Frequently Asked Questions

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Frequently Asked Questions2022-01-24T07:35:09-08:00

Answers to a variety of frequently asked questions

This section of the BCPSEA benefits website is intended to help you navigate what happens to your benefits in the case of different work and life circumstances. You will note commonly asked questions and the action(s) that may be required. It’s important to note that some of these situations may require immediate action either by you, or by your District’s Benefits Administrator.

If your situation is not listed and you require additional information, contact the Benefits Administrator at your District.

What happens if I make a false statement concerning my or my Spouse’s smoking habits?2022-02-03T08:47:13-08:00

If an Optional Life or Optional Spouse Life insurance claim is filed and the smoking habits have been misrepresented, the claim will be denied. Any premiums which have been paid will be refunded.

If I am presently being charged a smoker rate for Optional Life or Optional Spouse Life insurance, can this rate be changed to a non-smoker rate at a later date?2022-02-03T08:47:26-08:00

Yes.

If the Insured has abstained from the use of tobacco products for at least the past 12 consecutive months, he or she may apply for the preferred non-smoking rate by completing the Smoker Declaration form.

I have optional life insurance for myself and/or my Spouse. Is it necessary to periodically complete a form to ensure that my smoking habits, or that of my Spouse, have not changed?2022-02-03T08:47:37-08:00

No.

The only time that you or your Spouse must again attest to your smoking habits is when there is a change in the amount of optional life insurance. If an increase is requested, the Smoker Declaration form must be completed on the Application, indicating the smoking status at the time of the requested increase.

Can I waive coverage?2022-02-03T08:48:41-08:00

Most if not all of the benefits offered by the District through the BCPSEA Benefits Program are mandatory as part of your employment with the District.

You may waive extended health and dental for yourself and all Eligible Dependents if you have coverage under another plan (ie. Spouse’s employer’s plan) by completing the BCPSEA Benefits Change form (for new hires) or Waiver of Coverage form, and providing evidence of the other benefits plan (if applicable at your District).

If you wish to apply for previously waived benefits coverage at a later date, you should refer to the sections on Changes – Life Events and Late Applicants.

If I become disabled, are the premiums for my benefits continued?2022-02-03T08:48:52-08:00

If you become disabled, you may be eligible for long term disability (LTD), Workers’ Compensation and/or other disability insurance benefits.

If you are approved for LTD benefits by the insurer, your premiums for LTD will be waived as long as you meet the definition of disability.

You may also be eligible for waiver of life insurance, optional life insurance, and/or accidental death & dismemberment premiums.

The insurers have strict application timelines, so you should contact your Benefits Administrator as soon as possible after you become disabled for more information.

Am I required to register for PharmaCare?2022-02-03T08:49:05-08:00

If you are a BC resident and enrolled with the Medical Services Plan (MSP), you can register your family to receive your maximum financial assistance under Fair PharmaCare. Your family includes you, your spouse and any dependent children whose Medical Services Plan coverage is on the same contract as you or your spouse.

Your extended health coverage (EHC) through Pacific Blue Cross requires that you take advantage of other plans that are available to you, such as the Fair PharmaCare program. As a result, the EHC plan will only pay for eligible drugs up to your deductible and amounts that exceed the 70% PharmaCare co-payment. In other words, your EHC plan does not provide coverage for drug expenses that are eligible under the Fair PharmacCare program. After you reach a certain threshold of drug expenses, PBC will contact you to request proof that you have registered with the Fair PhamaCare program.

You can still register for PharmaCare. As part of the registration process, you will be asked for your family’s annual net income based on your previous year’s income tax returns. You will also be asked to provide authorization for the Canada Revenue Agency (CRA) to send information from your tax return to Fair PharmaCare. You will be advised of your annual Fair PharmaCare deductible at time of registration, and will receive notice each year for the following year’s annual deductible.

You can contact PharmaCare at 1-800-663-7100 (8:00 AM to 8:00 PM weekdays, 8:00 AM to 4:00 PM weekends). You can also register on-line at www.gov.bc.ca.

Should I purchase additional out-of-country travel insurance when traveling outside of Canada?2022-02-03T08:49:16-08:00

You are strongly encouraged to check into additional out-of-country emergency medical insurance when traveling outside of Canada. Your benefits program may have Out-of-Country emergency medical insurance but this may not be sufficient in some cases.

What happens when I need to claim?2021-10-20T14:19:34-07:00

Forms for claiming reimbursement for out-of-province expenses can be found under “Making Claims”. You should note that the claiming deadline for MSP services is 90 days from the date of service.

An overview of your out-of-province plan can be found in “Details” in the Extended Health benefit section under “My Plan”.

What happens when I have a medical non-emergency while travelling?2022-02-03T08:49:27-08:00

While travelling outside your province of residence, you are eligible for reimbursement for non-emergency expenses subject to the following conditions:

  • Non-emergency expenses are reimbursed as if these expenses were incurred in your province of residence, subject to the Deductible, in-province reimbursement percentage, and maximums. See details under the Extended Health benefit under “My Plan” to find out what expenses are eligible in your province of residence.
  • Expenses payable or provided under a Government plan are not eligible for reimbursement.
What happens when I have a medical emergency while travelling?2022-02-03T08:50:13-08:00

While travelling outside your province of residence, you are eligible for reimbursement for the following expenses in an emergency:

  • Local ambulance services when immediate transportation is required to the nearest hospital equipped to provide essential treatment.
  • The hospital room charge and charges for services and supplies when confined as a patient or treated in a hospital, to a maximum of 90 days. Pacific Blue Cross should be notified within 5 days of your admission to hospital. If reasonable, you may be transported to the hospital nearest your home for further medical treatment. If this is not possible, the 90 day limit may be extended.
  • Services of a Physician and laboratory and x-ray services.
  • Prescription drugs in sufficient quantity to alleviate an Acute medical condition.
  • Other services and supplies depending on the coverage available under your plan.

