Pacific Blue Cross Health Insurance for BC

Eligible Expenses Covered at 80% with No Deductible

Hospital
Private or semi-private room
$20 a day for hospital cash from the fourth day of hospitalization for up to 90 days when under age 65 and confined to a hospital

Local Ambulance services

Accidental dental
Up to $2,500 per calendar year

Vision
Cost of prescription lenses, frames, contact lenses and laser eye surgery up to:

* Benefit begins after 6 months on the plan.

Private Duty Nursing
Covers the cost for private duty care nursing in your home. The nurse must be a Registered Nurse (RN) and care begins immediately following the discharge of an acutely ill patient from a hospital, up to:

Medical Services and Supplies:

• Crutches, casts and rigid support braces
• Ostomy and ileostomy supplies
• Oxygen and oxygen supplies
• Permanent prostheses, including mastectomy forms
• Wheelchairs or scooters up to $5,000 (lifetime limit)
• Hospital-type beds
• Wigs and hairpieces required as a result of medical treatment — $500 for each person (lifetime limit)
• Hearing aids — up to $300 every 5vyears after a 3-month waiting period
• Custom-made orthotics — up to $250 every 2 years, when prescribed by a physician, podiatrist, or chiropractor
• Blood pressure monitors — up to $150 every 5 years, upon referral by a physician

Paramedical Coverage
Benefits are paid for visits to registered: physiotherapists, massage practitioners†, chiropractors, naturopaths, chiropodists, podiatrists, osteopaths, speech pathologists, psychologists, registered dieticians† and acupuncturists. Increasing benefit coverage up to:

Out-of-Province, In Canada Travel-100%

Accidental Death & Dismemberment
Principal sum up to $25,000 (under the age of 70)

Final Expense Benefit
Covers up to $3,000 for each person (after 24 months on the plan if death occurs naturally; immediate coverage for accidental death).

Survivor Benefit
No contributions payable by the beneficiary for 12 months.
No survivor benefits are available for the first 12 months following approval of application.

Virtual Care
24/7 access to virtual care for referrals to specialists along with prescriptions from our Preferred Pharmacy Network delivered directly to your door.

Disease Support Programs
If diagnosed with cancer, this benefit covers up to $300 of a qualifying program in which physicians and health care practitioners assist in recovery and improving the quality of life.

Blue Cross Healthy Blue Living

Save 10% for living a healthy lifestyle 

Only Pacific Blue Cross offers British Columbians a discount on health insurance for making healthy choices. With Healthy Blue Living, you receive 10% off your monthly Health and Prescription Drug plan rates. To qualify, you:

• Are a non-tobacco user
• Fall within the normal Body Mass Index (BMI) range for your age
• Maintain a healthy blood pressure
• Have healthy cholesterol and blood sugar levels

Essential and Enhanced plans are available. The Pay Direct drug card only comes with the Enhanced option. 
Both cover 80% of eligible costs incurred up to:

Essential 

• Covers prescription drugs that are recognized under government plans, like BC PharmaCare.
• Drugs for birth control are not covered.

Enhanced 

• Provides the greatest amount of prescription drug coverage available on the Blue Choice plan.
• Augments the Essential Drug Option to also include drugs that are not recognized under government plans and covers birth control.
• Offers a Pay Direct Drug Card to eligible applicants. This allows your pharmacist to submit your claim electronically. Pacific Blue Cross pays the pharmacy 80% of your prescription cost, and you pay the pharmacist the remaining 20%. There is no need to submit a paper claim.

Exclusions are the same for both options. These include smoking cessation drugs, over-the-counter drugs, fertility drugs and drugs not requiring a prescription. Dispensing fees are not covered.

