Member Benefits

Extended Health benefits are designed to help reimburse those health care expenses for you and your eligible dependents that are not covered by your provincial health insurance program.

Eligible expenses are defined as charges for any services and/or supplies included in the contract as a benefit that is considered by the insurer to be a customary charge medically necessary for health care and maintenance, ordered/preferred by a Physician (unless otherwise specified), not normally paid by a Government plan or any other Provider of health coverage, and incurred while the Member or Dependent is covered under the contract for the expense being claimed.

Extended health coverage may include (depending on the Plan in your District) reimbursement for health-related expenses such as: prescription drugs; private or semi-private hospital accommodation; paramedical services such as physiotherapists, chiropractors and registered massage therapists; vision care; medical supplies and services such as blood glucose monitors, hearing aids and private out-of-hospital nurse services; accidental injury to natural teeth; and out of province emergency medical services.

If both you and your spouse have coverage under your employers’ plans, you may be able to coordinate your claims between the two plans. By doing so, you may be eligible to receive up to 100% reimbursement for your eligible claims.

If you are not sure if a health-related expense is eligible, or if you expect a major expense, you should confirm your coverage with the Insurer before incurring the expense. All eligible expenses reimbursed by the Insurer are subject to their reasonable and customary limits.

All benefit plans have restrictions that are designed to ensure that the plan is used only as intended. Your benefit plan will not reimburse any health or dental expenses resulting from the following, to the extent that monies are received, expenses reimbursed under any other group or individual benefit plan or for which any third party is liable:

General Exclusions include:

1. Pacific Blue Cross will not be liable for any portion of an expense for which a Member or Dependent is entitled to reimbursement under any other group or individual benefit plan or insurance policy, or due to the legal liability of any other party.
2. In no event will benefits be payable for expenses resulting directly or indirectly from, or in any manner or degree associated with, any of the following:
   1. intentional self-inflicted injury while sane or insane, war, whether declared or undeclared, or any act of war, or participation in a riot, insurrection, or civil commotion
   2. active duty in the military forces of any nation or international organization, or in any civiilian noncombatant unit which serves with such forces in combat
   3. a direct or indirect attempt at, or commission of, an indictable offence under the Criminal Code of Canada or simlar law of any other country
   4. any injury, illness, or condition for which care is provided or may be provided or available without cost by public authorities or by a tax-supported agency, included preventive treatment and services available under any Workers’ Compensation Act or similar plan.
3. Any payment demanded or received by means of balanced billing, extra billing, or extra charging which results in an excess of the schedule of costs prescribed by the provincial health plans
4. For residents of Alberta or Washington State working in British Columbia, charges in excess of the charges that would otherwise apply had you resided and had services been performed in British Columbia.

The following are not Eligible Expenses under the Extended Health benefit:

1. Except as specifically provided in your District’s Contract: dentures or dental treatments, hearing aids, eyeglasses, contact lenses, surgical lens implants, or examinations for the prescription or fitting of any of these, x-rays, hospital coinsurance, vitamins and/or minerals, contraceptives, fertility drugs, erectile dysfunction drugs, medications used to treat or replace an addiction or habituation, support stockings, orthotics, arch supports, transportation charges incurred for elective treatment and/or diagnostic procedures, or for health or health examinations of any kind.
2. Charges for the rental of a telephone, television or similar equipment in a Hospital.
3. General anesthetic, medications used to prevent baldness or promote hair growth, food replacements or supplements, HCG injections, drugs not approved for sale and distribution in Canada, and medications available without a prescription.
4. Allergy testing unless rendered by a naturopath.
5. Personal comfort items, items purchased for athletic use, air humidifiers and purifiers, services of Victorian Order of Nurses or graduate or licensed practical nurses, services of religious or spiritual healers, occupational therapy, services and supplies for cosmetic purposes, public ward accommondation, rest cures.
6. Charges for completion of forms or written reports, communication costs, delivery and mailing or handling charges, interest or late payment charges, non-sharable or capital costs levied by local hospitals, or charges for translating documents into English.
7. Professional services of Physicians or any person who renders a professional health service in the patient’s province of residence, except as expressly provided in the District’s Contract.
8. That portion of a claim normally covered by a Government plan which has been refused on the basis that the claim was not submitted within that plan’s time limits.
9. Out-of-province expenses incurred due to elective treatment and/or diagnostic procedures, or complications related to such treatment.
10. Out-of-province expenses incurred due to therapeutic abortion, childbirth, or complications of pregnancy occurring within 2 months of the expected delivery date.
11. Charges incurred outside the province/territory of residence for continuous or routine medical care normally covered by the Government plan in the person’s province/territory of residence.
12. Expenses of a Dependent hospitalized at the time of enrolment.
13. Services performed by a Physician who is related to or resident with the Member or Dependent.
14. Any drug, vaccine, item or service classified as preventative treatment or administered for preventive purposes, and which is not specifically required for the treatment of an existing illness or injury.
15. Fees for ambulance services when an ambulance is called but not used.
16. Ambulance charges for work related illness or injury assessed by Workers’ Compensation Board to be the employer’s responsibility.
17. Retroactive coverage and payment of any expense, include expenses that receive special authorization from PharmaCare.
18. Any other item not specifically included under benefits.

