Health plan switch halts benefits to dead soldier's daughters
Girls' grandmother paying out of pocket since Canada Life took over PS insurance plan
An Ontario woman who's been caring for her granddaughters for nearly six years says she's suddenly unable to claim the girls' medical benefits even though they're entitled through their father, a deceased Canadian military veteran.
Gloria Timothy, 66, is a widow and retiree who lives in Windsor with granddaughters Destiny, 19, and Alexsis, 15.
Her son-in-law Stefan Jankowski had always dreamed of becoming a soldier. He died of a prescription drug overdose in July 2011 after returning from active duty in Afghanistan with post-traumatic stress disorder.
- Their daughter nearly drowned. Now they're going into debt paying for her care
- Many public servants still waiting on Canada Life to process claims
Soon after, Timothy's daughter Michelle, the girls' mother, also began to struggle with mental illness, slipping into a cycle of self-medication and occasional homelessness, according to her family.
On Family Day in 2018, Destiny and Alexsis went to live with Timothy, essentially cutting ties with their mother. They've had no contact with her for five years and aren't entirely sure where she's living.
- This week CBC Ottawa will be sharing more stories of public servants affected by the switch to Canada Life. If you'd like to share your story send us an email.
'They will no longer talk to me'
Until this summer, Timothy had no problems submitting claims for health and dental benefits through Sun Life, which administered Canada's Public Service Health Care Plan. The plan covers dependents of federal public servants including Canadian Forces members both living and dead.
When she would occasionally receive a payment made out to the girls' mother, Timothy said she would simply call their previous insurance provider Sun Life and an agent would immediately correct the error.
I just can't keep laying all this money out.- Gloria Timothy
"I had no issues getting reimbursed for everything I submitted for the children for five years," Timothy told CBC last week.
That all changed after July 1, when the federal government transferred the health-care plan to Canada Life and existing members were required to enrol.
Despite numerous attempts to explain her situation to the company, Timothy said Canada Life agents have refused to deal with her because she's not officially listed as the member under her son-in-law's plan — her daughter is.
"They will no longer talk to me," said Timothy.
WATCH | Grandmother on fighting for benefits:
Since July 1, Timothy has had to pay out of pocket for her granddaughters' prescriptions, therapy appointments and even an ambulance trip when Alexsis suffered a panic attack and had to be rushed to hospital. So far, the medical bills total $550.
"The bills have added up and I am on a fixed income, a widow, and I just can't keep laying all this money out," said Timothy, who has temporarily halted her granddaughters' therapy sessions because she can no longer afford to pay for them.
"They are the surviving dependents, they should never have been cut off [from] their benefits," she said.
Told to contact mother
When Destiny contacted Canada Life to ask about being named as a member so she could submit her own claims as well as her sister's, she was told she'd still need her mother's permission.
"We haven't had any contact with her, it's been five, maybe six years now, and we would like to keep it that way because she's not in a right state of mind. We don't want to see her like that," Destiny said.
"Me and my sister left my mom and came to live with my Nana as it was way better and safer for us to be here."
Timothy has contacted the Canadian Forces about her family's predicament and was advised to provide a notarized letter from the Children's Aid Society proving she's the girls' guardian. She has now submitted that letter, but is still waiting to hear back from Canada Life.
"To me, the military should have the say whether the children have their benefits," Timothy said. "I had hope then that this was all going to be resolved."
They've also contacted their Member of Parliament, Timothy said.
Destiny has a full-time office job but plans to return to post-secondary school to study human resources and accounting. She will remain a dependent under her father's plan until 21, or 25 if she's studying full time.
She said it's unfair that she and her sister have essentially been cut off from the medical benefits their father suffered to provide.
"These children — me, my sister — we've lost a parent," she said. "The last thing that we have from them is benefits, and now we don't even have access to [that]."
Canada Life 'committed to fixing this'
In an email to CBC on the weekend, Canada Life said it's committed to delivering the benefits guaranteed under Canada's Public Service Health Plan.
"No one should be denied coverage for needs covered under their benefits plan," a company spokesperson wrote.
"While many customers continue to access their benefits without issue, we recognize that a percentage are experiencing difficulty, leading to high call volumes and wait times. We are committed to fixing this."
The company said it's expanding call centre hours and hiring more agents, introducing automatic enrolment and escalating "urgent need and priority cases." It has also introduced an "urgent situations review team" to help resolve certain cases.
The Treasury Board, which oversees the operations of the federal government, said in an email that it shares "the concerns and frustrations" of health-care plan members who are experiencing difficulties getting the benefits they're owed.
"We understand the stress that this ongoing service issue is having on individuals and their families," the department said.
'You can't do that to someone'
Timothy, who worked for 20 years in a dental office where she dealt with insurers daily, believes Canada Life was simply unprepared to deal with this volume of cases, and seems unequipped to deal with exceptional circumstances.
"I think they're having a hard time taking on this caseload," she said.
Destiny said she decided to speak out because she believes many other beneficiaries are in the same situation.
"I'm so sorry to everyone that is going through this, and know that it will get resolved soon," she said.
"Hopefully it will help other people to speak up and actually fight back and get their benefits back, because it's so unfair that it's just taken away. You can't do that to someone."
ABOUT THE AUTHOR
With files from Meg Roberts