PharmaCare coverage confirmed

Authority Health Insurance BC – Pharmacare

Burdened by several serious health issues, Alfred, a senior, was not able to afford his expensive prescription medications on his pension income.

Alfred had lived out of country for a few years, but had recently decided to return home to be closer to family. After registering with PharmaCare, Alfred received a letter from the program stating that his deductible would be changed because the Canada Revenue Agency (CRA) did not have a record of his 2012 tax return, which PharmaCare used to confirm his eligibility.

He then received another notice from the program, stating that his PharmaCare deductible was being set at $10,000 per year. Alfred did not think that decision was fair, so he came to us. We investigated whether a reasonable procedure was used to determine Alfred’s eligibility for coverage.

The program uses information from the Canada Revenue Agency to determine an applicant’s eligibility for PharmaCare coverage. Our investigation found the program had attempted to retrieve Alfred’s 2012 CRA Notice of Assessment without success. Alfred had filed his taxes as a non-resident in 2012 and therefore the information that the program was seeking from CRA was not available. Alfred, however, provided the program the income verification documents he had received personally from CRA, but the program then demanded a notarized affadavit for additional confirmation at Alfred’s expense.

We asked Alfred whether he had other additional official records available and found that he had pension records from his previous country of residence. We consulted with the program and discussed whether these additional official records could count as proof of income for the purpose of determining eligibility. The program agreed and subsequently wrote to Alfred confirming he had been assessed for full PharmaCare coverage with no deductible. Alfred thanked us for our help and was able to obtain the medication he required.

Category Seniors
Type Case Summary
Fiscal Year 2014
Location Vancouver Island / Sunshine Coast