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Health Claims

This section describes the claims process for each benefit. It also explains how you can coordinate health and dental benefit payments with your spouse's/partner's plan.

All eligible extended health claims must be submitted to the Insurer by December 31 of the following calendar year in which the individual incurred the expense.

Provincial healthcare programs

All employees should register for their provincial healthcare programs to ensure maximum coverage (ie: Pharmacare in British Columbia and Special Support Program in Saskatchewan and Manitoba). Certain high-cost prescription drugs are government funded and require special approval from the province's health care program. In order to qualify you must register before you are eligible for reimbursement.

Submitting claims by mail

To submit eligible extended health claims by mail, for Pacific Blue Cross (PBC) groups print and complete the Extended Health Care Standard Claim Form. To submit eligible extended health claims by mail for Green Shield Canada (GSC) groups, print and complete the GSC Extended Health Care Claim Form. Ensure that all information on the form is complete and clearly legible. Pacific Blue Cross/Green Shield Canada will mail the cheque for your eligible expenses directly to your home.

Prescription Drugs

If your plan includes a "pay-direct drug card" transactions will occur at the point of sale (i.e. at a pharmacy). In some cases, paper claim submission  is required for prescription drug expenses. In this case, you pay for the cost of the prescription drug, then complete Pacific Blue Cross's Extended Health Care Standard Claim Form (PDF) or the Green Shield Canada Extended Health Care Claim Form and forward it to the insurer with the original receipt(s) attached.

If, for any reason, you have a pay-direct drug card and it was not used at the point of sale, simply complete the Extended Health Care Claim form for either Pacific Blue Cross or Green Shield Canada and attach the original receipt(s).

Pre-authorization for Extended Health and Dental Care Claims

For any extensive course of treatment involving crowns, bridgework, etc., we recommend you ask your dentist to complete a cost estimate before the work is completed. Have your dentist send the estimate to Pacific Blue Cross/Green Shield Canada's claim department to determine how the expenses will be reimbursed.

Pre-authorization is also required for any extended health care durable medical supply expense exceeding $5,000.

Submitting Claims online

For GSC online services:

  1. Visit greenshieldcanada.ca with your GSC ID card handy.
  2. Sign in as a 'Plan Member' and click on 'Register'.
  3. Create a user name and password and provide all of the requested information. Complete your registration by clicking on 'Register'.
  4. For your security, you also need an access code. An email containing your confidential access code will be automatically sent to you.
  5. Upon receipt of your access code, sign in to Plan Member Online Services, then enter your access code and click 'Submit'. You are now fully registered!

Take the online experience mobile with the GSC on the Go™ app - Once you've signed up for Online Services, you're also signed up for our GSC on the Go app. Just download the app and use your Plan Member Online Services user name and password to get started. GSC on the Go gives you many of the same great features you'll find online, including online claims submission, an electronic ID card, provider lookup, and more.

For more information about Green Shield Canada, visit greenshield.ca.

Pacific Blue Cross CARESnet

More and more members rely on CARESnet to access information about their Blue Cross benefit plans. We encourage all Pacific Blue Cross and BCCA benefit plan members to register for CARESnet. To register for CARESnet or to take an online tour, click here. If you have any questions or require more information, contact Pacific Blue Cross.

Your benefits on the go...Download CARESnet Mobile for easy access to your benefits anytime, anywhere.

Coordination of Benefits

You may be able to coordinate your benefits if your spouse also has coverage under another employer's health and/or dental care plan. This means that as long as your spouse has couple or family coverage, you can submit claims to your spouse's benefit plan (and vice versa). If one plan does not refund 100% of the expenses, the other plan will refund the difference, subject to the plan limits.

