COVID-19 and your benefits plan: Frequently Asked Questions

Wednesday, Mar 18, 2020

As BC’s health benefits society, the health and wellbeing of our members and their families is of paramount importance. Pacific Blue Cross has developed an online resource to help address benefit-related questions we are receiving from advisors and plan sponsors about the COVID-19 pandemic and our group insurance practices. It will be updated regularly.

  1. If a member is diagnosed with COVID-19, what do they need to do to get access to their disability benefits?
    If a member has a confirmed COVID-19 diagnosis, claims will be processed and paid based on the regular guidelines. The waiting period will be waived. We are currently requesting members with a clinical diagnosis to complete a Plan Member Confirmation of Illness Form in place of a formal physician’s statement.
  2. If a member has been in contact with someone else who has been diagnosed with COVID-19, can they access their disability benefits?
    Members who have been advised to self-monitor for symptoms if they may have been exposed to someone who is infected and are asymptomatic are not eligible for disability benefits. We will suggest they consult the HR department of their organization or apply for EI benefits.
  3. What if my organization decides to suspend operations temporarily, how will the disability benefits come into play?
    If your organization decides to suspend operations temporarily and your staff are asymptomatic, they will not be eligible for benefits.
  4. If a member is travelling out of country and hospitalized for recovery and treatment of COVID-19, does the STD elimination period begin and could benefits be paid for a period the Member is not in Canada?
    As the member is already out of country when they become ill and would be hospitalized for treatment that is medically necessary, the terms of the policy would be met. While the policy may already have 0-day elimination for hospitalization, as an industry, we have agreed to waive the elimination period for eligible COVID-19 claims. If the claim is allowed, the elimination period will be waived but the maximal period considered would be 14 days, subject to the other provisions of the policy.
  5. If a member is travelling out of country, is diagnosed with COVID-19 and is medically directed to quarantine, does the STD elimination period begin and could benefits be paid for a period the member is not in Canada?
    Quarantine is the medically necessary treatment for diagnosis of COVID-19. Thus, as an industry, we have determined that we will assess self-quarantine claims and consider up to the 14-day maximum. While the member is out of country, they would be following instructions of physicians, therefore, this would meet the terms of the policy.

    If the claim is allowed, the elimination period will be waived, but the maximal period considered would be 14 days subject to the other provisions of the policy. In this case, the fact that the diagnosis has been made implies that the quarantine has been medically directed (vs. self-quarantine, which is not medically directed).
  6. If a Member is traveling out of country and is exposed to the COVID-19 and decides to self-quarantine (no diagnosis), does the STD elimination period begin and could benefits be paid for a period the member is not in Canada?
    An STD claim for quarantine and mild symptoms with no positive COVID-19 test does not meet the definition of disability under the policy and does not qualify for disability benefits. The claim will be denied, and the individual will be redirected to EI.
  7. If a Member is within Canada and is exposed to the COVID-19 and decides to self-quarantine (no diagnosis), does the STD elimination period begin and could benefits be paid for a period the member is not in Canada.
    An STD claim for quarantine and mild symptoms that do not meet the definition of disability under the policy and no positive COVID 19 test does not qualify for disability benefits therefore the claim will be denied and the individual will be redirected to EI.
  8. If a Member is within Canada and is directed to quarantine/self-isolate by the Government or a Healthcare Professional, is the Member eligible for disability benefits?
    An STD claim for a directed quarantine with no symptoms is not payable. Individuals should be referred to EI for benefits.
  9. Does my Group Benefits contract include coverage to my employees if they catch COVID-19?
    If your Group Benefits plan includes Extended Health Care, COVID-19 would be a recognized illness under that program. Each contract is unique, to find details on what’s covered, refer to your specific contract details. A Pacific Blue Cross representative is the best person to respond to questions about your specific contract and the coverage it provides.
  10. If a vaccine is developed to protect against COVID-19, will the cost be covered by my plan?
    There is research and development underway for a COVID-19 vaccine, but it’s too early to predict if it will be needed or it would be made available to the public. Your Extended Health Care contract will indicate which vaccines, if any, are a covered expense.