Emergency travel assistance is also available through medi-assist, a plan which will coordinate the following services to:

  • Locate the nearest appropriate medical care.
  • Obtain consultative and advisory services (including second medical and surgical opinions and review of appropriateness, quality, and costs of hospitalization and outpatient procedures) from medical advisors under agreement with medi-assist.
  • Investigate, arrange, and coordinate medical evacuations and related transportation needs
  • Investigate, arrange, and coordinate the repatriation of remains.
  • Replace lost passports, locate qualified legal assistance and local interpreters, and other incidental aid required by the Member and/or Dependent in distress.

Click here for the medi-assist information brochure.

What happens when I travel outside my home province?2022-02-03T08:50:23-08:00

If you are a Member who is covered for Extended Health under the BCPSEA Buying Group, you may be eligible for coverage while travelling outside of your home province. Please refer to the Extended Health section under My Plan for coverage details.

Print off the medi-assist brochure if you will be travelling outside your home province. If a medical issue arises call the relevant number for immediate assistance and guidance.

Please note the following expenses are not covered when incurred out-of-province:

  • Expenses incurred due to elective treatment and diagnostic procedures, or complications related to such treatment.
  • Expenses incurred due to therapeutic abortion, childbirth, or complications of pregnancy occurring within 2 months of the expected delivery date.
  • Expenses for continuous or routine medical care normally covered by the Government plan in your province of residence.
What happens when I retire?2022-02-03T08:50:36-08:00

Prior to your retirement, it’s important that the following steps are taken to ensure a smooth transition from working life to retirement:

  • You are required to advise the Benefits Administrator of your retirement date in writing.
  • If you have any questions regarding coverage after retirement, contact the Benefits Administrator.

To obtain information regarding the conversion privileges for BCPSEA benefits:

  • You are eligible for the Conversion Privilege if application is received by the Insurer within 31 days following retirement date.
  • The insurer(s) will provide you with a package of information on applying for the Conversion Privilege. The packages will be mailed to your home address. Application is completely optional.
  • If you are interested in applying for the Conversion Privilege for Extended Health and/or Dental, you may access the following conversion form:
  • Extended Health/Dental Conversion form

Conversion Privileges

Basic Life, Optional Life and Optional Spouse Life Conversion Privilege

You can continue Basic Life insurance, Optional Life insurance and/or Spouse Optional Life insurance (if applicable) as an individual policy(ies) following termination or retirement from the District.

If you wish to do so, the following steps must be taken:

  • Contact Pacific Blue Cross using the contact information provided on the Notification of Conversion form and Group Life Conversion Privilege Notification Form that you should receive from your Benefits Administrator
  • The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of termination of BCPSEA benefits.
  • Some limits apply (ie. amount cannot exceed $200,000).
  • Premiums will likely be higher than the premium under the BCPSEA Benefits Program.

Basic and Optional Accidental Death & Dismemberment (AD&D) Conversion

You can continue Basic and/or Optional AD&D insurance (if applicable) if you are under age 70 at date of retirement from the District.

  • Contact SSQ using the contact information provided on the Notification of Conversion form that you should receive from your Benefits Administrator.
  • SSQ will provide you with a package of information on applying for the Conversion Privilege for Basic and Optional AD&D (if applicable. The package will be mailed to your home address. Application is completely optional.
  • The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of termination of the BCPSEA benefits.
  • Some limits apply (ie. amount cannot exceed $200,000).
  • Premiums will likely be higher than the premium under the BCPSEA Benefits Program.

Extended Health and Dental Conversion Privilege

When your coverage under the BCPSEA extended health or dental terminates, you are entitled to convert to one of Pacific Blue Cross’ (PBC) Personal Health and/or Dental plans. If you convert to one of PBC’s plans, you must take the following steps:

  • You are required to complete an Extended Health and/or Dental Conversion form and send this form directly to PBC.
  • PBC must receive the first payment and application within 60 days of termination of BCPSEA benefits to waive the General Pre-existing Conditions clause in the Personal Health Plan
  • In some instances, waiting periods which apply to certain benefits (ie. vision, dental) will also be waived if the Employee had coverage for these benefits under the BCPSEA Benefits Program.

Note:
The individual policies do not have coverage equivalent to that of the BCPSEA Benefits Program.

What happens when I turn 65?2022-02-03T08:45:58-08:00

You can refer to “My Plan” for information on any benefits that may change once you reach age 65 (or at a later age depending on your District). If you have any questions regarding coverage after age 65, you should contact your Benefits Administrator.

If you are retiring at age 65, you may be interested in the conversion privileges in the BCPSEA Benefits Program. To obtain information regarding the conversion privileges:

  • You are eligible for the Conversion Privilege if application is received by the Insurer within 31 days following termination date.
  • Application is completely optional.
  • If you are interested in applying for the Conversion Privilege for Extended Health and/or Dental, you may access the following conversion form
  • Extended Health/Dental Conversion form

Conversion Privileges

Basic Life, Optional Life and Optional Spouse Life Conversion Privilege

You can continue Basic Life insurance, Optional Life insurance and/or Spouse Optional Life insurance (if applicable) as an individual policy(ies) following termination or retirement from the District. If you wish to do so, the following steps must be taken:

  • Contact Pacific Blue Cross using the contact information provided on the Notification of Conversion form and Group Term Life Conversion Form that you should receive from your District’s Benefits Administrator
  • The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of termination of the BCPSEA insurance.
  • Some limits apply (ie. amount cannot exceed $200,000).
  • Premiums will likely be higher than the premium under the BCPSEA Benefits Program.

Basic and Optional Accidental Death & Dismemberment (AD&D) Conversion

You can continue Basic and/or Optional AD&D insurance (if applicable) if you are under age 70 at date of termination or retirement from the District. If you wish to do so, the following steps must be taken:

  • Contact SSQ using the contact information provided on the Notification of Conversion form that you should receive from your District’s Benefits Administrator.
  • SSQ will provide you with a package of information on applying for the Conversion Privilege for Basic and Optional AD&D (if applicable), including the options available and the associated costs of coverage. The package will be mailed to your home address. Application is completely optional.
  • The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of termination of the BCPSEA benefits.
  • Premiums will likely be higher than the premium under the BCPSEA Benefits Program.

