This section is a general outline of the various benefits and services available to you, as an
eligible employee, under the Extended Health Care, Dental, and Medical Service Plans. It is your
responsibility to verify an item or service is covered prior to purchase.
The Benefits Service Centre at Telus Sourcing Solutions BC has been
contracted to provide benefits administration services for employees covered
under the Public Service Benefit Plans.
For all inquiries regarding benefit plan enrollment and covered items, please
contact the Benefits Service Centre:.
Benefits Service Centre
Block E, 2261 Keating Cross Road
Saanichton BC V8M 2A5
Email:
BenefitsServiceCentre@telus.com
Phone: 1-877-277-0772 (toll free within BC)
Fax: 250-652-4882
For further information regarding claims or covered items for Extended
Extended Health and Dental, view information on Caresnet, or contact:
The Extended Health Plan is designed to partially reimburse specified medical
expenses or services not covered by MSP, Pharmacare, or the Hospital Insurance Program.
An annual deductible of $65 per person or per family is subtracted
from your first claim in each calendar year. (Effective January 1, 2011
- $80)
After the annual deductible is applied, you will be reimbursed 80% of
eligible expenses unless otherwise specified. After $1,000 has been paid
for a person in a Calendar year, further Eligible expenses submitted by
or on behalf of that person within the Calendar year will be reimbursed
at 100%, subject to the maximums stated in this Contact.
Effective April 1, 2010 - The plan reimburses up to
a $250,000 lifetime maximum for each covered person.
Employees who reached the former lifetime maximum prior to April 1, 2010
are not eligible to claim any expenses prior to April 1, 2010 that ex-ceeded
the $100,000. However, services rendered on or after April 1, 2010 may
be claimed to the new lifetime maximum of $250,000.
If the lifetime maximum is reached it may be reinstated on the basis of
satisfactory evidence provided by the employee to the carrier of complete
recovery and return to good health.
Some restrictions and maximums apply. Please see further details below or contact Pacific Blue Cross in Vancouver at 604
419-2000 or toll-free 1-800-873-2583, or email your enquiry at Pacific Blue Cross.
Preauthorization is recommended for items costing over $1000.
Pacific Blue Cross offers CARESnet, an on-line system which allows
you to view your extended health claims and claims history. You may arrange to have extended health
and dental claim reimbursements deposited directly into your bank account. The enrolment form for
this service can be downloaded from the CARESnet section of
Pacific Blue Cross' website.
Acupuncture treatments performed by a medical doctor or an
acupuncturist registered with the College of Traditional Chinese
Practitioners and Acupuncturists of British Columbia. Payable to a maximum limit of $200 per individual per calendar year up to $500 per family
per calendar year.
(If a 1 or 2 person family, only the individual limits apply.)
Breast Prosthetics (see Mastectomy Forms and Bras)
Chiropractic treatments performed by a chiropractor registered with
the College of Chiropractors of British Columbia. Payable to a maximum limit of $200
per individual per calendar year up to $500 per family per calendar year. (If a 1 or 2 person family,
only the individual limits apply.)
X-rays taken by a Chiropractor are not covered.
Claims are processed as follows:
Reimbursed 80% of $10 for the first 10 visits;
Subsequent visits reimbursed 80% of the service cost, subject to benefit
plan maximum limits and reasonable and customary pricing.
Effective January 1, 2011 – Reimbursed 80% of $10 for the first 8
visits. Subsequent visits reimbursed 80% of service cost, subject to benefit
plan maximum limits and reasonable and customary pricing.
Service cost of a registered clinical psychologist or counsellor is payable to a maximum of $500 per family per
calendar year.
Contact the BC Association of Clinical Counsellors in Victoria at (250) 595-4448 or toll
free at 1-800-909-6303 or visit their website at
www.bc-counsellors.org to determine
if a selected counsellor is registered for claiming purposes.
Contact the College of Psychologists in Vancouver at (604) 736-6164 or visit their website at
www.collegeofpsychologists.bc.ca to determine
if a selected psychologist is registered for claiming purposes.
