Online claiming is the fastest and easiest way to make a claim because you will be able to see right away if your claim has been approved and payment will usually be deposited into your bank account within 48 hours. No more mailing claim forms and waiting for the cheque in the mail.

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Our plan consists of a core health plan with prescription drug and dental coverage options so you can choose the coverage you need.

Core Health Plan

Vision Care

Pacific Blue Cross covers the cost of prescription lenses, frames, contact lenses and laser eye surgery. This is an increasing benefit coverage up to a predetermined maximum.

Registered Therapists and Health Practitioners

Benefits are paid for visits to: naturopaths, massage therapists, physiotherapists, chiropractors, speech pathologists, chiropodists/podiatrists, psychologists, audiologists, acupuncturists, and nutritionists. This is an increasing benefit coverage up to a predetermined maximum.

Hospital Accommodation

Benefits cover the cost for semi-private or private hospital rooms (no age restrictions).

Hospital Daily Cash Benefit

If you are confined to a hospital, we will pay you $20 a day, for up to 90 days, from the 4th day of hospitalization, up to age 65.

Local Ambulance Private

Benefits cover the cost of ambulance fees in emergencies, including air ambulance and Treat No Transport.

Treat-No-Transport are charges for treatment when an ambulance is called to the scene of an accident or place of illness and transportation to hospital is not required.

Duty Care Nursing

Benefits cover the cost for private duty care nursing in your home, provided the nurse is a Registered Nurse(RN) and care begins immediately following the discharge of an acutely ill bed patient from a hospital, up to a predetermined maximum.

Out-Of-Province, In-Canada Travel

Benefits cover 100% of Out-of-Province and In-Canada medical emergency care.

Medical Services and Supplies

Benefits cover supplies and services not covered by PharmaCare up to a predetermined maximum.

Accidental Dental

Benefits cover up to $2,500 per person for accidental damage to natural teeth.

Accidental Death

Benefits cover the principal sum up to $25,000 (under the age of 70).

Final Expenses Benefit

Benefits cover up to $3,000 for each person.

Survivor Benefit

Benefits begin 12 months following approval of application.

Only Pacific Blue Cross Personal Health Insurance gives you 24/7 access to virtual care for referrals to specialists along with prescriptions from our Preferred Pharmacy Network delivered directly to your door.

Prescription Drug Options

Essential Prescription Drug Option

The Essential drug option covers 80% of the cost of PharmaCare-eligible prescription drugs. This is an increasing benefit coverage up to a predetermined maximum.

Enhanced Prescription Drug Option

The Enhanced drug option covers 80% of the cost of PharmaCare-eligible prescription drugs, plus prescriptions that are not eligible under the government PharmaCare plan. Drugs used for birth control are eligible under this option only. This is an increasing benefit coverage option up to a predetermined maximum.

The Enhanced drug option can include a Direct Pay Drug card provided no pre-existing medical conditions exist at the time of application. With a Direct Pay Drug card, your pharmacist submits your claim electronically. PBC pays the pharmacy 80% of your prescription cost, and you pay the pharmacist the remaining 20%. There is no need to submit a paper claim.

Dental Options

Essential Dental Plan Option

The Essential dental plan covers eligible expenses after a three-month no-claims waiting period, up to a predetermined maximum. Eligible expenses include:

Diagnostic expenses (oral examinations, x-rays)
Preventive treatments (polishing, fluoride treatments)
Restorative treatments (fillings)
Periodontal cleaning (scaling and root planing)
Prosthodontic services (repairs & minor services only)
Oral surgery (routine extractions)

In addition, the plan covers emergency treatment of the above services while temporarily outside of BC or the Yukon. There is no financial limit on the amount that will be paid for the services covered over the lifetime of the plan.

Enhanced Dental Plan Drug Option

The Enhanced dental plan covers all of the Essential dental benefits with the addition of major restorative services, up to a combined predetermined maximum.

The plan covers 50% of eligible expenses incurred after 12 consecutive months on the plan. The maximum amount payable for major restorative, orthodontic and denture services is limited to $500 for each covered person per year.