Extended Health and Dental Conversion Privilege

When your coverage under the BCPSEA extended health or dental terminates, you are entitled to convert to one of Pacific Blue Cross’ (PBC) Personal Health and/or Dental plans. If your coverage terminates, the following steps must be taken:

  • You must complete the Extended Health and/or Dental Conversion form and send directly to PBC.
  • PBC must receive the first payment and application within 60 days of termination of BCPSEA benefits to waive the General Pre-existing Conditions clause in the Personal Health Plan.
  • In some instances, waiting periods which apply to certain benefits (ie. vision, dental) will also be waived if the Employee had coverage for these benefits under the BCPSEA Benefits Program.

Note:
The individual policies do not have coverage equivalent to that of the BCPSEA Benefits Program.

What happens if I become disabled? – All other groups2022-02-03T08:50:51-08:00

Sick Leave:

Your District provides a sick leave plan for Employees unable to work due to illness or injury for some or all of the period prior to eligibility for Short Term and/or Long Term Disability benefits. Please refer to your Collective Agreement or contact your District’s Benefits Administrator for more information.

Waivers of Premium:

Employees approved for LTD benefits may be eligible to receive a Waiver of Premium for the following benefits, if disability commenced prior to age 65, and disability has been continuous throughout the Elimination Period:

  • Basic Life insurance
  • Optional Life insurance
  • Spouse Optional Life insurance*
  • Child Optional Life insurance *
  • Long Term Disability
  • Basic Accidental Death & Dismemberment insurance
  • Optional Accidental Death & Dismemberment insurance

* Waiver of Premium will apply to the Spouse and/or Child Optional Life insurance if the Employee supplied evidence of insurability and was approved at the time of disability for the Spouse and/or Child(ren) Optional Life insurance.

Applications for Waivers of Premium

Life Insurance including Basic Life, Optional Life, Spouse Optional Life and Child Optional Life

If you are eligible for LTD benefits through the BCPSEA, and are applying for a Waiver of Premium for your life insurance, please attach the waiver application form with your LTD application.

If you are eligible for LTD benefits through another benefits program through the District, and are applying for Waiver of Premium for your life insurance, the following steps must be taken:

The Benefits Administrator will complete the Premium Waiver Benefits Application. If your LTD coverage is not provided through Pacific Blue Cross, the LTD approval letter must also be enclosed. The Benefits Administrator will send the Premium Waiver Benefits Application along with a copy of the LTD approval letter to the Life and Disability claims office:

or

  • Pacific Blue Cross
    PO Box 7000
    Vancouver BC V6B 4E1
    Phone:604 -419-2000
    Toll Free: 1-877-222-2583
    Fax: 604-419-8055

Pacific Blue Cross will send the Benefits Administrator and the employee a letter to advise whether or not the waiver has been accepted. Pacific Blue Cross must receive the complete Waiver of Premium forms no later than 6 months after the waiting period (which equals the employee’s LTD elimination period).

Once an employee has returned to work after claiming disability benefits, Pacific Blue Cross must be notified. Please fax or mail the Return to Work Notice form using the fax number or mailing address listed to advise Pacific Blue Cross of the employees return to work.

What happens if I become disabled? – Teachers2022-02-03T08:51:58-08:00

Sick Leave:

Your District provides a sick leave plan for Employees unable to work due to illness or injury for some or all of the period prior to eligibility for Short Term and/or Long Term Disability benefits. Please refer to your Collective Agreement or contact your District’s Benefits Administrator for more information.

Waivers of Premium:

Employees approved for LTD benefits may be eligible to receive a Waiver of Premium for the following benefits, if disability commenced prior to age 65, and disability has been continuous throughout the Elimination Period:

  • Basic Life insurance
  • Optional Life insurance
  • Spouse Optional Life insurance*
  • Child Optional Life insurance *
  • Long Term Disability
  • Basic Accidental Death & Dismemberment insurance
  • Optional Accidental Death & Dismemberment insurance

* Waiver of Premium will apply to the Spouse and/or Child Optional Life insurance if the Employee supplied evidence of insurability and was approved at the time of disability for the Spouse and/or Child(ren) Optional Life insurance.

Applications for Waivers of Premium

Life Insurance including Basic Life, Optional Life, Spouse Optional Life and Child Optional Life

If you are eligible for LTD benefits through the BCPSEA, and are applying for a Waiver of Premium for your life insurance, please attach the waiver application form with your LTD application.

If you are eligible for LTD benefits through another benefits program through the District, and are applying for Waiver of Premium for your life insurance, the following steps must be taken:

The Benefits Administrator will complete and submit the Premium Waiver Benefits Application. With the Teachers LTD program being administered through a different carrier, and the district Benefits Administrator not receiving notification of disability approval, there will be a supplemental form required when requesting a Waiver of Premium for life insurance under the BCPSEA Buying Group Plan. The Teachers Employee Statement will need to be signed and submitted to Pacific Blue Cross directly by the plan member, along with the LTD approval letter, in order to process the life insurance waiver application. In turn, the Benefits Administrator will send the Premium Waiver Benefits Application to the Life & Disability Claims Office. All documentation can be sent to the following address:

or

  • Pacific Blue Cross
    PO Box 7000
    Vancouver BC V6B 4E1
    Phone:604 -419-2000
    Toll Free: 1-877-222-2583
    Fax: 604-419-8055

Pacific Blue Cross will send the Benefits Administrator and the employee a letter to advise whether or not the waiver has been accepted. Pacific Blue Cross must receive the complete Waiver of Premium forms no later than 6 months after the waiting period (which equals the employee’s LTD elimination period).

Once an employee has returned to work after claiming disability benefits, Pacific Blue Cross must be notified. Please fax or mail the Return to Work Notice form using the fax number or mailing address listed to advise Pacific Blue Cross of the employees return to work.