There are some rules about coordinating health and/or dental benefits:

  • To coordinate benefits with a spouse, you both must be covered under an employer's health and/or dental care plan. At least one of you must have couple or family coverage. 
  • You or your spouse can never receive a refund of more than 100% of eligible expenses. 
  • You must always submit claims for expenses incurred for yourself through your BCCA Employee Benefits insurer first. Make sure photocopies of your receipts are kept. If the refund is less than 100% of the cost, you can then submit a claim for the difference to your spouse's plan. 
  • Your spouse must always submit claims for expenses incurred for himself or herself to his or her own plan first. If your spouse's refund is less than 100% of the expense, then he/she can submit a claim for the difference to BCCA Employee Benefits. 
  • Claims for dependent children must go first to the plan of the parent whose birthday comes first in the calendar year. If you and your spouse have the same birthday, submit the children's claims to the plan of the parent whose first name comes first in the alphabet. If you and your spouse are separated or divorced, the child's claim must go first to the plan of the parent who has custody of the child.

    You will receive an explanation of benefits from the first Insurer that processes the claim. This statement must be attached to the second claim form. You should also attach copies of their receipts.

    Medical Travel Benefit (MTB)

    To submit an eligible MTB claim, print and complete the PBC Standard Health Care Claim Form (PDF) or the GSC MTB Claim Form (PDF). A pre-authorization is recommended for MTB claims to ensure that the submitted expenses are eligible. Mail the completed form to the address noted on the form. A cheque for your eligible expenses will be mailed directly to your home if approved.

    Out-of-Country Claims For Pacific Blue Cross Groups

    Click here for information on out-of country/province claims for PBC.

    Pacific Blue Cross will coordinate the claim with the Medical Services Plan of British Columbia directly on your behalf. Claims should be made promptly as the MSP claiming deadline is 90 days from the date of service.

    Please note that in the event of a medical emergency while out-of-country, you should contact the travel assistance provider immediately to arrange payment. For any trips out-of-country, even of short duration, please ensure to carry your Medi-Assist card with you and your Pacific Blue Cross ID card, so this information is easily accessible.

    Canada/U.S. (toll-free): 1-888-699-9333
    All Other Countries (collect): 1-604-419-4487

    The customer service representatives at Medi-Assist can help co-ordinate the coverage options.

    Out-Of-Country Claims for Green Shield Canada

    Click here to learn more about your travel benefit.

    Your GSC travel benefits are provided by our partner, Allianz Global Assistance. Through Allianz Global Assistance, you can take advantage of a vast network of medical providers, resources and contacts, all offering quality service, when you travel outside your home province.

    If your emergency is such that you require immediate medical assistance call for an ambulance (911 if available where you are located). Once you arrive at the hospital have a family member contact GSC Travel Assistance to open a case. The contact number is 1-800-936-6226 toll free. If the toll free number does not work, you can use the collect number: operator+519-742-3556. GSC Travel Assistance is available 24/7 including holidays. GSC must be contacted by phone within 48 hours of commencement of treatment. You can also call this number prior to leaving your province of residence for pre-trip assistance.

    When contacting GSC Travel Assistance, quote the group number and the GSC ID number on your card. If your emergency is one that does not require immediate urgent medical assistance, contact GSC Travel Assistance to open a case prior to seeking medical treatment.

    Dental Claims

    You must submit all eligible dental claims within 90 days of the completion date of services. Failure to submit a claim within the 90 day limit will not invalidate the claim if it is submitted as soon as reasonably possible. In no event will PBC/GSC pay any claim or adjustment submitted later than 1 year from the date the expense was incurred.

    An expense is incurred on the date the dentist performs a single appointment procedure. For procedures that take more than one appointment, the employees incur the expense until the entire procedure is completed. You may be required to provide the dentist's statement of the treatment received, pre-treatment x-rays and any additional information considered necessary by PBC/GSC.

    Submitting dental claims electronically

    Your dentist may be able to send claims electronically to the Insurer, which can facilitate payment for dental claims directly between PBC/GSC and your dentist. You should discuss this option with your dentist.

    Submitting dental claims by mail

    To submit eligible dental claims by mail, print the PBC Dental Claim Form the standard dental claim form supplied by the dentist can also be used) or for Green Shield Canada groups use the GSC Dental Claim Form.

    Sign and date the form. Mail the completed form to the appropriate insurance carrier. The cheque for your eligible expenses will be mailed directly to your home.