Additional eligible expenses include:

Major Restorative services (crowns, bridges, inlays and onlays)
Endodontics (root canals)
Orthodontic coverage.(children only, benefit begins after 24 months)
Complete or partial dentures

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Pacific Blue Cross Visitors to Canada Insurance provides coverage for costs related to emergency medical care resulting from an accident or sudden illness while visiting British Columbia. Plan coverage includes:

Stand-Alone Dental

Plan Highlights

Eligible dental expenses include all necessary services by a dentist or denturist for the care and maintenance of teeth including:

Diagnostic: two recall examinations (check ups) every calendar year
X-rays: the equivalent of one full-mouth series each calendar year (complete series x-rays are limited to once every three years)
Preventive therapy: topical fluoride applications are limited to twice every calendar year
Restorative dentistry: all procedures to restore natural teeth to normal function using silver and tooth-coloured fillings, and stainless steel crowns
Scaling and root planing
Prosthetic repair services to reline or repair fixed or removable appliances
Routine extractions

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Group Dental Add-On

If the health plan available through your employer doesn't include dental coverage, Pacific Blue Cross offers an add-on that individuals can purchase to supplement existing Blue Cross group health care plan. The add-on is available in Essential and Enhanced options:

Essential Dental Option

Diagnostic expenses
Preventive treatments
Restorative treatments
Periodontal cleaning
Prosthodontic services
Oral surgery

Enhanced Dental Option

Covers all of the Essential Dental Benefits with the addition of endodontics and major restorative services.

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Our plan consists of a core health plan with prescription drug and dental coverage options so you can choose the coverage you need.

Core Health Plan

Vision Care

Pacific Blue Cross covers the cost of prescription lenses, frames, contact lenses and laser eye surgery. This is an increasing benefit coverage up to a predetermined maximum.

Registered Therapists and Health Practitioners

Benefits are paid for visits to: naturopaths, massage therapists, physiotherapists, chiropractors, speech pathologists, chiropodists/podiatrists, psychologists, audiologists, acupuncturists, and nutritionists. This is an increasing benefit coverage up to a predetermined maximum.

Hospital Accommodation

Benefits cover the cost for semi-private or private hospital rooms (no age restrictions).

Local Ambulance Private

Benefits cover the cost of ambulance fees in emergencies, including air ambulance and Treat No Transport.

Treat-No-Transport are charges for treatment when an ambulance is called to the scene of an accident or place of illness and transportation to hospital is not required.

Duty Care Nursing

Benefits cover the cost for private duty care nursing in your home, provided the nurse is a Registered Nurse(RN) and care begins immediately following the discharge of an acutely ill bed patient from a hospital, up to a predetermined maximum.

Out-Of-Province, In-Canada Travel

Benefits cover 100% of Out-of-Province and In-Canada medical emergency care.

Medical Services and Supplies

Benefits cover supplies and services not covered by PharmaCare up to a predetermined maximum.

Accidental Dental

Benefits cover up to $2,500 per person for accidental damage to natural teeth.

Accidental Death

Benefits cover the principal sum up to $25,000 (under the age of 70).

Final Expenses Benefit

Benefits cover up to $3,000 for each person.

Survivor Benefit

Benefits begin 12 months following approval of application.

Only Pacific Blue Cross Personal Health Insurance gives you 24/7 access to virtual care for referrals to specialists along with prescriptions from our Preferred Pharmacy Network delivered directly to your door.

Prescription Drug Options

The Enhanced drug option covers 80% of the cost of PharmaCare-eligible prescription drugs, plus prescriptions that are not eligible under the government PharmaCare plan. Drugs used for birth control are eligible under this option only. This is an increasing benefit coverage option up to a predetermined maximum.

The Enhanced drug option can include a Direct Pay Drug card provided no pre-existing medical conditions exist at the time of application. With a Direct Pay Drug card, your pharmacist submits your claim electronically. PBC pays the pharmacy 80% of your prescription cost, and you pay the pharmacist the remaining 20%. There is no need to submit a paper claim.