What happens when my child becomes overaged based on the definition of Dependent Child?2022-02-07T11:41:21-08:00

An Overage Dependent Child is eligible for benefits to the maximum age allowed in your District’s plan, provided they are a natural, adopted or step-child who is single (i.e. unmarried and not living in a common-law relationship) and is financially dependent on you or your spouse. The Overage Dependent Child must also be either in full-time attendance at a recognized school, college or university or be considered disabled. Full time attendance at school typically means more than ten hours of classroom instruction per week or to be registered in at least 3 classes per semester.

Pacific Blue Cross (PBC) will continue coverage as follows, unless otherwise ineligible:

  • When the Dependent Child reaches the minimum age of termination unless they are a student (ie. Age 21 depending on your District’s plan) or functionally impaired – coverage ends the end of the month of the Dependent Child’s birthday.
  • When the Dependent Child reaches each birthday after previously qualifying for student status (ie. age 22 to 24 depending on your District’s plan) – coverage ends the end of the month of the Dependent Child’s birthday if not in school.
  • When the Dependent Child reaches the maximum age after previously qualifying for student status (ie. age 25 depending on your District’s plan) – coverage ends the end of the month of the Dependent Child’s birthday.
  • If your over age Dependent Child is disabled, PBC must approve continuation of coverage once your child has reached the minimum age, for extended health and dental. To obtain approval please complete the BCPSEA Change Form and provide a copy of the approved CRA or PWD (Persons with Disability) document to your School District Benefits Administrator. The School District Benefits administrator will submit the change form and the necessary documentation to Enrollment@pac.bluecross.ca. PBC will confirm in writing back to the School District Benefits Administrator whether coverage has been approved or declined. Your School District Benefits Administrator will contact you once confirmation has been received.

If your child is considered an Overage Dependent the following steps will be taken:

  • The Benefits Administrator will provide you with the Overage Dependent form if the dependent child is nearing the minimum age (ie. age 21), and for ages 22 to maximum age for annual re-certification.
  • You must complete the Overage Dependent form if the child is a student as defined above, and return to the Benefits Administrator.
  • You have 31 days to return the completed form; otherwise, the Dependent Child will be removed from coverage at the end of the month of the birthday of the Dependent Child.
What happens when I want to enrol an Eligible Dependent in the BCPSEA Benefits Program?2022-02-07T11:41:43-08:00

You may enrol your Eligible Dependents in the BCPSEA Benefits Program for your District.

If you are enroling an Eligible Dependent, you must enter the Dependent(s)’ names on the BCPSEA Benefits Enrolment form (for new hires) or the BCPSEA Benefits Change form (if adding or changing Dependents).

The following individuals are considered Eligible Dependents:

Spouse:
The person legally married to the Employee or a person of the opposite or same sex who has been residing with the Employee in a common-law relationship for at least 1 year and who is publicly represented as the Employee’s spouse.

You can only enrol one spouse on the BCPSEA Benefits Program at a time:

  • A legal spouse
  • An estranged spouse (separated)
  • An ex-spouse (divorced)
  • A common-law spouse (opposite or same sex)

Coverage may not be continued for an ex-spouse without a separation agreement or court order that states the member must continue coverage for the ex-spouse under the “employer sponsored plan.”

You will be required to sign the Common Law Spouse Declaration form to enrol a common-law spouse.

Dependent Child(ren):

For Extended Health and Dental coverage with Pacific Blue Cross (PBC), see definition of Dependent Child(ren).

For Child Optional Life: Up to age 21, or 25 if in full-time attendance at school, to any age for handicapped children. A child’s coverage is effective from birth. If the child is institutionalized, the benefit will not be effective until the child ceases to be confined.

Dependent Children may include:

Handicapped Child:

A mentally or physically handicapped dependent child may be covered to any age provided the child is incapable of self-sustaining employment and is wholly dependent upon you or your Spouse for support and maintenance.

If you are enroling a Handicapped child as a dependent the following steps must be taken:

  • You should indicate on BCPSEA Benefits Enrolment form any applicable information regarding the child’s handicapped status.
  • Insurer(s) may require additional information at a later date to verify the child’s status. If required, the Insurer(s) will request the additional information directly from the Employee.
  • You should contact your Benefits Administrator if your Dependent Child becomes handicapped at a later date.

Step child / Adopted child:
If you are enroling a Step/Adopted Child as a Dependent, the following steps must be taken:

  • You must complete the BCPSEA Benefits Change form to add a legally adopted child as a dependent, and provide the form to the Benefits Administrator.
  • The form must include date of adoption, if other than date of birth
  • Step children must be living with and/or legally adopted by you to be considered Eligible Dependents.
  • Coverage will be effective on the effective date of the change.
  • If Family Status has changed (ie. from Couple to Family), appropriate premium adjustments (if applicable) will be effective the first of the month coincident with or next following date of change.

Legal wards:

If you are enroling a Legal Ward as a Dependent Child, the following steps must be taken:

  • You must complete the BCPSEA Benefits Change form to add a legal ward as a Dependent Child, and provide that form to the Benefits Administrator
  • You must provide a copy of the court document. Please note that a notarized statement is not sufficient.
  • Coverage will be effective on the effective date of the change.
  • If Family Status has changed (ie. from Couple to Family), appropriate premium adjustments (if applicable) will be effective the 1st of the month coincident with or next following date of change.

Note: Grandchildren can be Eligible Dependents only if legally adopted by, or legal wards of the Employee.

Dependents that are enrolled as Late Applicants:

If you apply for coverage for your Dependents later than 4 months (for Extended Health and Dental) and 31 days (for Dependent Life) following their initial eligibility date, the Dependent(s) will be considered a Late Applicant(s).

