“New health plan for federal workers has some members feeling like they ‘fell through the cracks'”
Because of changes to the Public Service Health Care Plan, Louise Sullivan said her husband Mike is giving up the majority of his physiotherapy treatments which, after a stroke eight years ago, have allowed him to retain some mobility and regain some independence. Louise Sullivan stretches a brace across her husband’s knee, then holds his arm while he attempts to hobble from their living room to the kitchen and back. Michael Fairhead is noticeably exhausted. As is she. The Ottawa couple — both retired federal public servants in their mid-sixties — used to live an active life, travelling the world before Fairhead lost function in most of his right side after a stroke eight years ago. But Sullivan believes what little mobility he still has would not have been possible without years of intensive physiotherapy, something she says will now be reduced significantly after the government of Canada made a series of changes to the country’s largest health insurance plan — the Public Service Health Care Plan (PSHCP). “Without the physio, what’s going to happen is his body is going to atrophy,” she said. “What I’m really worried about is he’s going to get to the point where he won’t be able to do anything on his own and I will be left doing all the things that he can now do.” Sullivan and Fairhead are among the 1.7 million federal workers, retirees and dependents who saw their insurance provider switch from Sun Life to Canada Life on July 1, and with it changes to what services and drugs are covered, how they’re approved and what happens when they need to talk to an agent. The Treasury Board Secretariat (TBS), which oversees labour relations between the federal government and the public sector, said changes made to the PSHCP, including claim limits, coverage terms and eligibility, were approved in the fall of 2022 — independent of the switch to Canada Life. Those changes came into effect after Canada Life won a tender to administer the plan. Still, CBC News has heard from dozens of members who say they’re frustrated by both the government and the insurance provider. Louise Sullivan worries that her husband, Michael Fairhead, pictured here, will regress without continued intensive physiotherapy, something she can no longer afford under the Public Service Health Care Plan’s coverage changes. (Jean Delisle/CBC) In Fairhead’s case, coverage for his physiotherapy used to be practically unlimited. Under the previous terms, the couple was covered at 80 per cent for claims up to $500 and claims over $1,000. Now, it’s capped at $1,500 annually. The cost for his physiotherapy last year was more than $14,000, according to Sullivan. In response to the new cap, Sullivan said she’s made the difficult decision to cut his physiotherapy from three days a week to once a week at most. While she plans to help him with whatever exercise she can, she knows she won’t be able to make up for the difference. “That’s my biggest fear is that he’s going to get to the point where he’s going to be so sore and so stiff that he won’t even want to get out of bed and that will devastate me,” she said. Along with coverage limits, the new plan dictates people must choose generic drugs. Beverley Cormier, 59, recently switched to a new medication to help with flare-ups for her rheumatoid arthritis. Under her husband’s plan, the first month was covered at 80 per cent by Sun Life, but when the next 30 days were set to go through, she learned from the drug’s maker, Pfizer, that it had been declined by Canada Life. “It’s really hard how you can explain to people how one day you feel really good and then the next day you can hardly move and this medication was making such a big difference in such a short amount of time,” she said, her voice cracking. That medication comes with a $1,700 a month price tag. Cormier had only been on the medication for a month before the terms of the plan changed. Her husband, Norm Cormier — a veteran who worked for the military for 27 years — contemplated coming out of retirement to find another job. Not being able to get through to an agent at Canada Life after being denied twice for the medication compounded the frustration. Canada Life has since covered the drug after CBC asked Treasury Board President Mona Fortier’s office about it. The TBS told CBC the medication requires prior approval. “When it’s your medication and you’re suffering, you just want somebody to tell you something,” Beverley Cormier said. She did suffer. Because of the delay getting the medication approved, she went 10 days without it, resulting in a debilitating flare-up. Susan Judges, 52, is also eligible for the plan because her husband is a veteran. She had to pay hundreds of dollars out of pocket for medications before problems with her plan were resolved earlier this month. Despite calling four to five times a day since the switchover and sending emails, it took weeks before anyone from the company responded. Louise Sullivan tries to assist her husband, Michael Fairhead, with some of his daily exercises. The struggle to get out of his wheelchair and shuffle a few metres might as well be a marathon — one she fears he’ll lose the ability to even attempt. (Jean Delisle/CBC) “I feel like we fell through the cracks,” she told CBC. Yet, she still faces weeks before being reimbursed the $300 because of ongoing problems with their enrolment — a decision between paying for food or medication. “I’ve maxed out my credit cards paying for the little medication that I do have right now,” said Judges. The multitude of worries and frustrations are ones Roy Goodall has heard over the last few weeks. “It’s a terrible situation,” said the president of the National Association of Federal Retirees. “I don’t envy the people who are faced with this.” He said the association plans to address the cap on physio coverage with the government when there’s a review of coverage in two years. In the meantime,