Dental Options

Essential Dental Plan Option

The Essential dental plan covers eligible expenses after a three-month no-claims waiting period, up to a predetermined maximum. Eligible expenses include:

Diagnostic expenses (oral examinations, x-rays)
Preventive treatments (polishing, fluoride treatments)
Restorative treatments (fillings)
Periodontal cleaning (scaling and root planing)
Prosthodontic services (repairs & minor services only)
Oral surgery (routine extractions)

In addition, the plan covers emergency treatment of the above services while temporarily outside of BC or the Yukon. There is no financial limit on the amount that will be paid for the services covered over the lifetime of the plan.

Enhanced Dental Plan Drug Option

The Enhanced dental plan covers all of the Essential dental benefits with the addition of major restorative services, up to a combined predetermined maximum.

The plan covers 50% of eligible expenses incurred after 12 consecutive months on the plan. The maximum amount payable for major restorative, orthodontic and denture services is limited to $500 for each covered person per year.

Additional eligible expenses include:

Major Restorative services (crowns, bridges, inlays and onlays)
Endodontics (root canals)
Orthodontic coverage.(children only, benefit begins after 24 months)
Complete or partial dentures

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With four tiers of coverage to choose from, Guaranteed Acceptance offers some of the most flexible plan design available, so you can tailor the plan to suit your health needs—at a price that fits your budget. And no medical questionnaire is required.

Core Health Plan

Step 1: Health	ESSENTIAL	BRONZE	SILVER*	GOLD*
Lifetime Maximum	$250,000	$250,000	$375,000	$500,000
Prescription Drugs	80% PPN, 70% Non-PPN, $350 Limit Blue Rx, LCA, 8% Markup Limit, $5 Dispensing Fee Birth Control and vaccinations incl	80% PPN, 70% Non-PPN, $350 Limit Blue Rx, LCA, 8% Markup Limit, $5 Dispensing Fee Birth Control and vaccinations incl	80% PPN, 70% Non-PPN, $500 Limit Blue Rx, LCA, 8% Markup Limit, $5 Dispensing Fee Birth Control and vaccinations incl	80% PPN, 70% Non-PPN, $750 Limit Blue Rx, LCA, 8% Markup Limit, $5 Dispensing Fee Birth Control and vaccinations incl
Physiotherapists, massage therapists, chiroproactors, chiropodist/podiatrists, naturopaths, acupuncturists, osteopaths, speech therapists		$500 combined limit, $30/visit	$400 per practitioner, $30/visit	$500 per practitioner, $30/visit
Psychology and Clinical Counselling	$250 Online CBT Eligible	$500 Online CBT Eligible	$500 Online CBT Eligible	$750 Online CBT Eligible
Medical equipment, Home care, & Nursing	Year 1-2: $1,200 Year 3-4: $2,500 Year 5+: $5,000 (separate maximums for private duty nursing)	Year 1-2: $1,200 Year 3-4: $2,500 Year 5+: $5,000 (separate maximums for private duty nursing)	Year 1-2: $1,200 Year 3-4: $2,500 Year 5+: $5,000 (separate maximums for private duty nursing)	Year 1-2: $1,200 Year 3-4: $2,500 Year 5+: $5,000 (separate maximums for private duty nursing)
Hospital accommodation			Private: $195/day, Semi: $165/day Max 60 days	Private: $195/day, Semi: $165/day Max 60 days
Local Ambulance	80%	80%	80%	80%
Hearing Aids			Years 1-4: $300 / every 4 years Years 5+: $400 / every 4 years 3-month wait period	Years 1-4: $300 / every 4 years Years 5+: $400 / every 4 years 3-month wait period
Vision Care			$150 / every 2 years $50 Eye Exam	Years 1-2: $150 / every 2 years Years 3+: $250 / every 2 years $50 Eye Exam
Travel	Covers 100% of out-of-province within Canada medical emergency care
Accidental Death & Dismemberment	Principal sum up to $25,000 (under the age of 70)
Health & Wellness / Other benefits	EQ Care^®, Health Connected^®, New Parent Boost, Second Medical Opinion
* A dental option must be chosen with either Silver or Gold Health Options

Only Pacific Blue Cross Personal Health Insurance gives you 24/7 access to virtual care for referrals to specialists along with prescriptions from our Preferred Pharmacy Network delivered directly to your door.

