Accomplishments and Challenges

Claim Volumes

FNHA and PharmaCare worked closely to ensure a seamless transition. The majority of FNHA clients now have their claims adjudicated through FNHA's Plan W. As of December 30, 2017, approximately 596,000 pharmacy claims were made through Plan W.

Call Centre Issues

Call volumes to both FNHA and Health Insurance BC peaked in the first two weeks of October. To manage call volumes, FNHA adjusted operations by adding staff and shifting staff allocation to periods of peak demand.

Call response times have improved substantially. In the first week of October some callers waited over 1 hour before their call was answered, by the last week of December callers experienced an average wait time of less than 1 minute. Moreover, week over week call volumes are steadily declining.

Transitional Special Authority Coverage

Transitional Special Authorities through FNHA's Plan W provide continued coverage for clients, ensuring their therapies remain the same. These arrangements are also referred to as "grandparenting coverage." In preparation for October 1, 2017, over 110,000 Transitional Special Authorities were implemented. Following the transition, an interim process was established, expediting Special Authority requests to better serve FNHA clients at the pharmacy counter.

Provider Issues

A number of residual provider issues continue to be addressed. Specifically, there have been instances where providers billed the incorrect plan and advised clients a benefit item was not covered, and instances of providers not applying FNHA Plan W rules for Plan W clients. A small number of providers may be sharing inaccurate information about the creation of Plan

We continue to actively work with those providers and the communities that they serve.

We encourage clients who are being asked to pay for medications to call our Health Benefits Support line at 1.855.550.5454.

Specialty Agency Drugs

In the transition to FNHA's Plan W, BC's specialty health agencies have taken over responsibility for the provision of drug therapies for clients accessing treatment for cancer, kidney disease, organ transplants, and HIV/AIDS. The transition of a small number of clients who received medication directly from NIHB rather than the agencies is ongoing.

Over-the-Counter Items

To ensure continuity of care, it was determined that most over-the-counter medications and a small number of non-drug over-the-counter devices would be included in the PharmaCare Plan W formulary.

Enrolling Clients

The vast majority of FNHA clients were automatically enrolled in Plan W for October 1, 2017, meaning that clients were not required to complete any new forms. However, there remains a small number of clients that will still need to be enrolled. FNHA encourages clients with questions about their coverage to contact the eligibility department.

Communications and Engagement

The creation of Plan W marked the first time FNHA has directly communicated with its entire client base. FNHA informed clients and health care providers about the transition to Plan W through a variety of communication channels. We continue to test and evaluate our communications channels in order to keep citizens and communities informed and updated.

Addressing Client Questions

We are committed to serving our clients; the most effective channel to address concerns and receive information is through the Health Benefits Support line. Benefit Support Representatives are available from 8am to 8pm Monday to Friday and 8am to 4pm Saturday and Sunday. We urge our partners, as well as any clients with questions, to call 1.855.550.5454.

Communications Highlights By The Numbers:

2 client letters

1 physician letter

1 letter to all Chiefs in BC

12 partnerships with colleges/associations/agencies

13 articles and newsletters

32 presentations and engagement sessions

134 social media posts

418 broadcasts of 3 different radio ads

520 marketing kits

33,700 views on social media