For Dependent Life (if applicable) and Extended Health:

If your Dependent(s) is/are considered a Late Applicant they must provide satisfactory medical evidence of insurability to the Provider prior to becoming eligible for coverage. To become eligible for coverage the following steps must be taken:

  • You must complete the Evidence of Insurability form and submit this form to the Insurer. For Dental, please review the information below to determine if you are required to complete the Evidence of Insurability form. Please ensure you choose the correct form from the Forms page for the benefit you are applying for as the forms differ by insurer.
  • The Insurer will advise you of approval and provide a copy of this approval to the Benefits Administrator.

Your coverage commences when formal written approval is received from the Insurer(s). Retroactive premiums to the effective date of coverage may be required.

For Dental:

If your dependent(s) is/are considered a late applicant, the effective date of coverage will be based on whether your district requires a dental declaration submitted for approval or if there is a dollar amount restriction for the first year of coverage (i.e. $100/$200/$250 maximum in the first year). Your District Benefits Administrator will advise you which dental late applicant rules apply to your plan. Based on these options, the following steps must be taken for the dependent(s) to become eligible for coverage:

  • For school districts that require a dental declaration to be submitted, the district administrator will send the declaration as well as a copy of the BCPSEA enrolment form to Enrollment@pac.bluecross.ca. The provider will send the school district a letter stating whether your dependent(s) have been approved or denied coverage.
  • If approved, the effective date of coverage will be the 1st of the month following approval by the provider.
  • For school  districts that have a dollar amount late applicant restriction for the first year of coverage, the district administrator will send a copy of the BCPSEA enrolment form to the provider at Enrollment@pac.bluecross.ca.
  • The effective date of coverage will be the date indicated by the benefits administrator on the enrolment form.
What happens when I die?2022-02-03T08:53:00-08:00

It is likely the Benefits Administrator will be advised in the event of your death by the Executor or Beneficiary of your estate.

For more information, please contact your Benefits Administrator.

In the event of your death the following actions will be taken by the Benefits Administrator, provided they are aware of your death:

  • The Benefits Administrator will send a letter to the Beneficiary with a Plan Sponsor’s Statement of the Claim Form competed.
  • The Beneficiary will complete Part 2 of the Group Claim Report and send this back to the Benefits Administrator with one of the following:
    • Completed PBC Life Claim Form which will be provided by the School District Benefits Administrator.
    • Proof of Death – Government Issued Certificate of Death OR completed Attending Physician’s Statement. Please note that the document submitted must be the original. Originals will be sent back upon request. Attending Physician’s Statement.
  • Once the Benefits Administrator has received the necessary documents back from the Beneficiary these are sent, with a copy of the employee’s original Enrolment Form and any beneficiary changes to:Pacific Blue Cross
    Life & Disability Claims
    PO Box 7000
  • The cheque will be sent to the School District Benefits Administrator unless otherwise requested.The Benefits Administrator will also provide the original enrollment card and any subsequent beneficiary change forms to the insurer.If the location of the Beneficiary is not known immediately, the Benefits Administrator will likely receive notice from the Executor of your estate.
    • Notification of the Survivor Benefits, if applicable; andThe Beneficiary will also be provided with:
    • Notification of Conversion Privilege, if Surviving Spouse has Optional Spouse Life insurance.

Conversion Privilege

When an Employee dies, all or part of Spouse Optional Life insurance (if applicable) may be converted to an individual policy without medical evidence of insurability provided an application is made with 31 days of the Employee’s date of death.

Spouse Optional Life Conversion Privilege

To convert the Spouse Optional Life insurance, the following steps must be taken:

  • Benefits Administrator will advise Surviving Spouse of right to convert insurance following the Employee’s death, and will provide the contact information for Pacific Blue Cross.
  • Surviving Spouse is responsible to contact Pacific Blue Cross if they are interested in applying for the Conversion Privilege for Spouse Optional Life insurance. Click here for contact information for conversion with Pacific Blue Cross.
  • The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of the Employee’s death.
  • Some limits apply (ie. amount cannot exceed $200,000).
  • Premiums will likely be higher than the premium under the BCPSEA Benefits Program.

Survivor Benefits

Benefits may continue for the Surviving Spouse and Eligible Surviving Dependents for a period following your death. See “My Plan” for further information on the policy for your District.

If your Surviving Spouse and Eligible Surviving Dependents are eligible to receive this benefit the following steps will be taken:

  • Benefits Administrator sends Letter to Surviving Spouse advising how long coverage will continue.
  • Benefits Administrator sends a Letter to Surviving Spouse advising of the date of termination of coverage and conversion options available.

Death of the Surviving Spouse

In the event of the death of your Surviving Spouse the following steps will be taken:

  • Benefits Administrator sends a Letter to (any) Surviving Dependent Children advising how long coverage will continue.
  • Benefits Administrator sends a Letter to Surviving Dependent Child(ren) advising of the date of termination of coverage.
What Happens when I am diagnosed with a terminal illness?2022-02-03T08:53:03-08:00

For disability benefits please refer to the “Becoming Disabled” section of the What Happens When guide.

If you are eligible for basic life insurance and are diagnosed with a terminal illness (death expected within 24 months) you may be eligible to receive up to 50% of your insured benefit amount to a maximum of $50,000. Application for this advance is voluntary and subject to insurer approval.

If approved, this advance payment and the interest accrued will reduce the benefit amount paid to your beneficiary at the time of your death. To apply for the Life Advance Payment, please ask your benefits administrator to assist you with completing the Living Benefit Claim form and have your physician complete the Living Benefit Attending Physician’s Statement. Please send the completed forms to the following address:

Pacific Blue Cross
PO Box 7000
Vancouver BC V6B 4E1

No Living Advance Payment will be made if the insurer receives the request within the twenty-four months preceding the date on which the your life insurance terminates, as a result of an accident or injury, or following the termination of this benefit or policy.