Note: If you are interested in accessing counselling services, you may wish to refer to the
Employee and Family Assistance Program (EFAP) section of this guide.
EFAP provides short-term counselling services at no cost to you.
Prescribed oral or injectable contraceptives payable subject to Pharmacare’s policies
including referenced based pricing, lowest cost alternative, a maximum dispensing fee, and a
maximum markup for retail pricing of medication.
Covered drugs and medicines purchased from a duly-licensed pharmacy on the prescription
of a duly-licensed medical or dental practitioner, payable subject to Pharmacare’s policies
including referenced based pricing, lowest cost alternative, a maximum dispensing fee, and a
maximum mark up for retail pricing of medication. It is recommended that you shop around for
the best value.
Where an alternative drug is required other than those normally covered by
Pharmacare, your doctor can contact Pharmacare for special authority to reimburse the alternative
drug.
This includes injectables provided by a medical practitioner, drugs used by a
medical practitioner when providing services under circumstances where the drug is not otherwise
provided, and certain supplies required for administration of a drug (for example, insulin
injection).
This does not include vitamins, food supplements, or medicines registered under
the Proprietary or Patent Medicines Act of Canada or drugs and medicines that can be purchased
without a prescription.
REMEMBER to show your extended health card to the pharmacist when
purchasing prescriptions. If the pharmacy participates in the Blue Net system, the drug plan will
reimburse this amount directly to the pharmacy — you will only pay your portion at the till.
If the pharmacy does not participate in Blue Net, the employee is required to pay the entire cost
of the prescription and submit a paper claim to Pacific Blue Cross for reimbursement.
In an emergency requiring immediate transportation, you can claim the cost of a
local ambulance or transportation by railroad, boat or airplane to the nearest hospital.
In an acute emergency you can claim the cost of transportation by air-ambulance
from the place where the injury or sickness occurs to the nearest acute care hospital and return
fare, including the round trip fare for one attending person (doctor, nurse, first-aid attendant)
where required.
Massage treatments performed by a massage therapist registered with
the College of Massage Therapists of British Columbia are payable.
Effective May 1, 2010 – Massage Therapy will be capped at $750 per
person per year.
Claims are processed as follows:
Reimbursed 80% of $10 for the first 10 visits;
Subsequent visits reimbursed 80% of the service cost, subject to
reasonable and customary pricing.
Effective January 1, 2011 – Reimbursed 80% of $10 for the first 8
visits. Subsequent visits reimbursed 80% of the service cost, subject to
reasonable and customary pricing.
Mastectomy Forms and Bras
Mastectomy Forms and Bras are payable to a maximum of $1000 per calendar year.
Medical examinations made by a physician or surgeon for you and all your registered
dependents required by a statute or regulation of the provincial and/or federal government
for employment purposes, are payable provided such charges are not otherwise covered.
Naturopathic services performed by a naturopathic physician licensed
by the College of Naturopathic Physicians of British Columbia. Payable to a maximum
limit of $200 per individual per calendar year up to $500 per family per calendar year. (If
a 1 or 2 person family, only the individual limits apply.)
X-rays taken by and drugs, medicines, or supplies recommended and prescribed by a
naturopathic physician will not be covered.
Claims are processed as follows:
Reimbursed 80% of $10 for the first 10 visits;
Subsequent visits reimbursed 80% of the service cost, subject to benefit
plan maximum limits and reasonable and customary pricing.
Effective January 1, 2011 – Reimbursed 80% of $10 for the first 8
visits. Subsequent visits reimbursed 80% of the service cost, subject to
reasonable and customary pricing.
Needleless injectors when prescribed by a physician, payable up to $500 per 60 months, OR
diabetic needles payable up to $500 per 60 months — you cannot claim both.
An employee or registered dependent may switch from needles to a needleless
insulin injector at any time. However, once the switch has been made to a needleless insulin
injector, the cost of needles will not be reimbursed for a period of 60 months from the date of
the last purchase of the needleless insulin injector.
Note: This benefit is payable 100% to benefit plan
limits.
No annual deductible on this benefit.
