Health Care Claims
Submit your original receipts with a completed Extended Health Care Claim Form for claims such as prescription drugs, vision care, medical equipment or services and registered therapists such as chiropractors, physio therapists and massage therapists.
Be sure to enter all requested information on the form then print and sign it. Our online forms also include helpful claiming instructions.
To ensure prompt payment, please follow these steps:
- Ensure all supporting documents and original receipts are included (remember to keep photocopies for your records).
- Please use blue or black ink only.
- Keep your receipts loose and flat in the envelope (no staples, paper clips or tape)
- Submit only one of each official receipt (no cashier or Interac receipts)
- Put all of your health expenses on one form (drugs, paramedical treatments, etc)
- Mail the signed form, with your receipts, to Pacific Blue Cross at the address indicated on the form. Forms may also be delivered in person to our office.
eClaims
Providing your plan sponsor has selected this feature,
we accept online claims submission for
vision care, physiotherapy, chiropractic, massage therapy. See how easy it is to use eClaims.
Additional information if you are claiming for:
Prescription drugs claims
- Pay direct drug card: Your benefit plan includes this feature if your Pacific Blue Cross identification card shows BLUEnet Pay Direct Drugs in the lower left corner. If so, your pharmacist will be able to bill Pacific Blue Cross electronically for eligible prescription drugs. Simply show your Pacific Blue Cross identification card as proof of coverage when ordering your prescription, and your pharmacist will take care submitting the eligible amount under your plan to Pacific Blue Cross directly for payment and you pay for any amounts not covered by your plan. Learn more about pay direct drug cards here.
- Member reimbursement: Prescription drugs may also be paid for directly by you and then claimed for reimbursement on an Extended Health Care Claim Form. Remember to include your original receipts when submitting the form.
Hospital accommodation
Claims for semi-private and private acute care rooms in British Columbia hospitals can be submitted directly to Pacific Blue Cross by the hospital on the member's behalf when the member requests semi-private or private preferred accommodation for acute care and the benefit is included as part of their extended health care plan.
Custom foot orthotics or orthopedic shoes
If your claim is for custom foot orthotics or orthopedic shoes, special claiming instructions are available here: See the checklists on the right-hand side of this page.
Not all extended health care plans cover foot orthotics or orthopedic shoes. You can verify coverage eligibility by referring to your plan booklet, or by signing in to CARESnet.
Claims for Veterans Affairs, RCMP or Canadian Forces:
Claim forms for Veterans Affairs Canada (VAC), Royal Canadian Mounted Police (RCMP) or Canadian Forces (CF) members can contact our Federal Administered Programs Department by calling 604 419-2795 within the lower mainland or 1-800-663-6723 toll free.
RCMP members must include a 1393 form to the Health Services Office. The 1393 forms are available through your detachment. They are to be sent to:
Health Services Offices
Division "E" ("M"),
657 W 37th Ave
Vancouver, BC V5Z 1K6.
Canadian Forces members are to submit your claims to your base Health Care Coordinator.
Coordination of benefits can save you out-of-pocket expenses
If the dependent making the claim has coverage under more than one plan,
please see our information on coordination of benefits.
Claiming Deadline
Most plans provide a specific period of time in which allowable expenses must be submitted. You can find out the specific claiming deadline for your plan by referring to your plan booklet, or by signing in to CARESnet.
We suggest that you submit your claims promptly. Pacific Blue Cross can only pay claims we receive, with correct and complete information, within one year of the service date.
Dental Claims
In most cases your dentist will take care submitting the eligible amount under your plan to Pacific Blue Cross directly for payment and you pay for any amounts not covered by your plan.
If your dental office gives you a receipt instead, submit it along with a Dental Claim Form.
Be sure to enter all requested information on the form then print and sign it. Our online forms also include helpful claiming instructions.Pacific Blue Cross requires this information on each claim:
- Patient's full name
- The member's policy and ID numbers
- Patient's dependent number and birth date
- If PBC is to reimburse the member, we also need the member's mailing address.
We also need all the information about the dental services that were performed. This includes:
- Procedure code
- Date of service
- Fee charged
- Tooth numbers and surfaces, if applicable
- The dentist's signature or authorization (or attach a receipt)
- The dentist's name and Pacific Blue Cross ID number
- A note indicating if Pacific Blue Cross should reimburse the member or the dentist (for example, write "pay member")
Coordination of benefits can save you out-of-pocket expenses
If the dependent making the claim has coverage under more than one plan,
please see our information on coordination of benefits.
Claiming Deadline
Most plans provide a specific period of time in which allowable expenses must be submitted. You can find out the specific claiming deadline for your plan by referring to your plan booklet, or by signing in to CARESnet.
We suggest that you submit your claims promptly. Pacific Blue Cross can only pay claims we receive, with correct and complete information, within one year of the service date.
Health Spending Account Claims
Please use the Health Spending Account Claim Form and attach original detailed receipts and any benefits statements from other plans. You may make your EHC and HSA claim together on the same form.
Health Spending Account Claims are considered by your group plan and the Medical Services Plan of BC before they can be claimed under your Health Spending Account. For most expenses, you will need to submit:
- Health Spending Account claim form*
- An explanation of benefits statement if another insurance carrier has considered the claim (such as your spouse's plan)
- Original paid receipts (photocopies are only accepted if you have submitted the original receipts under another group plan)
*Make sure to answer yes for each expense to the question “Apply unpaid balance to HSA plan?” in the provided column on the claim form. Please see the reverse of the HSA claim form for detailed claiming requirements for each benefit.
Coordination of benefits can save you out-of-pocket expenses
If the dependent making the claim has coverage under more than one plan,
please see our information on coordination of benefits.
Claiming Deadline
Most plans provide a specific period of time in which allowable expenses must be submitted. You can find out the specific claiming deadline for your plan by referring to your plan booklet, or by signing in to CARESnet.
We suggest that you submit your claims promptly. Pacific Blue Cross can only pay claims we receive, with correct and complete information, before your claiming deadline.
Disability Claims
Unlike health, dental and HSA claims, disability claims require multiple stakeholder involvement.
In the first step, forms need to be completed by the employer, the employee and the attending physician. If enough details are provided with the claim to make a decision, BC Life will assess the claim and make a decision about coverage.
The third step in the process, providing the claims has been accepted, is payment, while the fourth and fifth steps involve the employer, the employee and others working together to enable a well-planned and safe return to work.