What happens when my Spouse gains their own benefits plan?2022-02-03T08:53:04-08:00

If your Spouse gains their own benefits plan, the following steps must be taken:

  • If you wish to make a change in your BCPSEA Benefits Program coverage, you must complete the BCPSEA Benefits Change form and provide this form to the Benefits Administrator.
  • If you wish to waive BCPSEA coverage, you must also complete the Waiver of Coverage form.
  • This change will be effective on the date of application.
  • If the Family Status has changed (ie. from Couple to Single), appropriate premium adjustments will be effective the first of the month coincident with or the next following date of change.
What happens when my Spouse loses their own benefits plan?2021-10-20T21:15:35-07:00

If your Spouse loses their own benefits plan and wants to be covered by the BCPSEA Benefits Plan, the following steps must be taken:

  • If you wish to apply for coverage in the BCPSEA Benefits Program, you must complete the BCPSEA Benefits Change form within 31 days of Spouse’s benefits plan terminating and provide to the Benefits Administrator.
  • If you wish to make a change in your BCPSEA Benefits Program coverage, you must complete the BCPSEA Benefits Change form and provide this form to the Benefits Administrator.
  • If you wish to waive BCPSEA coverage, you must also complete the Waiver of Coverage form.
    This change will be effective on the date of application.
  • If Family Status has changed (ie. from Couple to Family), appropriate premium adjustments (if applicable) will be effective the 1st of the month coincident with or next following date of change.
What happens if I lose my Spouse or Dependent Child?2022-02-07T11:44:21-08:00

If you lose a Spouse or Dependent Child, the following steps must be taken:

  • You must complete the BCPSEA Benefits Change form terminating coverage for your Spouse or Dependent Child and provide this form to the Benefits Administrator.
  • If you are making an Optional Life or Optional Accidental Death claim, the Benefits Administrator will provide you with an insurance claim form.
    • Benefits Administrator will request a copy of the Spouse or Dependent Child’s death certificate.
    • You must complete the insurance claim form and provide to the Benefits Administrator.
  • Termination of coverage will be on the effective date of the change.
  • If the Family Status has change (ie. from Family to Couple), appropriate premium adjustments (if applicable) will be effective the first of the month coincident with or the next following date of change.
What happens when I have a new child?2021-10-20T21:02:47-07:00

If you have a new child through birth or legal adoption the following steps must be taken:

  • You must make the necessary change on the BCPSEA Benefits Change form and provide this form to the Benefits Administrator.
  • You must make the change within 4 months for Extended Health and Dental, or the Dependent Child may be treated as a Late Applicant.
  • If you already have Family Status, Pacific Blue Cross (PBC) will enrol the Dependent Child retroactive to the date eligible.
  • However, if you enrol your Dependent Child for dental and the child is three (3) years or older, the coverage will be effective on the first of the month following date of enrolment and the Late Applicant rules will be applied.
  • If the Family Status has changed (ie. from Couple to Family), appropriate premium adjustments (if applicable) will be effective the 1st of the month coincident with or the next following date of change.
  • If you gain a new child through legal or common-law marriage, the child must live with you or your Spouse to be an Eligible Dependent Child.

The following steps must be taken to enrol the child on your benefits plans:

  • You must make the necessary changes on the BCPSEA Benefits Change form and provide this form to the Benefits Administrator.
  • You must make the changes within 4 months for Extended Health and Dental, or the Dependent Child may be treated as a Late Applicant.
  • If the Family Status has changed (ie. from Couple to Family), appropriate premium adjustments (if applicable) will be effective the 1st of the month coincident with or next following date of change.

Note:

If you are already covered for Family coverage and fail to report the addition of a new Dependent Child to your extended health and dental plan, the Dependent Child will be added retroactively and there will be no premium adjustments.

What happens when I get divorced or legally separated?2021-10-20T21:13:32-07:00

Employees can enrol only one spouse on the BCPSEA benefits program:

  • A legal spouse
  • An estranged spouse (separated)
  • An ex-spouse (divorced)
  • A common-law spouse

If you become divorced or legally separated from your Spouse, the following steps must be taken:

  • To delete or change your Eligible Spouse, you are required to complete and sign the BCPSEA Benefits Change Form and provide that form to the Benefits Administrator.
  • You must complete the Common Law Spouse Declaration Form, if applicable, to enrol a new common-law spouse.
  • If the Family Status has changed (i.e. from Couple to Single), appropriate premium adjustments will be effective the first of the month coincident with or the next following date of change.

Note:

  • Coverage may not be continued for an ex-spouse without a separation agreement or court order that states the member must continue coverage for the ex-spouse under the “employer-sponsored plan.”
  • You may change your Eligible Spouse from an ex-spouse or estranged spouse to a common-law or a new legal spouse on the date the new spouse is eligible for coverage.
  • You will be required to sign a Common Law Spouse Declaration form to enrol a common-law spouse.
  • If you and your common-law spouse stop living together, the common-law relationship is deemed to have ended and the Spouse is no longer eligible for coverage under the BCPSEA Benefits Program.
What happens when I get married or gain a common-law spouse?2021-10-20T21:05:09-07:00

Spouse is defined as the person legally married to the Employee or a person of the opposite or same sex who has been residing with the Employee in a common-law relationship for at least one year and who is publicly represented as the Employee’s Spouse.

Employees can enrol only one spouse on the BCPSEA benefits program:

  • A legal spouse
  • An estranged spouse (separated)
  • An ex-spouse (divorced)
  • A common-law spouse

If you are adding a spouse to the BCPSEA Benefits Plan, the following steps must be taken:

  • You have 4 months to enroll a new spouse due to marriage in your Extended Health and Dental plans.
  • You must complete the BCPSEA Benefits Change form and provide the form to the Benefits Administrator.
  • You can only enrol one spouse in your benefits plans.
  • If the Family Status has changed (ie. from Single to Couple), the appropriate premium adjustments will be effective the first of the month coincident with or the next following date of coverage.

