Advisor COVID-19
Resource Centre

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.

Learn more below  

To our trusted Advisors,

As BC’s health benefits society, the health and wellbeing of our members and employees is our top priority. We also recognize the role Pacific Blue Cross plays in the health care of you and your family. As the situation surrounding COVID-19 (coronavirus) continues to evolve, we want to do our part to ensure the health of our community.

COVID-19 is proving to be a great test for us all, but rest assured we continue to operate—just differently. We are following recommendations from the government and health authorities to protect the safety of our employees who serve our clients and members. To support social distancing guidelines and those staying home following travel, we have begun to work remotely.

Read more...
 

Our precautionary measures to fight the spread of the virus will have impacts as we deliver our plan:

  • Paper claims, calls, and emails will be temporarily delayed.
  • Our walk-in centre remains closed.
  • Travel emergencies will continue to be handled by calling Medi-Assist.
  • Disability payments will be prioritized.
  • Prescription medications will follow recommendations by the Ministry and the BC College of Pharmacists.
  • We have created a member COVID-19 Resource Centre with information on the pandemic, answers to questions on benefits or insurance coverage, details on prescription medications and early refills as well as mental health support to help manage and navigate these difficult times.
  • Payment cheques and direct deposit payments continue to be processed.
  • Electronic claims continue without interruption and are fast and easy:

We also ask that you help us fight the spread of COVID-19. By removing paper-based claims from our business we can encourage social distancing, pay you faster, and help the environment. Please encourage plan sponsors and administrators to use digital invoices, manage member enrollment, access claim and enrollment forms, and view policy and plan benefits information by signing on to ADMINnet on our website. You can also find useful digital services by signing on to ADVISORnet.

We also understand the vital role you play in keeping your members safe by connecting them to their benefits. Understandably, you have questions for us during this unique time. We have created answers on our COVID-19 Plan Sponsor FAQ resource page.

We will continue to follow the recommended approach from the local health authorities for protection and prevention. And we’ll keep you informed of any updates.

Healthy wishes,

John D. Crawford
President and Chief Executive Officer
Pacific Blue Cross

I acknowledge that I have the honour of working on the traditional territory of the Coast Salish Peoples, specifically the shared traditional territories of the Sḵwx̱wú7mesh Úxwumixw (Squamish), Tsleil-Waututh, xʷməθkʷəy̓əm (Musqueam) and Kwikwetlem First Nations.

 

 

What can Advisors do to help?

We ask that you help us fight the spread of COVID-19 by encouraging social and physical distancing. There are resources to help you through ADVISORnet and ADMINnet.

Go digital with Pacific Blue Cross on ADVISORnet.

Advisors and Brokers

Digital Tasks

Information

Access to policy & plan benefits

Reports, commission statements & invoices

View online

 

Go digital with Pacific Blue Cross on ADMINnet.

Plan Administrators

Digital Tasks

Manage member enrollment

Enroll, terminate, reinstate
Update member information & order ID cards
View coverage & HSA information

View Policy & Plan Benefits Information

View invoices and reports

Access to claim and enrollment forms

Waiver and Enrollment forms
STD/LTD forms
Life & ADD claim forms

 

 

 

Managing health and wellbeing during COVID-19

 

COVID-19 and your benefits plan: Frequently Asked Questions

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.

Finding solutions to benefits during COVID-19

We understand the vital role you play in the healthcare ecosystem, connecting plan sponsors and members to their benefits. As the impact of COVID-19 (coronavirus) continues to evolve, we understand the financial challenges.  Yet, today – more than ever, healthy benefits and employees are critical. We are doing what we can to help with clarity, adjustments and flexibility.

  1. Will Pacific Blue Cross offer temporary suspension of coverage?

    We are finding solutions to pause, not cancel, coverage. Rather than terminating a group, we will allow plans to suspend all coverage (premium and claims) for a maximum of 60 days—so you won’t pay premiums and we won’t pay any claims—with no penalty for reinstating. The overall plan structure and the contract will remain in force.

    This will be extended for June 2020 and will be reassessed on a monthly basis going forward.

    Plan sponsors will be accountable for communicating the impact of these changes in coverage to their plan members. We want to thank you for your patience as we work through this and other solutions to help support you and your business.     

  2. How can Pacific Blue Cross support employers who want to reduce employee work hours?

    We understand there are financial impacts to businesses beyond your control, so we are being flexible with how we define eligible work hours. At this time, we will be relaxing the eligibility provision as it relates to minimum hours of work required.

    This will be extended for June 2020 and will be reassessed on a monthly basis going forward.

    While it might be necessary for employers to cut staff hours below the contractual minimum amount, it doesn’t mean that the employee’s coverage will be reduced. We want you and our members to be assured that we are committed to covering the pre-pandemic benefit amounts, with coverage remaining in place for all benefit lines during the period for which employees are working reduced hours.

    As such, there will be no change in volume-based coverage even though the employee’s hours have been reduced.  The coverage will remain in place provided premiums continue to be paid. From an administrative standpoint, as it relates to a reduction in minimum hours worked, it will be the responsibility of the plan sponsor to administer these changes internally. There will be no need to make changes to our Admin system at this time.

    We want to thank you for your patience as we work through this and other solutions to help support you and your business.

  3. How can Pacific Blue Cross support employers with temporary layoffs?

    We understand businesses are trying to find creative ways to keep their talent for the long term while ensuring economic stability.