    Disability Claims

    If you become disabled and are unable to perform the duties of your own occupation, you should apply for Long Term Disability and Life Waiver of Premium. If your BCCA employer plan includes Short Term Disability coverage, you should apply for this benefit immediately. If your plan does not include this benefit, you should contact your local Employment Insurance (EI) office to inquire and apply for EI Disability benefits.

    Note that provided you qualify for Long Term Disability benefits, benefit payments will not begin until the Elimination Period (waiting period) under your particular plan has been satisfied.

    For all claims of this nature, please contact your Benefits Administrator at your place of employment as soon as possible. Instructions will be provided at that time, including the necessary claim forms which will require completion.

    Your Benefits Administrator will forward these forms to the BCCA Employee Benefits office who will then forward them to the insurer for processing. 

    Note: to maintain confidentiality of medical information, please return any forms with medically related information to your Benefits Administrator in a sealed envelope. Your Benefits Administrator/Employer does not have to see this information.

    • Claims must be submitted six to eight weeks before the end of the Elimination Period (for Long Term Disability) and as soon as possible after the date of disability for Short Term Disability claims (refer to your benefit summary for the applicable elimination periods for both Long and Short Term Disability benefits).

    If you are eligible for Worker's Compensation (WCB) Benefits, you will receive a Worker's Compensation claim form from your physician. However, you should still apply for Long Term Disability benefits as well as Life Waiver of Premium. WCB disability benefits are typically higher than what you would receive through your LTD plan and are deducted from any disability benefit you may become eligible for. However, although you may not receive payment now, if you stop receiving benefits from WCB and are still deemed to be disabled, you may still be able to claim for LTD benefits in the future. As well, the benefit premiums would be waived during the disability period if you qualify for waiver of premium. Please contact your Benefits Administrator in these situations.

    Continuation of Extended Health and Dental Care benefits while disabled

    Please note that under the BCCA Employee Benefits' plan, at the employer's request, EHC and Dental coverage can continue for one year from the date of approval for LTD benefits for disabled employees provided premiums continue to be paid. After this one year period, the disabled employee has 60 days to convert their EHC/Dental coverage to an individual plan if they wish. Information regarding conversion of EHC/Dental benefits is provided under the Converting Benefits for Extended Health and Dental Care section of this site. Under no circumstances will EHC/Dental coverage continue for more than 1 year from the date of approval for LTD benefits.

    AD&D or Voluntary AD&D Insurance Claims

    In the event of accidental injury or death, you or your Beneficiary should contact your plan's Benefits Administrator as soon as possible, who should then contact the BCCA Employee Benefits office. Instructions will be provided at that time, including the necessary claim forms which will require completion.

    The insurer will also require the following documents:

    • Proof of Death - Original Provincial Death Certificate (or certified copy).
    • Newspaper clipping, if available (for AD&D claims)
    • Police Report (for AD&D claims)

    Once all forms are completed by the appropriate individuals, the original forms and supporting documents should be forwarded to your Benefits Administrator. Your Benefits Administrator will forward these forms to BCCA Employee Benefits who will then forward them to the insurer for processing. Please note that in some cases the insurer may request a toxicology or autopsy report to verify the cause of death.

    Life Claims

    In the event of accidental injury or death, you or your Beneficiary should contact your plan's Benefits Administrator as soon as possible, who will then contact BCCA Employee Benefits. Instructions will be provided at that time, including the necessary claim forms which will require completion.

    The insurer will require the following documents:

    • Proof of Death - Original Provincial Death Certificate (or certified copy) or Funeral Director's Statement of Death.

    Once all forms are completed by the appropriate individuals, the original forms and supporting documents should be forwarded to your Benefits Administrator. Your Benefits Administrator will forward these forms to BCCA Employee Benefits who will then forward them to the insurer for processing.

    Beneficiary Designation

    It's important to note that along with the above forms, BCCA Employee Benefits will include your original enrolment card and any beneficiary change forms for Life claims and a copy of your enrollment card/change forms for Dependent Life/AD&D/Optional Life claims. Because of this, it is important to ensure your beneficiary designation is up-to-date.


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