Your solution for an affordable and flexible benefit plan
The success of any benefit plan depends on whether it meets the goals for which
it was created. There are a lot of
things to consider when designing a benefit plan that meets your business
needs.
Employers start with core coverage that provides coverage for many health care products
and services where the provincial government health plan falls short. Employers
can then choose from several additional benefits to meet the unique needs of their
workforce. Your costs depend on the core health plan and the additional benefits
you select.
Plan Highlights:
Blue Chip Plus has flexibility built in; even the core coverage provides flexible
options. There is no overall lifetime maximum* on the core extended health plan
and employers can choose the length of the waiting period; the optional deductible
and the percentage amount of co-insurance coverage for their plan.
*Certain benefits may include lifetime limits.
Core Benefit Plan
- Prescription Drugs:
Covers up to 100% of prescription drugs from
your choice of formulary (Brand name, PharmaCare or Blue Cross formulary). An optional
per prescription deductible can also be included on the plan to help contain costs.
- Bluenet Pay Direct Drug Card:
Your pharmacist submits your claim
electronically. PBC pays the pharmacy your plan's percentage of the prescription
cost. Your employees pay the pharmacist the remaining percentage. There is no need
to submit a paper claim.
- Registered Therapists and Health Practitioners:
Covers visits to
registered massage therapists, physiotherapists, chiropractors, naturopaths, chiropodists,
podiatrists, osteopaths, speech pathologists, psychologists, registered dieticians
and acupuncturists. You choose a calendar year maximum from $250 up to $500 with
additional options to limit dollar amounts for each visit and/or the number of visits
- Hospital Accommodation:
Covers the cost for a semi-private or private
hospital room up to $100 per day.
- Local Ambulance:
Coverage for the cost of ambulance. Includes air
ambulance and payment for Treat No Transport charges (when an ambulance is called
but transport to hospital is not required).
- Private Duty Care Nursing:
Covers private duty nursing care in
your home with a Registered Nurse, following the discharge of an acutely ill patient
from hospital up to $10,000 per person per calendar year. There is a $25,000 lifetime
maximum on this benefit.
- Medical Services and Supplies:
Covers items like casts, crutches,
oxygen and oxygen supplies, wheelchairs, hearing aids blood pressure monitors and
more.
- Hearing Aids:
Benefit covers $500 per person per 5 calendar years.
- Orthotics
Benefit covers custom made orthotics up to $300 per adult
per 2 calendar years and $300 per child every calendar year.
- Employee and Family Assistance Program:
Benefit provides toll-free
telephone access to confidential short-term counseling, advisory and information
service provided by Shepell-fgi for a wide range of personal and work/life issues
to employees and dependent family members 24hours a day/7 days a week.
- Second Opinion® Medical Consultation:
When diagnosed with a serious
health condition, this benefit provides access to a second opinion from specialists
at the McGill University Health Centre, one of the largest and most advanced medical
campuses in North America.
- Out-of-Country Referral
When a medical treatment is not available
in the employee's province of residence, this benefit provides coverage over and
above the amount covered by the government health plan for services and supplies
on the referral of a Physician and/or Surgeon related to medically necessary treatment.
Pacific Blue Cross must pre-approve any expense over $1,000 and the benefit has
a $25,000 lifetime maximum.
- Survivor Benefit
A dependent whose coverage would otherwise cease
because of the death of the employee will continue to be eligible for benefits without
further payment of contributions provided the employee was covered for at least
12 months before death. Coverage continues until the earliest of:
- 24 months after the death of the employee
- The date the covered person ceases to be a dependent other than as the result of
the employee's death
- The date the policy terminates
- Life Insurance:
The core benefit Life Insurance is provided to
employees only. Benefits are paid to the employee's designated beneficiary. Options
include the choice of a flat benefit amount of $25,000 to $100,000 or a multiple
of annual salary to a maximum of $250,000 (groups with 4-24 employees) or $500,000
(groups with 10 or more employees).
Additional Life coverage options to cover spouse and dependents are available. (see
Life Insurance Options below)
- Accidental death and dismemberment:
Coverage options include the
choice of a flat benefit amount of $25,000 to $100,000 or a multiple of annual salary
to a maximum of $250,000 (groups with 4-24 employees) or $500,000 (groups with 10
or more employees)
Extended Health Care Options
Vision Care Can be included as an optional benefit. Choose a maximum
up to $300 every two calendar years. Option to include eye exams and/or laser eye
surgery under the Vision Care maximum. If eye exams are a separate benefit, choose
a maximum from $50 up to $100 every two calendar years.