    As a way to help support employers and their employees during this period of uncertainty, we will be offering the following  extension-of-coverage guidelines for temporary layoffs, where coverage can be extended:

    • up to 90 days for disability benefits
    • 180 days for all other benefits

    Disability benefits would be payable on the later of the return-to-work date or the end of the disability benefit elimination period

    We want you and our members to be assured that we are committed to covering pre-pandemic benefit amounts, with coverage remaining in place for all benefit lines for the duration of these extended layoff provisions, provided premiums continue to be paid.

    For these types of layoff requests, the plan sponsor should continue to follow standard practice of submitting them to us for updating and approval. All other standard enrollment actions can still be handled by submitting the appropriate change requests or using the self-serve functionality on our ADMINnet site.

  4. What will Pacific Blue Cross be doing about policy renewals while the COVID-19 crisis is ongoing?

    We recognize the difficulty many of our groups are having during this crisis. For that reason we will be automatically deferring renewals to July 1, 2020 for all fully insured groups below 50 lives that have a May or June effective date, with no adjustment or pro-rating as a result. The renewal anniversary date will remain unchanged for 2021. For clients with greater than 50 lives, we understand that they may also have some concerns about their upcoming renewals. In these situations, please reach out to your respective Account Executive for guidance.  

  5. My client’s business is taking a financial hit as a result of COVID-19. Is Pacific Blue Cross offering any kind of premium grace period for my clients?

    We appreciate the struggles small businesses and other organizations are having in trying to weather the storm that is COVID-19. To assist in the effort, on a temporary basis, Pacific Blue Cross will be increasing our payment deadline from 31 days to 60 days for all small and medium sized fully insured clients, without a corresponding suspension of claims.

    This will be extended for June 2020 and will be reassessed on a monthly basis going forward.

    If, it turn outs, your client needs this additional payment extension and have set up a pre-authorized withdrawal of premiums, please contact our Group Collections department at GroupCollections@pac.bluecross.ca prior to April 15th to deactivate the automatic withdrawal for the next bill run and implement an alternate, more flexible payment method available to you during this time (i.e. online banking or electronic funds transfer).

    We also realize that some of your larger clients may be experiencing similar financial pressures, if so please reach out to your Account Executive and they can work together with you to help identify the client’s needs and work on some possible options for consideration.

    Finally, for those clients that are able to continue to pay their invoice on time, please have them do so. It's helping us continue to provide services to them and their employees during these very uncertain times.

    We want to thank you for your patience as we work through this and other solutions to help support you and your business.

  6. Will Pacific Blue Cross be offering premium relief?

    Now that British Columbia has eased into Phase 3 of its restart plan, providers are returning to deliver health services. We have been closely monitoring claim volumes – and with the claims data in-hand, we have made an informed decision on further premium reductions for fully insured non-refund groups.

    For July, 2020, we will be applying the following premium reductions to fully insured non-refund groups, which will take the form of a rate change under the group policy:

    • 10% credit against dental premiums paid
    • No further credit against non-drug-related extended health care premiums paid

    Going forward, decisions on extensions will be made on the 10th of each month and retroactive to the first of the month. Credits will be applied on a retroactive basis.

    We want to thank you for your patience as we work through this and other solutions to help support you and your business.     

    Commissions
    We are also committed to supporting advisors during this pandemic. Although some commission payments might be temporarily reduced as a result of this interim premium reduction policy, we will reconcile the commission at a later date to make sure that commission payments are not negatively impacted as a result of this temporary policy measure.

    If you have any questions about the premium reduction, reach out to your account executive.

Member Access to Digital, Virtual and Tele-Health Care with Pacific Blue Cross

As BC’s health benefits society, the health and wellbeing of our members is our top priority. As the impact of COVID-19 (coronavirus) continues to evolve, and we fight the spread of the virus through social and physical distancing – it has changed the way we access health care.

As with all coverage, benefits vary from plan to plan. The details are in your contract and can be found on the Member Profile and with our mobile app from the App Store or Google Play.

Pacific Blue Cross currently supports the following:

Benefits vary from plan to plan

Digital, Virtual & Tele-Health Care

Registered Counselling

Yes

Psychological services

Yes

Naturopathic services

Yes

Dental Services

Yes
Assessing Urgent Dental Emergencies  

Employee Family Assistance Program

Yes
Homewood

Mental Health support

Yes
Homewood & Starling Minds

Disability case management (case planning, return to work planning & remote rehabilitation)

Yes
Pacific Blue Cross

Health Risk Assessment

Yes
My good health

Prescription medication home delivery

Yes
Preferred Pharmacy Partners

Some Virtual Care services

(billed to MSP)

Yes
Babylon by TELUS Health & Medi-Map

 

As of March 24, 2020, Pacific Blue Cross will allow the following:

Benefits vary from plan to plan

Digital, Virtual & Tele-Health Care

Physiotherapy

Yes

Chiropractic services

Yes


To ensure safe and effective treatments, Pacific Blue Cross will require the following for Tele-Health and Virtual Care services for Physiotherapy and Chiropractic services:

  • Services must all meet all regulations as outlined by the respective college, whether services are provided in-person or via tele-re habilitation.  This includes, but is not limited to, services provided by practitioners who are licensed to practice in the jurisdiction of member residence.
  • All receipts issued to member must include “Tele-health” for these services.

Want to boost your plan with EQ Care?

Add EQ Care to your plan and boost virtual care for your members:
  • Virtual heath care from any device, from wherever you are
  • On-demand 24/7 access to a care manager and doctor
  • Referrals to specialists and mental health professionals
  • Prescriptions to your pharmacy of choice including home delivery

 

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.