A documentation discrepancy

Authority Health Insurance BC – Medical Service Plan

Cory had recently separated from his spouse. Now a single father on a limited income, he was unable to pay for Medical Service Plan premiums. Cory applied for premium assistance, but his request was denied because his income was still deemed too high. Eligibility for premium assistance is based on the net family income from the previous year, as reported to Canada Revenue Agency.

Cory called us, explaining how he submitted documentation to the program that showed that he was separated and his income had decreased significantly as a result. The program responded, saying Cory’s records were not sufficient to confirm eligibility for premium assistance. Cory was also reminded that he had a $798 outstanding balance of unpaid MSP premiums. The debt was sent to collection.

We investigated whether the program used a reasonable procedure to determine Cory’s eligibility for premium assistance. We reviewed the legislation pertaining to retroactive premium assistance and contacted the program to discuss how the legislation applied to Cory’s situation as we believed he was eligible based on the documentation he provided. The program agreed to review Cory’s file again and this time determined that Cory’s records did in fact make him eligible for premium assistance. In addition, the program eliminated Cory’s outstanding balance.

Category Income and Benefits
Type Case Summary
Fiscal Year 2014
Location Vancouver Island / Sunshine Coast