If you are adding a common-law spouse to the BCPSEA Benefit Plan the following steps must be taken:

  • You have 4 months following 1 year of common-law marriage to enrol a new common-law spouse as a dependent in your Extended Health and Dental plans.
  • You must complete the BCPSEA Benefits Change form and Common Law Spouse Declaration form that verifies the common-law relationship has been in place for 1 year, and provide these forms to the Benefits Administrator.
  • If the Family Status has changed (ie. from Single to Couple), the appropriate premium adjustments will be effective the first of the month coincident with or the next following date of coverage.
What happens if I terminate employment with the School District?2021-10-20T21:11:06-07:00

If you terminate employment with the School District it is important that you obtain information regarding the conversion privileges for the BCPSEA benefits.

  • You may refer to the Details section for each benefit located in “My Plan” for information regarding the conversion privileges for BCPSEA benefits.
  • You are eligible for the Conversion Privilege if the completed applications for individual insurance and the first premium are received within 31 days after the group insurance terminates or reduces.
  • The Benefits Administrator will provide you with a Notification of Conversion form and the Group Life Conversion Privilege Notification Form that will tell you what benefits you are eligible to convert and contact information for each of the insurers if you are interested in conversion to an individual plan for a specific benefit.
  • If you had Life and/or Optional Life through the BCPSEA plan and you contact Great-West Life, they will provide you with a package of information on applying for the Conversion Privilege for these benefits for yourself and/or your spouse including options available and the associated costs of coverage. The package will be mailed to your home address. Application is completely optional.
  • If you had Basic and/or Optional AD&D through the BCPSEA and you contact SSQ, they will provide you with a package of information on applying for the Conversion Privilege for these benefits. The package will be mailed to your home address. Application is completely optional.
  • If you had Extended Health and/or Dental and you are interested in applying for the Conversion Privilege for these benefits, you may access the following conversion form: Extended Health/Dental Conversion form
What happens when I take a Leave of Absence?2022-02-03T08:43:46-08:00

BCPSEA benefits may be continued during a Leave of Absence. You should refer to the Details section for each benefit located in “My Plan” to review the Continuation of Benefits provisions at your District.

If you decide to take a Leave of Absence of more than 31 days, the following steps must be taken:

  • You must complete the Notice of Leave form for an upcoming Leave of Absence of more than 31 days, indicating type of leave (ie. Maternity Leave, Parental Leave, or other paid or unpaid leave).
  • Benefits Administrator must receive written approval from Insurer(s) for continuation of an Employee’s benefits during a Leave of Absence, unless provided for a specific benefit as outlined under the Details section of “My Plan”.
  • Employee must sign the Waiver of Coverage form if waiving benefits during the leave of absence, if allowed by your District, and return to the District Benefits Administrator.
  • Benefits Administrator files Notice of Absence form and Waiver of Coverage form (if applicable) in Employee’s personnel file.

Deferred Salary Leave

  • If you elect to go on a deferred salary leave, approval to continue benefits will have to be obtained for the period that you are not actively at work.
  • If approved for Continuation of Coverage, the life insurance, accident insurance (if applicable) and disability insurance (if applicable) coverage levels will remain at 100% of your annual salary.

The following information outlines the Continuation of Coverage policies in the BCPSEA Benefits Program. For more details, you should refer to your Collective Agreement and/or contact your Benefits Administrator.

Maternity and Parental (including Adoption) Leaves in Canada

Coverage may be continued during a Maternity or Parental Leave, but not more than the period required under the relevant legislation. Continuation of coverage beyond the legislated time period requires Insurer approval. Please contact the Benefits Administrator for more information.

Benefit periods for Maternity Leaves and Parental Leaves (including Adoption) under legislation of British Columbia are:

  • Maternity Leave: 17 weeks (the first 2 weeks are considered an unpaid waiting period by EI)
  • Parental Leave: 35 weeks in total (can be taken by either parent or both). If taken by the father, Parental Leave will be 37 weeks (the first 2 weeks are considered an unpaid waiting period by EI)

EI Compassionate Care Leave

All benefits can be continued as long as the Employee is not terminated and premiums are continued. If an Employee becomes disabled while on EI Compassionate Care Leave, the LTD benefit Elimination Period will be deemed to commence on the date that Employee is scheduled to return to Active Employment, provided the Employee is still Disabled and still eligible for LTD benefits

Lay-off

Coverage may or may not be continued during lay off as described in the District’s Collective Agreement or in School Board policy and is subject to Insurer approval. Please contact the Benefits Administrator for more information.

Secondments, Elections, Appointments, Leaves for Public Office or Union Leaves

Coverage may or may not be continued during secondments, elections, appointments, leaves for public office or union leaves as described in the District’s Collective Agreement or in School Board policy.

Unpaid Leave of Absence

Coverage may or may not be continued during unpaid leaves of absence as described in the School Board policy.

What happens if I change positions at the District?2022-02-03T08:41:29-08:00

General information about your eligibility for benefits is contained in the Details section of each benefit plan located in “My Plan”.

Contact the Benefits Administrator to discuss if there are any changes to your eligibility for benefits.

What happens when my salary increases my life insurance in excess of the Non-Evidence Maximum (NEM)?2022-02-02T13:32:27-08:00

If your District’s Life Insurance benefit includes a Non-Evidence Maximum that is less than the Overall Maximum, you must provide evidence of good health to become eligible for the amount of excess insurance.

To do so, you must complete the Evidence of Insurability form and submit to the Life Insurer.

All medical information indicated on the application will be maintained by Great-West Life to maintain the Employee’s right to confidentiality of information.

What happens to my benefits when my salary changes?2022-02-03T08:41:56-08:00

Basic Life, Basic Accidental Death & Dismemberment (if applicable for your District), and Disability (if applicable for your District) benefits are often governed by an Employee’s Earnings.

Earnings are defined based on your District’s policy or other agreement. Please contact the Benefits Administrator for more information.

What do I need to know when designating my Beneficiary(ies)?2021-10-20T21:14:57-07:00

You are required to nominate who will receive the proceeds of your Life and/or Accidental Death benefits in the event of your death.