Dental benefits are designed to help you and your family pay for eligible dental expenses.

Eligible expenses are defined as charges for any services and/or supplies included in the contract as a benefit that is considered by the insurer to be a customary charge medically necessary to maintain or restore teeth, ordered/preferred by a Dentist (unless otherwise specified), not normally paid by a Government plan or any other Provider of health coverage, and incurred while the Member or Dependent was covered under this Contract for the expense being claimed.

Basic dental coverage provides reimbursement for routine dental services provided to maintain good dental health such as regular check-ups, cleanings and fillings, and may include restorative and endodontic procedures (such as surgical services and root canals). Major dental coverage includes treatments that are not included under the basic coverage such as crowns, bridges and dentures. Orthodontic procedures include treatments such as braces and retainers used to assist in re-aligning teeth.

If both you and your spouse have coverage under your employers’ plans, you may be able to coordinate your claims between the two plans. By doing so, you may be eligible to receive up to 100% reimbursement for your eligible claims.

If you are not sure if a dental expense is eligible, or if you expect a major expense, you should confirm your coverage with the Insurer before incurring the expense.

The following are not included as eligible expenses under your dental plan:

1. Expenses for benefits, care, or services provided without cost or at nominal cost by any government plan or any public or tax supported authority or agency.
2. To the extent that monies are received, expenses reimbursed under any other group or individual benefit plan or for which any third party is liable.
   Expenses incurred due to intentional self-injury or due to war, riot, or insurrection, or service in the military forces of any country, or arising from a direct or indirect attempt at or commission of an indictable offence under the Criminal Code of Canada or under similar law of any other country.
3. Charges for services commenced prior to the effective date of coverage, and expenses incurred after the termination date of coverage.
4. Charges for broken appointments, oral hygiene or nutritional instruction, completion of forms, written reports, or communication costs.Procedures performed for congenital malformations or for purely cosmetic reasons.
5. Charges for drugs, general anesthesia, pantographic tracings, grafts, implants and/or services performed in conjunction with implants.
6. Services and supplies for a full mouth reconstruction, a vertical dimension correction, or correction of a temporomandibular joint (jaw structure) dysfunction.
7. Incomplete or temporary procedures.
8. Recent duplication of services by the same or different dentists/denturists such as, but not limited to, the replacement of existing fillings for reasons other than damage caused by erosion or decay.
9. Services performed by any person who is related to or resident with you or your dependant.
10. Any extra procedure which would normally be included in the basic service performed.
11. Items not listed in the carrier’s fee schedule.
12. Services or items which would not normally be provided, or for which no charge would be made, in the absence of insurance.
13. Any other item not specifically included as a benefit.

Life insurance is intended to help protect your family’s financial security in the event of your death.

All premiums for life insurance that are paid by the District are considered a taxable benefit, and will be added to your taxable income. Benefits paid to your beneficiary(ies) are not taxed.

Your designated beneficiary(ies) will receive any life insurance benefits payable under the Plan in the event of your death. You may name any person(s) and/or organization(s) as your beneficiary(ies).

If you do not designate a beneficiary, any benefits payable will go to your estate.

