Extended Health & Health Spending Account Claim Forms

Extended Health & Health Spending Account Claim Forms

Please enter your policy number exactly as it appears on your PBC Member ID Card to download claim forms for your extended health or health spending account benefit plans.

Please note:

• Click here for more information on how to submit an Extended Health Care claim.
  
  
• Effective January 1, 2006, Pacific Blue Cross has revised its claiming criteria for members who have custom foot orthotic or orthopedic shoe coverage as part of their extended health care plan.
  
  NOTE: Not all extended health care plan cover foot orthotics or orthopedic shoes. You can verify coverage eligibility by referring to your plan brochure, signing into CARESnet (our member self-service website), or by calling our Customer Service department at 604 419-2600 or 1 888 275-4672
  
  
  • Orthopedic shoe claiming checklist [pdf]
    
  • Orthopedic shoe claiming checklist - French [pdf]
    
  • Custom foot orthotics claiming checklist [pdf]
    
  • Custom foot orthotics claiming checklist - French [pdf]
    
  
  
• Providers, RCMP and Canadian Forces members looking for claim forms click here.

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