Clear and Simple Claims Process

Making a claim is easy.

1 Fill out the appropriate form and attach the original paid receipts.
2 Mail it in to the address on the form.
3 Keep a copy of claim form and receipts for your records.

It’s that simple. Click on the links below for important
information relating to the claims process.

Extended Health Care (e.g. prescription drugs, Physiotherapist, Chiropractor, etc.)
Dental Care (ask your dental office for a completed Standard claim form)

Prescription Drugs

  • If you have a pay direct drug card, use it to fill any prescriptions. The insurance company will pay the pharmacy according to the plan your employer has selected. If your plan has a deductible and/or coverage is less than 100%, you will need to pay the difference yourself.
  • If you don’t have a drug card, complete an Extended Health Care claim form and submit for reimbursement

Dental

  • Talk to your dental office, as most will submit claims electronically on your behalf. If your plan does not have 100% coverage, your dental office with bill you for the balance.
  • Should you require to submit a manual claim ask your dental office for a completed standard signed dental claim form

Extensive Extended Health or Dental Claims

  • For dental, we’re talking crowns, bridgework, etc., which may exceed $300. Have your dentist submit an estimate for preapproval so that you are aware of what your reimbursement will be.
  • For Extended Health Care, any durable medical supply expense exceeding $500 must be pre-approved.
  • For both, send the request to the Pacific Blue Cross Claims Department, PO Box 7000, Vancouver, BC, V6B 4E1.
Disability (Short- and Long-Term)

If you become disabled and cannot perform the duties of your occupation, call us so we can walk you through the next steps:

Short Term Disability Long-Term Disability
  • If you have short-term disability coverage, your benefit payments commence following the waiting period under the plan. You, your employer and your physician will need to complete the claim form.
  • If you don't have short-term disability coverage, contact your local Employment Insurance office to apply for Disability benefits.

  • If you qualify for Long-Term Disability (LTD), these payments commence after the waiting period (technically called the Elimination Period), generally 120 days.
  • Claims must be submitted 4 weeks before the end of the Elimination Period. If you have Worker’s Compensation (WCB) Benefits, you can get a WCB Claim Form from your doctor.
  • You can still apply for LTD benefits under your bclear plan, but WCB benefits are typically higher, and are deducted from any disability benefit you receive from your bclear plan.
  • If you stop receiving WCB benefits and are still considered to be 'disabled’, you may still be able to claim for LTD benefits under your bclear plan.

Medical Travel Benefit

If you had to travel to get the treatment you needed, you may be reimbursed for your travel expense.

  • Get pre-authorization for these expenses to ensure they are eligible.
  • Print and complete the Standard Health Care Claims Form.
    • Note that the referring doctor must complete Part A of the form.
    • You must complete Parts B and C, as applicable.
    • Follow the rest of the instructions as you do with any claim form.
Out of Province/Country claims

If you needed medical attention while you were out of British Columbia or out of the country, save all your receipts.

  • Complete an Emergency Out-of-Province Claim form.
  • Attach receipts and itemized bills outlining the services you were charged for and mail it in to the address on the form.
  • Mail it in right away to ensure your claim is not denied.
  • Pacific Blue Cross will coordinate the claim with the Medical Services Plan of British Columbia directly on your behalf. This process is explained on the first page of the claim form. (Note: the MSP claiming deadline is 90 days from the date of service.)
  • The Members Statement and Patient's/Guardian's Authorization for Release of Information must be signed in the space provided regardless of whether you or your dependent(s) 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 "Member's signature" and "Patient's signature" or "Parent/guardian" if the patient is a minor.

Reminder for when you travel:

  • Carry your Medi-Assist card, your provincial health card and your Pacific Blue Cross ID Card
  • Call the number on the card in case of a medical emergency while travelling. Here it is for easy reference:
    • Canada/US (toll-free): 1.888.699.9333
    • Other Countries (call collect) 1.604.419.4487
Life Insurance and Accidental Death and Dismemberment

In the event of an accidental injury or death, the beneficiary should contact your company’s benefits administrator as soon as possible, who will then contact us.

  • Both your employer and you (your beneficiary) will need to complete some forms.
  • In case of death, the insurer will need the following documents:
    • Proof of Death: original provincial death certificate (or certified copy) or the funeral director’s Statement of Death. If neither is available, then the Attending Physician’s Certificate of Death is needed.
  • In case of accidental injury or death arising from an accident, the insurer will also require a police report and a newspaper clipping (if available). Also a certificate from your employer and your own statement (in case of accidental injury) will be needed.
  • All these completed forms need to be sent to the bclear benefits office, and we will forward them on to the insurer.
    • In some cases, a toxicology report or autopsy may be required by the insurer to verify cause of death.

 

Claim submission deadlines

Submit your claim by December 31 of the following calendar year in which you had the claim.

  • If the company that offered you bclear benefits no longer employs you, you have up to 90 days after the date of termination of employment to submit all outstanding claims.

Coordinate benefits with your spouse

If your spouse has a benefit plan, with couple or family coverage, you can submit claims to your spouse’s benefit plan and he/she can submit claims to yours. This allows you both to maximize your benefits … if one plan doesn’t refund 100% of expenses, the other plan will refund the difference, subject to plan limits.

Some rules:

  • You must both be covered under an employer’s health or dental care plan, and 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 submit claims for expenses you incurred for yourself to bclear benefits first. Keep copies of your receipts. If the refund is less than 100% of the cost, you can then submit a claim for the difference to your spouse’s plan. Be sure to include a copy of the first plan’s payment.
  • The same goes for your spouse … he/she must submit expenses incurred for self to their plan first, and then claim the difference to the bclear benefits plan.
  • When it comes to claiming for dependent children, the claim first goes to the plan of the parent whose birthday comes first in the calendar year. If you both have the same birthday (it happens!), the claims go 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.

Following up on a claim?

  • For Extended Health and Dental claims, you can either call the Pacific Blue Cross Call Centre directly, 604.419.2600 for extended health claims or 604-419-2300 for dental claims or toll free 1.888.275.4672 for both or view the status of your claim on the CARESnet website.
  • CARESnet is an excellent resource and a way to access your information 24/7 online! Register today!

 

What People are saying:
One year we had an employee that was paralysed, and the support and help we received when we phoned in – was tremendous!
Jim Gordon
Controller,
EAC Construction