Reasonable charges for a physician’s services in the event of an emergency while traveling
or on vacation outside of your province of residence, are payable, less any amount paid or
payable by MSP.
Custom fit orthopedic shoes including repairs, orthotic devices and modifications to
stock item footwear when prescribed by a physician or podiatrist for the proper management
of congenital or post-traumatic foot problems are payable to a maximum of $400 per person
per calendar year, subject to benefit plan restrictions. Arch supports/inserts are not
covered.
Note: Prior to obtaining service for these items, please review
the Pacific
Blue Cross website for important information.
Fees for a registered nurse who is not related to the covered person by blood or marriage
(legal or common-law) for special duty nursing in acute cases while registered as a bed
patient in a public general hospital are payable. Such attendance must be recommended by a
duly qualified physician or surgeon. A special nurse providing the service must not be an
employee of the hospital in which special nursing services are performed.
Physiotherapy services performed by a physiotherapist registered with
the College of Physical Therapists of British Columbia.
Claims are processed as follows:
Reimbursed 80% of $10 for the first 10 visits;
Subsequent visits reimbursed 80% of the service cost, subject to
reasonable and customary pricing.
Effective January 1, 2011 – Reimbursed 80% of $10 for the first 8
visits. Subsequent visits reimbursed 80% of the service cost, subject to
reasonable and customary pricing.
Podiatrist treatments performed by a Podiatrist registered with the
British Columbia Association of Podiatrists. Payable to a maximum limit of
$200 per individual per calendar year up to $500 per family per calendar year. (If a 1 or 2
person family, only the individual limits apply.)
X-rays taken by a Podiatrist or other special fees charged by the podiatrist are not
covered.
Claims are processed as follows:
Reimbursed 80% of $10 for the first 10 visits;
Subsequent visits reimbursed 80% of the service cost, subject to benefit
plan maximum limits and reasonable and customary pricing.
Effective January 1, 2011 – Reimbursed 80% of $10 for the first 8
visits. Subsequent visits reimbursed 80% of the service cost, subject to
reasonable and customary pricing.
Prostate Serum Antigen Test (Effective January 1, 2008)
PSA test payable once per calendar year.
Registered Clinical Psychologist
— includes Registered Clinical Counsellor.)
Service cost of a registered clinical psychologist
or counsellor is
payable to a maximum of $500 per calendar year per person and/or family.
Contact the College of Psychologists in Vancouver at (604) 736-6164 or visit their website at
www.collegeofpsychologists.bc.ca to determine
if a selected psychologist is registered for claiming purposes.
Contact the BC Association of Clinical Counsellors in Victoria at (250) 595-4448 or toll
free at 1-800-909-6303 or visit their website at
www.bc-counsellors.org to
determine if a selected counsellor is registered for claiming purposes.
Note: If you are interested in accessing counselling services, you may wish to refer to the
BC Employee and Family Assistance Program (BCEFAP) section of this guide.
BCEFAP provides six counselling sessions annually, at no cost to you.
Smoking cessation coverage will be included as a benefit under the extended
health plan. You must be
eligible for benefits and enrolled in the extended health plan. If you wish to
be reimbursed, you must register in the Quittin’ Time Program prior to
purchasing any smoking cessation product/drug. Coverage under the extended
health plan includes nicotine replacement therapy (NRT) products such as the
gum, patch, or inhaler and eligible prescription drugs such as Champix or Zyban.
You will be reimbursed to a maximum of $300 per calendar year to a lifetime
maximum of $1,000 per individual. Reimbursement is subject to the normal plan
rules such as the annual deductible and 80% co-insurance. For more information,
visit the Quittin' Time website at www.quittintime.gov.bc.ca
The cost of renting, where more economical, or the purchase cost of durable equipment for
therapeutic treatment — including wheelchairs and standard hospital beds is payable.
Pre-authorization is recommended for items costing over $1000.
Corrective eyewear prescribed by an optometrist, ophthalmologist, physician and/or
surgeon is payable to a maximum of $225 every 24 months per covered adult, and every 12 months
per dependent child. (may also be used for laser surgery.)