Important information about designating a Beneficiary:

  • You may nominate anyone you wish as a Beneficiary.
  • You may nominate more than one person as a Beneficiary and allocate a percentage of the total benefit by Beneficiary.
  • You should appoint a Trustee on the BCPSEA Benefits Enrolment form if the Beneficiary(ies) are not of legal age.
  • If you wish to change your beneficiary(ies), you must sign and date the BCPSEA Benefits Change form.
  • The initial designation of a Beneficiary is made on the BCPSEA Benefits Enrolment form.
  • The Benefits Administrator will file the BCPSEA Benefits Enrolment form and BCPSEA Benefits Change form (if applicable) in the Employee’s personnel file for use in the event of your death.

Note:

  • There are two types of beneficiaries – revocable and irrevocable.
  • All beneficiaries are revocable unless the Employee designates in written notice to the Benefits Administrator that the beneficiary is irrevocable.
  • To effect a change from an irrevocable beneficiary to any other beneficiary, one of the following documents is required:
      • Renunciation by the irrevocable beneficiary, or
      • Evidence of death of the irrevocable beneficiary, or
      • Final Decree of Divorce, if the irrevocable beneficiary is the Spouse of the Employee

Estate as a beneficiary

If you do not wish to designate any specific person as Beneficiary, you must indicate “Estate” on the BCPSEA Benefits Enrolment form.

The proceeds of Life insurance and/or Accidental Death insurance in the event of your death will be paid in accordance with your Will, or if you do not have a Will, in accordance with the laws of intestacy of the province of in which you reside.

As a general rule, payments to designated persons, such as the Spouse or children of legal age, or children with a trustee appointed, are available more promptly as there is no need for Probated Wills or other title documentation.

What happens when I am considered a Late Applicant?2022-02-02T13:34:08-08:00

Employees who do not complete and sign the BCPSEA Benefits Enrolment form within the specified time periods listed below will be considered a Late Applicant.

  • Basic Life and Basic Accidental Death & Dismemberment: within 31 days of the initial Eligibility Date.
  • Extended Health and Dental: within 4 months of the initial Eligibility Date.

If you are considered a Late Applicant you must provide satisfactory medical evidence of insurability to the Insurer prior to becoming eligible for coverage.

To become eligible for coverage the following steps must be taken:

  • You must complete the Evidence of Insurability form and submit this form to the Insurer. For Dental, please review the information below to determine if you are required to complete the Evidence of Insurability form. Please ensure you choose the correct form from the Forms page for the benefit you are applying for as the forms differ by insurer.
  • The Insurer will advise you of approval and provide a copy of this approval to the Benefits Administrator.
  • Your coverage commences when formal written approval is received from the Insurer(s). Retroactive premiums to the effective date of coverage may be required.
  • For Dental: If you are considered a late applicant, the effective date of your coverage will be based on whether your plan requires you to submit a dental declaration for approval or if there is a dollar amount restriction for your first year of coverage (i.e. $100/$125/$250 maximum for the first year). Your District Benefits Administrator will advise you which dental late applicant rules apply to your plan. Based on these options, the following steps must be taken to become eligible for coverage:
    • For school districts that require a dental declaration to be submitted, the employee should complete a Dental Declaration Form (Evidence of Insurability Form) and provide it to the district benefits administrator. The district benefits administrator will send the declaration as well as a copy of your BCPSEA enrolment form to Enrollment@pac.bluecross.ca. The provider will send the school district a letter stating whether you have been approved or denied coverage.
    • If approved, the effective date of coverage will be the 1st of the month following approval by the provider.
    • For school districts that have a dollar maximum late applicant restriction for the first year of coverage, the district administrator will enroll you onto the dental plan and PBC will apply the dollar maximum restriction for the first year. The effective date of coverage will be the date indicated by the benefits administrator on the enrolment form.
What happens if I am recalled or rehired by the District?2022-02-03T08:42:41-08:00

If you were previously insured under the District’s Benefits Program and terminated service and then return to work within the Reinstatement Period, your coverage may be reinstated from your date of recall or rehire.

If you are recalled or rehired by the District the following steps will be taken:

  • The normal waiting period is waived provided coverage is requested within 31 days of the date of rehire
  • If coverage is requested later than 31 days from the date of rehire or you did not return to work within the reinstatement period, you will be treated as a New Applicant for life, accident and disability benefits (if applicable) and satisfy the waiting period before being re-enroled. Extended health and dental benefits can be reinstated with no waiting period if coverage is requested before 4 months from the date of rehire.
  • There may be differences in the District’s policy based on the previous termination of the Employee (ie. layoff, voluntary termination, etc.)
  • This reinstatement policy does not apply if you have converted the group policy to an individual policy at time of termination of employment
  • Contact your Benefits Administrator for specific time limitations.
What happens when I become eligible for benefits?2021-10-20T21:00:29-07:00

You are eligible for benefits under the BCPSEA Buying Group Benefits Program if you are actively working in a permanent or elected position related to the public or private educational system in British Columbia and are receiving regular remuneration for services rendered.

An Employee becomes eligible for benefits coverage in accordance with the eligibility requirements and the waiting period(s) outlined in each benefit under the Details section in “My Plan”.

To be eligible, you must:

  • Be in an eligible class
  • Work a minimum hours per week
  • Have completed the waiting period, and
  • Be “actively at work” on the eligibility date.

When you become eligible to receive benefits the following steps will be taken:

  • The Benefits Administrator will provide you with the BCPSEA Benefits website address www.bcpseabenefits.ca to access the BCPSEA Benefits Enrolment form. You must complete and sign the BCPSEA Benefits Enrolment form and provide this form to the Benefits Administrator.
  • When you become eligible for benefits and choose not to enroll you must complete and sign a Waiver of Coverage Form and provide it to your Benefits Administrator.
  • If you do not have access to the Internet, the Benefits Administrator will provide you with hard copies of the required enrolment forms.
  • Benefits Administrator advises you of the employee self-access tools and information on the BCPSEA Benefits website, including the details of the BCPSEA benefit plans for your District in “My Plan”.
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