What your members might be asking

  1. Coverage when travelling
    It’s always recommended that you refer to your specific plan and that members know the details before they travel. Your policy may include: 1) Emergency Out-of-province/Territory Emergency Medical Expenses, 2) Trip Cancellation and includes 3) Emergency Travel Assistance and 4) Government Integration. These are four distinct provisions under your Group Benefits program. The questions and answers below are intended to help you understand these four benefits in the context of COVID-19.
  2. Who should I call when I get sick while travelling?
    All members should contact Medi-Assist at 1 888 699–9333 within Canada and the US. and (collect) 1 604 419-4487 from all other countries to advise that they need to seek medical treatment. This should always be done in advance of seeking treatment, if possible. If it's not possible to contact Medi-Assist before you seek medical attention, you or a travelling companion that is able to provide all the medical and policy details on your behalf should call within 5 days. Medi-Assist is an emergency travel assistance company that is trained to provide travelers with the help they need to arrange their medical treatment in any situation while in another country and will work with PBC to ensure members can access the benefits they have in accordance with their policy.
  3. Does my Emergency Out-of-province/Territory Emergency Medical Expenses insurance cover me if I get COVID-19 while travelling?
    When travelling, if you or a covered member of your family has a medical emergency and gets sick (with COVID-19 or another illness), your Out-of-province/Territory Emergency Medical Expenses coverage will pay for your emergency medical treatments, subject to the terms of your contract. For medical expenses, Pacific Blue Cross will facilitate ”government integration” and apply any reimbursement you are eligible for from the Medical Services Plan (MSP) for your emergency medical expenses while you were travelling. All you have to do is fill out the form and we will take care of the rest.
  4. As a Group plan member, what happens if I am placed in quarantine by a medical doctor or Public Health official while I am travelling?

    If you or a family member experience a medical emergency and get sick while travelling, you would be eligible for coverage under your emergency Out-of-province/Territory Emergency Medical Expenses benefit for emergency medical expenses such as but not limited to medication, physician visits and hospitalization, subject to the terms of your contract. In addition, your Group Benefits insurance policy includes daily subsistence for the patient or a family member when hospitalization requires you to stay beyond your return date. This coverage will cover your costs for food, accommodations, and return transportation home (i.e. if you miss your originally scheduled flight), subject to the terms of your contract.

    If you are placed in medical quarantine or determine you need to self-isolate while travelling but are not sick or not having a medical emergency your plan would not provide any coverage for daily subsistence costs. This is because Emergency Travel Assistance is intended to protect you if you have a medical emergency or get sick.

    For information about further financial assistance that may be available if you are quarantined with COVID-19 while travelling, visit the Canadian Government website.

  5. What happens if I am quarantined by a doctor or Public Health official, but I’m nearing the maximum number of days eligible for coverage while out-of-country?
    If you are quarantined but nearing the maximum number of days of eligible coverage, your Out-of-province/Territory Emergency Medical Expenses coverage will be extended upon approval by Pacific Blue Cross until you are released from quarantine and able to secure safe passage home. This applies as long as you are under quarantine – whether you have been diagnosed or not. Coverage is based on the specific terms of your Group Benefits insurance policy.
  6. What about prescription medications?
    • If you have questions about your prescription(s), including early refills or potential home delivery options, please reach out to your Pharmacist.
    • Stocking up on larger quantities of medicines can create challenges for other clients – make sure to talk with your pharmacist about early refills and large purchases to determine the best plan for your needs. Pharmacists will use their best judgment to ensure that everyone gets the medicines they need, to support overall health and wellness.
    • Pacific Blue Cross supports the recommendations put forth by the British Columbia College of Pharmacists determining best practices for Early Refills and Emergency Supplies.
    • The College has created an information sheet for patients to help them understand the regulations around prescription renewals and emergency refills.
    • Pharmacists should also refer to the Pacific Blue Cross Pharmacy Reference Guide for our policy on Early Refill
    • Looking for a pharmacy in your area? Pacific Blue Cross has a robust Preferred Pharmacy Network to support you in accessing your medications.

We've also created a COVID-19 Resource Centre for members.