Military families among Canadians caught up in benefits mess

As Canadians prepare to observe Remembrance Day, some military members, veterans and their families say they’re feeling forgotten amid the messy transition of the Public Service Health Care Plan (PSHCP) to Canada Life.

The Winnipeg-based insurance company took over the plan from Sun Life on July 1. The plan provides drug and medical coverage to roughly 1.7 million federal public servants and retirees, their spouses and dependents.

Despite assurances of a seamless transition, however, thousands of PSHCP members have been denied coverage without warning or cause, and many have described frustrating ordeals trying to get their benefits restored.

In some cases, PSHCP members who have been unable to resume their coverage have been forced to pay out of pocket for necessary medication, treatment and medical supplies.

Some say they’re facing the difficult choice between paying for their prescriptions and paying for groceries.

It’s causing a lot of emotional distress, a lot of financial distress — it’s very difficult. – Lindsay Walker, wife of CAF veteran

A significant portion of those covered under the PSHCP who have reached out to share their experiences with CBC are Canadian Armed Forces (CAF) members, veterans and their families.

Our series Begging for Benefits featured some of their stories.

• Health plan switch halts benefits to dead soldier’s daughters
• Woman’s health ‘sliding backwards’ after drug coverage pulled
• Their daughter nearly drowned. Now they’re going into debt paying for her care

Canada Life has since resolved some of those cases, and says it’s working hard to whittle down the outstanding ones.

Earlier this week, the company launched an “urgent needs escalation process” to help PSHCP members who face especially desperate circumstances.

Veteran’s wife denied coverage

Among those still struggling is the Walker family of Ottawa.

Paul Walker, 36, was medically released from the CAF in February after a 13-year career as a signal operator.

His wife Lindsay Walker, 33, was permanently disabled in a traffic collision in June 2019. As a result of the crash, she developed functional neurological disorder and a condition known as “foot drop,” a weakness or paralysis of the muscles needed to lift the foot.

She was later diagnosed with a second rare condition called complex regional pain syndrome (CRPS) in her right leg and foot.

Her treatment plan includes intensive physiotherapy, chiropractic care, massage therapy and weekly nerve block injections. She’s also on a wait-list for a device called a spinal cord stimulator that uses an electrical current to distract the brain from the pain signals caused by her condition.

“I am hopeful about it,” Walker told CBC earlier this week. “It’s been a long journey living with CRPS and it’s a very debilitating condition just with very high levels of severe, constant pain.”

Currently, Walker’s medication costs between $800 and $1,000 per month. Until recently, it was all covered under her husband’s health insurance plan.

When she went to fill her prescriptions on Oct. 23, however, her pharmacist had some bad news for her.

“It just came back as ‘coverage terminated,’ with no answers,” Walker said.

No explanation

Despite spending hours on hold and speaking with several Canada Life agents over the following days, neither Walker nor her husband were able to discover why their benefits had suddenly been cut.

“Everything was correct but they couldn’t give us an explanation as to why it had been terminated, just that nothing was going through,” she said.

There were promises to escalate the case and follow up with a solution, but that never materialized. One agent gave the couple a number to contact that turned out to be a help line at Veterans Affairs Canada (VAC), but the department was also unable to help resolve their situation.

Thanks to an understanding pharmacist, Walker has enough medication to keep her symptoms at bay until next week, but then she fears the generosity will end and the pain will take over.

“We’re in a situation where we can’t pay $800 to $1,000 out of pocket every month for these medications while still being able to pay our other monthly expenses like our mortgage and utilities,” she said.

“It’s causing a lot of emotional distress, a lot of financial distress — it’s very difficult.”

Some emergency aid available

The Walkers, who have an eight-year-old daughter with autism, are now looking for emergency grants or loans to help them through their predicament.

VAC’s veterans emergency fund provides financial support to veterans and their families who are “facing an unforeseen financial emergency that is threatening their health and well-being,” the department said in an email to CBC.

Among the essentials covered by the fund are medical expenses. As of Thursday, VAC had received two applications for emergency financial aid related to the PSHCP switch. Both were approved.

According to VAC, the department “continues to monitor Veterans Emergency Fund approvals related to the transition to Canada Life since July 2023.”

Neither the Department of National Defence (DND) nor the CAF currently provide similar emergency assistance.

In an email, DND said public servants and CAF members have the right to submit coverage and claim-related appeals through the established process identified by the Public Service Health Care Plan.

A spokesperson for the Royal Canadian Legion said while it has heard from a few members who have been denied benefits under the PSHCP, the Poppy Fund remains its main source of emergency assistance for veterans.

According to the Treasury Board Secretariat, some 44,000 active CAF members including reservists and another 91,000 retired members are currently covered under the PSHCP. Their dependents who are also eligible for benefits under the plan total nearly 150,000.

Together, military members, veterans and their families account for about 17 per cent of all Canadians covered under the PSHCP.