All dental plans include a direct bill feature. We pay your dentist directly, so you only have to pay your portion (if applicable). Each covers eligible expenses for Basic services after a three-month no-claims waiting period, up to the annual maximum of

Essential

Essential Dental Option Covers procedures involved in the routine maintenance of your teeth (Basic services). Eligible expenses are covered at 70% for the first year and 80% for subsequent years. Eligible expenses include:

• Diagnostic expenses (oral examinations, x-rays)
• Preventive treatments (polishing, fluoride treatments)
• Restorative treatments (silver-colored fillings and tooth-colored fillings on front adult teeth)
• Periodontal cleaning (scaling and root planing)
• Prosthodontic services (denture services, repairs to inlays, onlays, crowns and bridges)
• Oral surgery
• Recall visits twice per calendar year

0–12 months $600 per year

13-24 months $900 per year

25 months + $1200 per year

Enhanced

Enhanced Dental Option Covers maintenance as well as more complex dental treatments.

Augments the Essential Dental option to include:

0–12 months

• Basic Services 70%

13–24 months 

• Basic Services 80%
• Endodontics 50%
• Major Restorative 50%

25 months

• Basic Services 80%
• Endodontics 50%
• Major Restorative 50%
• Complete or partial denture 50%
• Orthodontics 50%

Extended Health Coverage provides support for expenses not covered by government MSP. All Health levels cover 80% of eligible expenses.

Essential

Essential Health includes coverage for:

• Prescription drugs
• Medical equipment and supplies
• Virtual care
• Psychology, clinical counselling and online CBT

Enhanced

Enhanced coverage is available with Bronze, Silver and Gold Health. Benefits will vary depending on the tier, and include the following coverage in addition to Essential:

• Vision care*
• Registered therapists and health practitioners
• Hospital accommodation*
• Nursing care
• Ambulance services
• Out-of-province, in-Canada travel
• Accidental dental
• Accidental death and dismemberment
• Final expense benefit
• Survivor benefit

Dental coverage can be added to any plan, and is required with Silver or Gold Health tiers. All options cover basic services (i.e. cleanings, exams). The Gold tier provides coverage for endodontics (root canals) and major work, such as bridges and crowns.

To qualify, you must:

1. Apply within 60 days of the date on which your group coverage was cancelled,
2. Have been covered under your group plan for the same benefits for at least six continuous months.

The effective date of coverage for the conversion plan will be the first of the month following the termination date of your group coverage. Any claims before the effective date will not be eligible for coverage. Plan options cannot be changed once they are selected at inception.

Graduated yearly limits still apply. For example, maximum reimbursement for the Enhanced Drug Option for the first 24 months is $1,000 per person per year.

The Blue Choice Conversion Plan offers the same coverage limits as the Blue Choice Plan.

Each option covers 80% of these eligible expenses:

• Vision care
• Registered therapists and health practitioners
• Hospital accommodation
• Medical Services and Supplies
• Virtual care
• Nursing care
• Ambulance services
• Out-of-province, in-Canada travel
• Accidental dental
• Accidental death and dismemberment
• Final expense benefit
• Survivor benefit

Choose from Bronze, Silver or Gold Health coverage.

Each option covers 80% of eligible expenses and aligns with BC PharmaCare formulary pricing or the cost of the lowest priced equivalent drug.

Choose from Bronze, Silver or Gold Health coverage.

Each option covers 80% of basic services which include regular cleanings and check-ups.

Higher coverage is available to cover endodontics (root canals) and major work (bridges, crowns, etc.).

Boost your personal health plan by adding Bronze, Silver or Gold Dental coverage.

After a three-month no-claims waiting period and a calendar year deductible of $100, it covers up to:

0–12 months -60%, $500/person per year

13–24 months – 70%, $750/person per year

25 months + 80%, $1,000/person per year

Eligible dental expenses include all necessary services by a dentist, dental hygienist or denturist for the care and maintenance of teeth. Specifically, this includes:

• Diagnostic — 2 recall examinations every calendar year
• X-rays — the equivalent of one full-mouth series each calendar year (complete series x-rays are limited to once every 3 years).
• Preventive therapy — topical fluoride applications are limited to twice every calendar year
• Restorative dentistry — procedures to restore natural teeth to normal function using silver and tooth-colored fillings (front adult teeth only) and stainless steel crowns
• Scaling and root planing
• Prosthetic repair services to reline or repair fixed or removable appliances
• Routine extractions

The plan does not cover the cost of major reconstruction or prostheses for replacement of missing teeth.