge $22,000 in hospital bills toher credit card, along with $5,500 for herflight home.

"I did all those calls from my bed in the hospital after a two-hour surgery,"she said."Itwas a nightmare."

Roy said the bulk of her $30,000 claim was reimbursed in early February, but there's $3,000outstandingfor theflight.

Last week, MSHsent her an email saying it would not reimburse her for more than the cost of an economy flight.

Roy saidthere's another$500 missing from heroriginal claim, plus another $500 she's racked up ininterest on a line of credit money she doesn't expect to see repaid.

The ordeal has leftRoy fearful to leave Canada again, despite plans to visit herdaughter and grandchildren in the Philippines later this month.

"What if I have to go through that nightmare again?" she asked.

MSH reviewing cases

In a statement to CBC, MSHdid not respond to specific questions about the cases but said it's reviewing them and wouldreachout to both Hooykaas and Roy about their claims.

After CBC contacted MSH about her case in January, Hooykaas was assigned a case worker who shesaid sent her just one email and hasn't communicated since.

In an email last week, MSHreiterated that it would review her claims and contact her.

Thecompany also said it haddetected a"cybersecurity incident"on Feb. 9 and had to temporarily pause claims processing, creatinga backlog.While it has not said where that backlog currently stands, in an email to CBCthe company added that it inherited another five months of backlogged claims last July.

It also said it has hired more workers to improve service levels and clear the claims backlog.

Last week, Canada Life also wrote toHooykaas to tell her it'sjuststarting to process claims dating back to the second week of January.

Most of her outstanding bills have been covered by advances from GAC.

Employee advances

Near the end of January, GACtold CBCit had advanced $1.8 million to employees to cover medical expenses.

But according to the head of theProfessional Association of Foreign Service Officers (PAFSO), which represents employees posted overseas including those at embassies and consulates,that number has since ballooned to $3 million.

"That money is supposed to be used to advance Canada's interests abroad, to protect Canadians abroad, to help them with things that they need help with," said PAFSO president Pamela Isfeld.

"It should not be covering the rear end, frankly, of a contractor thatis just not up to the job."

GAC did not provide anyone for an interview, nor respond to CBC's questions about the current amount loaned to employees.

Isfeldsuggested the union couldgo to court to compel the government to fix the problem or bring in another insurance provider"until they get their act together."

In a statement to CBC, the Treasury Board said while there have beenimprovements with Canada Life and MSHresponse times, the department is continuing to work with the insurerto further address problems.

"There is no move being contemplated to terminate the contract," according to the statement.

Service levels aren'tbeing met

Canada Life did not respond to requestsfor an interview, but asix-month grace period meant to give the company time to improve customer service and claims processing expired on Jan. 1.

After that date, Canada Life is supposed to meet certain service levels, such as having 70 per cent of both English and French calls answered within20 seconds, and having 80 per cent of supplementary out-of-provinceand 90 per cent of comprehensive paper claims processed within 10 days.

According to information on MSH's website, as of two weeks ago theaverage claim processing timewas 48 days, down from 59 the week before.

In a statement posted to PSHCP members, the company acknowledged"the member experience has not met the expected level of service for which we strive."

The company said it is working on improving contact centre wait times, as well as the time it takes to process claims.

MSH also said it'sdeveloping a member portal so people can check their benefit statements and claim status online.