Has anyone ever had to fight with their empolyer's benefits program in order to gain access to current medications? I live in Ontario and am currently being denied access to Triumeq, Genoya and Stribild by my employer's benefits plan. These medications are all availible through our provincial drug benefit plan, however not through my employer's coverage, due to my income level I can't afford the deductable I would need to pay to join the Provincial plan.
To update this situation I have managed to get coverage for my Triumeq, after being kicked around by the companies HR department, forced to write business cases explaining why I require this medication etc, I got fed up and contacted a human rights lawyer willing to support me in a human rights complaint against my company and my union, neither of which were offering me any assistance in this matter.
These actions led to some bitch from HR contacting me to let me know I havent completed their process properly, to which I had previously followed their instructions to the Tee. At this point I had been nothing but patient, co-operative, and friendly. These things get you nowhere. After raising my voice on the phone to this lady, explaining how much they've fucked up and reinforcing how serious I was about my human rights complaint, can you believe I was given full coverage the very next day.
The root cause of this issue would seem to have been a complete act of incompetence carried out by my company's newly restructured HR department as well as Union representation that would just rather not talk about these types of problems. Over the course of dealing with this issue I witnessed co-workers having similar issues with "family" medical expenses which were responded to swiftly with grievances by the union and settled usually within a week or two. It seems I work in a very hetero-male dominated industry and it would seem issues like these dont concern good red blooded "family" men.
The moral of the story is get nasty when you need to.
A side note on health care plans in Canada, each province had a socialized basic health care plan which provides for basic needs with no drug coverage. You can purchase private drug coverage plans or most are provided by the employers, If you are unemployed or of low income you can get medications paid for by a provincial fund set up to provide meds to unemployed and low income people. I was stuck in between this system with employer coverage which was hanging me out to dry, an income too high to essentially qualify for government assistance and a union who could really care less about me. Needless to say I was looking for a new job, although in the end I dealt with my issue and ended up staying with the company for purely financial reasons.
No, under my ssd they're covering everything and then some. Sorry to hear of your problem. :(