Effective January 1, 2009 — maximum of $250 every 24 months per covered adult, and
every 12 months per dependent child; (may also be used for laser surgery).
Note: This benefit is payable 100% to benefit plan limits.
No annual deductible on this benefit.
Vaccinations for travelling outside of the country
expenses incurred due to treatment for diseases, conditions or injuries for which care,
benefits or services are provided by or under MSP, Hospital Insurance Plan or Pharmacare; or for
which care, benefits or services are provided without cost or at a nominal cost by public
authorities
nicotine transdermal system ("the patch"), or nicotine gum
(except as provided under the Quittin' Time
Program. For more information, visit the Quittin' Time website at
www.quittinTime.gov.bc.ca
).
expenses of a physician and/or surgeon, except for limited expenses for emergency treatment
while traveling outside BC
transportation charges or living expenses incurred for elective treatment and/or diagnostic
procedures
vitamin preparations (excepting Vitamin B12 for the treatment of pernicious anemia), food
supplements, mineral supplements, remedies prescribed by a naturopath or a podiatrist, HCG
injections, those drugs not approved under the Food and Drug Act for sale and distribution in
Canada, medications available without a prescription, travel for health or health examinations
of any kind
expenses incurred due to war (declared or undeclared) or an act of war or participation in a
riot or civil insurrection
expenses incurred due to suicide or attempted suicide
orthoptic treatment, refractions, or prescriptions for any of them
expenses incurred due to dental services, except as a result of accidental injury
any portion of a specialist's fee not allowable under MSP due to non-referral, or an amount
of fees charged by any practitioner in excess of the recognized fees for such service
x-rays taken by a podiatrist, chiropractor or naturopathic physician
expenses incurred due to services and supplies for cosmetic purposes
expenses incurred outside the province on an elective basis; services will only be allowable
for an unexpected illness or injury (emergencies) while the insured person is temporarily visiting
in other provinces of Canada or other countries
expenses contributed to or caused by occupational disabilities
services performed by any person who is related to or residing with the member, spouse or
dependent
expenses incurred for services and supplies received for an illness for which you or one of
your dependents were hospitalized on the effective date of insurance — unless such services and
supplies are received after a three-month period during which no services and supplies were
received in respect of that particular illness
service, treatments, or supplies expenditures in excess of reasonable and customary charges
or which are not reasonably necessary for the care and treatment for the illness or injury
The Dental Plan is designed to cover basic dentistry, or the services that are
routinely available in the office of a general practicing dentist and are necessary to restore or
maintain teeth.
Dental coverage outside of BC:
Dental benefits apply in the event of an emergency while traveling or on vacation anywhere outside
of BC, and will be reimbursed up to the amount that the plan would have paid had the service been
done in BC. Include an itemized statement with your claim.
If you change your dentist after a course
of treatment has begun, please notify both dentists and the carrier. Payment will be made provided
there is no duplication of services.
Your
responsibility:A dentist may charge more for services than the amount set in
the governing schedule of fees or more frequently than provided in the fee guide. You
should confirm the amount payable under this plan before dental services are performed. You are
responsible for any financial liability resulting from services performed which are not covered
or exceed the costs covered by the plan.
As an employee under this plan, it is your
responsibility to contact Pacific Blue Cross to verify that certain procedures are
covered prior to the treatment being performed. This web guide is a general outline on services
covered for the dental plan. For more in-depth information call Pacific
Blue Cross and/or register for
CARESNET
to view your personal account.
You will be 100 per cent reimbursed for the cost of basic dentistry, which
includes those services routinely available in the offices of general practicing dentists.
Cast crowns, bridges, removable prosthetic appliances or orthodontic services
are partially covered under parts B and C of the plan.
When services are performed by a specialist, the fee is equal to that of a
general practitioner, plus 10 per cent, or the current BC specialist fee guide amount, whichever
is less.
Some specialist procedures are not eligible.
