PETER POWER / FOR THE TORONTO STAR
Sun Life Financial is covering the medical marijuana costs of University of Waterloo student Jonathan Zaid.
Private insurer covers medical marijuana costs
A university student’s medical marijuana is being paid for by his private insurance company – a feat some industry insiders say is unprecedented.
By: Isabel Teotonio Living reporter, Published on Fri Mar 20 2015
After a hard-fought battle, Jonathan Zaid’s medical marijuana is being paid for by his private insurance company — a feat some industry insiders say is unprecedented.
Now, the third-year University of Waterloo student, who suffers from a rare illness called new daily persistent headache, is hoping this victory clears the way for other patients seeking coverage for cannabis.
“I had to fight a lot of battles to get to where I am,” says the 22-year-old Toronto native. “My persistence paid off in the end.”
Last summer, Zaid submitted a claim for his medical marijuana to insurance giant Sun Life Financial. It was denied. Insurance companies don’t typically pay for cannabis. Although medical marijuana is federally regulated it is not an approved medicine in Canada and has no Drug Identification Number (DIN).
But Zaid wouldn’t give up. He was frustrated with always asking his parents for money to buy his “medicine” from a licensed producer. And after trying 48 different drugs over the years, only marijuana eased his chronic headaches. He figured it should be recognized as prescription medication — after all, it was prescribed by a doctor.
Zaid, the son of a retired lawyer, presented research on his condition and the medicinal benefits of marijuana to an oversight committee of the University of Waterloo student union, which administers the student health plan. It would be up to the student association as the plan’s sponsor — that’s the organization or employer that sets up the healthcare plan — to ask Sun Life to make an exception.
Student Ben Balfour, who is part of the committee, says there was initial concern about approving Zaid’s request because it was their first time dealing with marijuana.
“We were testing the waters and we didn’t know how people would react,” says Balfour, vice-president of operations and finance for the Federation of Students.
But after much back and forth between Zaid and the committee, which includes a physician, his request was approved in December. The committee found Zaid’s evidence to be persuasive, that the plan could support the cost and that having Zaid’s medicinal marijuana covered would positively impact his academic success and wellbeing.
“It’s really something new and I was very excited to be a part of it,” says Balfour. “I’m just very glad that we were able to figure it all out in the end.”
Sun Life issued a cheque reimbursing Zaid for nearly $3,000, covering the costs of cannabis and a $750 vaporizer — he gave the money to his parents. His triumph doesn’t mean other U of W students are automatically covered for medicinal marijuana, which has not been added to the formulary. But, it opens the door for others to follow his lead and go through the same process.
Sun Life can’t comment on the specifics of this case or benefit plan. While medical marijuana is not an eligible expense in its standard benefit plans, Sun Life does consider requests for exceptions if directed by the organization or employer responsible for the benefit plan. Insurance behemoth Manulife has a similar policy, but is not aware of having made any exception for medical cannabis.
There are cases of the government paying for medical marijuana: Ontario’s Workplace Safety and Insurance Board (WSIB), Quebec’s Commission de la santé et de la sécurité du travail (CSST), and Veterans Affairs, via
Medavie Blue Cross, have covered cannabis costs.
It’s unclear how unusual Zaid’s case is because Sun Life will not comment on if other patients, or benefit plans, have requested similar coverage.
And, it’s unknown what effect, if any, it will have on future claims for cannabis made to insurers, says Wendy Hope, vice-president of external relations for the Canadian Life and Health Insurance Association. Hope says this sort of claim is not unprecedented and that some private insurers have, for some time now, been reimbursing costs for medical marijuana through health spending accounts – although it is rare.
Zaid attributes his success to not giving up, but realizes few patients have the strength, or know-how, to accomplish what he did.
“We’re talking about very sick people and lots of them don’t have the resources to spend in order to fight for fair access,” says Zaid. His advocacy work prompted him to launch the non-profit Canadians for Fair Access to Medical Marijuana and he now sits on the patient advisory board of licensed producer Bedrocan Canada.
Sarah Smith, who pays $180 a month out-of-pocket for medical cannabis after being denied by her private insurer, hopes Zaid’s case will impact insurance practices. Unlike Zaid, she says, “I didn’t have the fight in me.”
“I’m optimistic this will help open the eyes of insurance companies that not all prescriptions are pills, sometimes it’s an herb,” says Smith, not her real name. “They shouldn’t be differentiating — a prescription is a prescription.”
Zaid’s case is precedent-setting, says Marc Wayne, CEO of Bedrocan Canada and chair of the Canadian Medical Cannabis Industry Association.
“It’s an example of the way this type of thing has to work. . . Insurance companies aren’t going to come out and say, ‘We’re going to cover medicinal cannabis for everybody.’ It’s a case-by-case approach and hopefully it will reach a tipping point.”