Extended Health Claims

You must submit all eligible extended health claims to the Insurer by June 30 or December 31 (depending on your District’s policy) of the calendar year following the calendar year in which you incurred the expense.

If you terminate employment with the District, or are no longer eligible for employee benefits under the BCPSEA Buying Group program, you must submit all claims incurred before your termination within 90 days after you leave or after you are no longer eligible for coverage.

For employees who wish to submit their health claims online or would like specific details of their coverage, we encourage you to enroll and access PBC’s member portal (PBC Member Profile – bluecross.ca).

For questions regarding the status of your claims you can contact PBC’s Call Centre directly at (604) 419-2600 or toll free 1-888-275-4672.

• To submit eligible extended health claims by mail, print and complete the Extended Health Claim form.
• Ensure that all information on the form is complete and clearly legible.
• Incomplete or missing information will delay the processing of your claim.
• Sign and date the form.
• Attach all receipts, or photocopies of receipts if accompanied by an explanation of benefit from another carrier, to the form. Claims cannot be considered or paid without supporting receipts. Keep copies of your receipts and form for income tax and other purposes.
• Provide explanation or proof to support the claim, such as itemized bills, attending Physician’s statement, or any other information PBC considers necessary.
• Mail the completed form to Pacific Blue Cross.

Pacific Blue Cross (PBC) will mail the cheque for your eligible expenses directly to your home.

For questions concerning the status of your claims you can either contact PBC’s Call Centre directly at (604) 419-2600 for EHC claims or toll free 1-888-275-4672. You can also view the status of your claims by accessing the PBC CARESnet website.

You may use your pay direct prescription drug card to purchase prescription drugs at participating pharmacies. When you have a prescription filled, present your card to the pharmacist. The pharmacist will submit the claim directly through the card to PBC.

If your District’s plan allows Coordination of Benefits, you cannot use your drug card for your spouse’s expenses if he or she has prescription drug coverage under his or her employer’s plan. Your spouse must submit claims to his or her own plan first. See Coordination of Benefits.

As well, you cannot use your drug card for your child(ren)’s expenses if your spouse’s plan is the first payer. However, you can submit the balance of these claims (if any) to your plan if you select family coverage. To do so, follow the instructions for submitting claims by mail, as outlined above. See Coordination of Benefits.

Your pay direct prescription drug card is available from Pacific Blue Cross.

You must complete an Emergency Out-of-Province Claim form and forward to Pacific Blue Cross with attached itemized bills outlining the services for which you were charged.

Pacific Blue Cross will coordinate your claim with the Medical Services Plan of British Columbia direclty on your behalf. This process is explained on the first page of the claim form.

• You should ensure that claims are made promptly as the MSP claiming deadline is 90 days from the date of service.
• You must sign the Members Statement and Patient’s/Guardian’s Authorization for Release of Information in the space provided regardless of whether the Employee incurred the expense.
  • If your Spouse incurred the expense, both you and your Spouse must sign in the spaces provided.
  • If you incurred the expense, you must sign both spaces “Member’s signature” and Patient’s signature or parent/guardian if patient is a minor”