Diagnostic services covered include:
examinations, consultations, pathological reports and other diagnostic
aids
A specific oral examination will be paid once for any specific area and only if a
standard oral examination has not been paid within the previous 60 days
A complete oral examination will be paid to a maximum of once every three years, but
not if the plan has paid for any examination during the preceding nine months. The fee for
a complete oral examination will be reduced by the amount of any examination paid by this
plan within the previous nine months.
X-rays are paid for, up to the maximum established by the carrier for the calendar
year. Full mouth X-rays are covered to a limit of once every three years
Preventive services are covered as follows:
For dependents up to and including age 18, general recall services (oral exam,
polishing, scaling and fluoride) are covered once every six (6) calendar months
For adults and students covered under the dental plan, age 19 and older, these
services are covered once every nine (9) calendar months. If additional coverage is
required for those with oral hygiene or specific periodontal conditions, a clinical
description may be submitted by the dentist for review by the carrier, before the
additional coverage is paid.
space maintainers — to maintain, but not to obtain more space
Surgical services covered include:
all necessary procedures for extractions and other surgical procedures
normally performed by a general practising dentist
gums and bones (periodontal services): procedures necessary for the
treatment of disease of the soft tissue (gum) and the bones surrounding and supporting the
teeth, but not tissue grafts
root canals (endodontic services)
treatment of disease of the pulp chamber and pulp canal
Restorative services covered include:
amalgam and composite (white) fillings
specialty crowns and fillings such as synthetic porcelain plastic, composite resin,
stainless steel and gold may result in additional cost to be paid by the employee or
dependent
Denture repairs (prosthetics):
The Dental Plan covers the repair of fixed appliances and the repair or
reline of removable appliances that may be done by a dentist or a licensed dental mechanic.
Relines will only be covered once in any 24-month period. Service of a temporary nature while
waiting for a new denture to be made is not covered.
Those services required for major reconstruction of badly-decayed teeth, and
replacing missing teeth such as crowns, bridges and dentures are 65 per cent covered, once every
5 years only.
You should submit a treatment plan to the carrier for approval before treatment
begins, in order to determine how much of the cost will be paid by the plan, and the extent of
your liability.
Crowns
Restoration for wear, acid erosion, vertical dimension and/or restoring
occlusion is not covered. You should check with the carrier before proceeding.
Prosthetics
This includes:
removable prosthetics: full upper and lower dentures or partial dentures
of basic standard design and material. Full dentures may be provided by a dentist or a licensed
dental mechanic. Partials may only be provided by a dentist; and
fixed bridgework to artificially replace missing teeth with a fixed
prosthesis.
Replacement and repairs
A crown, bridge or denture is covered under this plan, but only every five
years. The repair costs are covered as required, provided that they are not of a temporary nature
while you are waiting for a new denture to be made.
The Medical Services Plan of BC (MSP) is your basic medical coverage. MSP insures medically
required services provided by general practitioners, specialists, laboratory services and
diagnostic procedures.
The Pharmacare division of the Ministry of Health provides financial
assistance for the purchase of prescription drugs. Pharmacare does not
provide out-of-province benefits.
Your annual deductible will be based on your family income and you are
required to register in order to receive the maximum benefit under the
plan. It is recommended that all employees register.
To register online visit: <http://www.healthservices.gov.bc.ca/pharme/>
or call the Fair Pharmacare Registration Desk at: 1-800-387-4977
After you reach your annual deductible, Pharmacare will reimburse you
for 70 percent of eligible expenses.
For information on Pharmacare and Extended Health Plan reimbursement
integration see Extended Health (Making a Claim
Involving Pharmacare) on this site.
If the Benefits Service Centre is unable to assist you with your inquiry
regarding MSP or Pharmacare, please contact:
Hospital benefits are provided to all eligible residents of BC. There may be a
small user fee charge for acute care, in-patient or out-patient services received in BC.
Reimbursement from MSP for hospital charges outside Canada is very limited.
The user fee may be eligible for reimbursement through your Extended Health
Benefit. The ambulance service does not provide out-of-province benefits. For more information
regarding ambulance service within BC, contact the BC Ambulance service at:
http://www.healthservices.gov.bc.ca/bcas/index.html