You may designate or change your beneficiary(ies) at any time.

For more information about designating your beneficiary, you may consider seeking legal counsel.

Optional Life coverage is available for you to purchase in units of $10,000 to a maximum of $300,000.

Optional life insurance would be paid to your beneficiary(ies) in addition to your basic life insurance coverage in case of your death.

You pay the entire cost of your optional life insurance. The cost of this coverage is based on your selected coverage amount, age, gender and smoking status. Evidence of good health may be required for approval of coverage.

Rate table

To apply, an Optional Life Application will need to be completed and submitted to the insurer for approval.

Your designated beneficiary(ies) will receive any optional life insurance benefits payable under the Plan in the event of your death. You may name any person(s) and/or organization(s) as your beneficiary(ies).

If you do not designate a beneficiary, any benefits payable will go to your estate.

You may designate or change your beneficiary(ies) at any time.

For more information about designating your beneficiary, you may consider seeking legal counsel.

Accidental Death and Dismemberment (AD&D) benefits are designed to provide financial security in the event that you are in an accident that results in loss of life, or loss of or loss of use of limbs, sight, hearing or speech.

Accidental Death & Dismemberment benefits provide coverage 24 hours a day, 7 days a week. In the event of death due to an accident, the benefit is payable to your beneficiary(ies) in addition to life insurance. The schedule of the ‘accidental loss of life’ and eligible ‘accidental loss of and loss of use’ claims is defined in your Plan.

Accidental Death & Dismemberment insurance typically terminates when you retire, reach age 70 or are no longer eligible for this benefit.

Your designated beneficiary(ies) will receive any Accidental Death & Dismemberment insurance benefits payable under the Plan in the event of your accidental death. You may name any person(s) and/or organization(s) as your beneficiary(ies).

If you do not designate a beneficiary, any benefits payable will go to your estate.

You may designate or change your beneficiary(ies) at any time.

For more information about designating your beneficiary, you may consider seeking legal counsel.

Click Details for information on your District’s Accidental Death & Dismemberment benefit provision.

The Optional Accidental Death and Dismemberment plan insures you 24 hours a day, world-wide. This coverage provides a lump sum, tax-free benefit in the event of an accident causing death, loss of (or loss of use of) limbs, loss of sight, speech or hearing. The amount of your coverage is doubled for paraplegia, quadriplegia and hemiplegia.

Optional Accidental Death and Dismemberment coverage is available in units of $10,000 to a maximum of $500,000. The monthly Single rate (employee only coverage) is $0.12 per $10,000 of coverage and the month Family rate (employee and dependents) is $0.18 per $10,000 of coverage. Please note that these rates are based on payroll deductions over 12 months.

You may choose to purchase Optional Accidental Death & Dismemberment insurance for yourself only, or for you and your family. Accidental death benefits payable under this coverage are in addition to any life insurance coverage you may have.

If you select family coverage, the benefit paid for your spouse and/or children will be a percentage of your coverage. The benefit amount payable depends on both your Plan rules as well as the composition of your family at the time of the claim.

You pay the entire cost of your Optional Accidental Death & Dismemberment insurance for you and your family. The cost of this coverage is based on your coverage amount and the type of coverage you select.

To apply, the Optional AD&D application form must be completed and signed and coverage is effective on the first of the month following receipt of your completed

Click Details for information on your District’s Optional Accidental Death & Dismemberment benefit provision.

Eligible Principals & Vice-Principals and Excluded Staff members have their disability benefits through the British Columbia Principals’ & Vice-Principals’ Association (BCPVPA). Click here for more information  on the disability provision through the BCPVPA disability plan. Please contact your School District Benefits Administrator for any additional questions.

Teachers have their disability benefits administered by the British Columbia Teachers Federation (BCTF) through a Salary Indemnity Plan (SIP). The plan provides short-term and long-term benefits to eligible plan members. Click here for more information on the SIP administered through the BCTF. Please contact your School District Benefits Administrator for any additional questions.

This information does not create or confer any rights. The exact terms of the plan are described in the more detailed provisions of the group benefits agreement or contract. In the event of a discrepancy between this information and the group contract, the terms of the contract will be applicable.