Dental Plan Options
Dental coverage is a valuable option to consider as part of your Blue Chip Plus
plan. Employees value dental care benefits because they know seeing a dentist regularly
is an important part of maintaining good overall health.
Blue Chip Plus offers complete flexibility. You can select any or all three categories
of dental coverage from Basic, Major and/or Orthodontic services. You also choose
your own deductible.
Basic Preventative and Restorative Services Option
The Basic Dental Option covers services for the basic care and maintenance of teeth
including procedures to restore teeth to natural and normal function. Eligible expenses
include:
- Recall Examinations (several options available)
- Diagnostic expenses
- Preventive treatments
- Restorative treatments
- Periodontal cleaning
- Prosthodontic services
- Oral surgery
You can choose from a range of co-insurance percentages. You also can also choose
to include unlimited coverage or a calendar year maximum up to $2,000.
Major Restorative Services Option
The Major Dental Option covers major restorations or replacement of missing teeth,
or the reconstruction of teeth where basic restorative methods cannot be used satisfactorily
(includes crowns, bridges and dentures). Various coinsurance percentages and plan
maximums can be applied depending on the size of your group.
Orthodontic Services Option
The Orthodontic Services Option covers all eligible expenses up to 50%. Eligible
expenses include ortho-exams, x-rays, diagnostic radiographs, casts, braces and
retainers.
- For groups with 4-9 employees, coverage is available for children only and you choose
a $1,000 to $2,000 lifetime maximum.
- For groups with 10 or more employees, coverage is can be selected for children only
or for children and adults with a lifetime maximum up to $3,000.
Life Insurance Options
Dependent Life Insurance Option
Dependent Life Insurance can be added as an option to cover your employee's spouse
and dependents. Dependent Life is designed to pay for final expenses such as funeral
costs. Coverage options are available up to $10,000 for spouse and $5,000 per dependent
child depending on your group size.
Optional Life Insurance
Groups with 10 or more employees can offer the opportunity for employees to add
additional Life Insurance coverage in units of $10,000 to a maximum of $250,000.
Critical Illness Option
When diagnosed with a life threatening illness, unexpected expenses such as special
equipment, private nursing or even childcare can add pressures making it difficult
to focus on recovery. You can help employees through a difficult time by providing
financial security through a critical illness plan. When it life take a catastrophic
turn, the Critical Illness Option provides a lump sum cash payment that can be used
to cover private nursing costs, home modifications, childcare costs, or whatever
else the employee chooses so the focus can be on recovery.
Coverage options are available up to $50,000 for the employee, $10,000 for spouse
and $5,000 per dependent child depending on your group size.
Disability Plan Options
Short Term Disability
Short Term Disability benefits are paid to an employee who, as a result of a non-occupational
injury or illness becomes disabled and is unable to perform their job. The benefit
provides income replacement up to 75% of salary depending on if the benefit is implemented
as a non-taxable or taxable benefit. Several options are available to choose for
benefit maximums, qualifying periods and benefit duration.
Long Term Disability
This benefit provides a monthly income (usually to age 65) for employees who become
totally disabled due to accident or sickness and are unable to work. The benefit
provides income replacement up to 75% of salary depending on if the benefit is implemented
as a non-taxable or taxable benefit. Several options are available to choose for
benefit maximums, and qualifying periods.
Eligibility / Enrollment Requirements
- Your business must have been operating for at least one year.
- The proportion of employees that are related to each other should not exceed 50%.
- A minimum of four participating employees.
- For 4 to 9 lives, 100% enrollment is required
- For 10 to 24 lives, 90% enrollment is required.
- Employees must work a minimum of 20 hours per week to be eligible for benefits.
- Retirees and individuals employed on a part time, seasonal, casual or contract basis
are not eligible.
- Eligibility for coverage is on the first of the month following your choice of waiting
period.
- For 4 to 9 employees, 3 to 6 months
- For 10 or more employees, 1 to 6 months
Exceptional Service is included
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Blue Cross members have an advantage
The Blue Advantage program allows Blue Cross members to save on medical, vision care and many other products and services offered by participating providers across Canada.
The program is unique because it provides savings at point of sale on the total cost of products and services from participating providers, regardless if the item is covered under your benefit plan. Simply present your Blue Cross identification card to the participating provider and mention the Blue Advantage program. Know more. Save more.