Dental Coverage

Step 2: Dental	BRONZE	SILVER	GOLD
Dental - Basic
Year 1	70% / $300	70% / $300	80% / $450*
Year 2	70% / $300	80% / $400	80% / $575*
Year 3+	70% / $300	80% / $500	80% / $700*
Dental - Major
Year 1			50% / $450*
Year 2			50% / $575*
Year 3+			50% / $700*
* combined Basic and Major yearly limit

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Step 1: Health

Step 1: Health	BRONZE	SILVER	GOLD
Paramedicals
Physiotherapists, massage therapists, chiroproactors, chiropodist/podiatrists, naturopaths, acupuncturists, osteopaths	$25/visit, 12 visits/yr	$400 combined	$600 combined
Speech therapists	$45/visit, 10 visits/yr	$45/visit, 10 visits/yr	$45/visit, 10 visits/yr
Psychologists	$65/visit, 10 visits/yr	$65/visit, 10 visits/yr	$65/visit, 10 visits/yr
Vision
Prescription eyewear	$150	$250	$300
Eye exam	$50	$50	$80
Medical equipment
Year 1	$1,500	$1,500	$2,500
Year 2+	$1,500	$2,500	$5,000
Hearing aid	$300/5 yrs	$400/5 yrs	$600/5 yrs
Hospital accommodation
Hospitalization	$125	$200	$250
Day limit	30 days	30 days	30 days

Only Pacific Blue Cross Personal Health Insurance gives you 24/7 access to virtual care for referrals to specialists along with prescriptions from our Preferred Pharmacy Network delivered directly to your door.

Step 2: Prescriptions

Step 1 Health Choice:	BRONZE	SILVER		GOLD
Step 2: Prescriptions	BRONZE	BRONZE OR	SILVER	SILVER OR	GOLD
Dispensing Fee	—	—	$10*	$10*	$10*
Year 1	$500	$500	$1,000	$1,000	$1,500
Year 2	$500	$500	$2,000	$2,000	$2,500
Year 3+	$500	$500	$3,000	$3,000	$5,000
*Maximum follows BC PharmaCare

Step 3: Dental

Step 3: Dental (optional)	BRONZE	SILVER	GOLD
Services
Basic	80%	80%	80%
Endodontics	—	80%	80%
Major	—	—	60% after Year 1
Limits
Year 1	$500	$600	$1,000
Year 2	$500	$800	$1,250
Year 3+	$500	$1,000	$1,500
Usage
Recall Package**	Every 9 months	Every 9 months	Twice per year
** Includes exam, polishing and flouride

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All guaranteed acceptance applications for April 1^st effective date must be received by 5pm on March 31, 2021. Applications made after 5pm will become effective May 1^st, 2021.

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Personal Health Insurance - Health and Dental

Design your plan in two easy steps

Build a plan that fits your health needs. Enjoy the flexibility to upgrade your level of health or dental coverage-- no medical review required-- upon your plan anniversary. Enjoy the flexibility to downgrade every two years.

Step 1 — Select your health coverage

Select coverage will vary based on the plan level selected.

HEALTH	BRONZE	SILVER	GOLD
Lifetime maximum	$375,000	$500,000	Unlimited
PRESCRIPTION DRUGS
Coverage	Payable up to 80%¹	Payable up to 90%¹	Payable up to 90%¹
Dispensing fee	$5	$10	$10
Yearly limit	$5,000	$10,000	Unlimited
PROFESSIONAL SERVICES
Practitioner services²	$400 per practitioner/yr, $30/visit	$600 per practitioner/yr, $40/visit	$800 per practitioner/yr, $50/visit
Mental wellness services³	$750 combined limit/yr	$750 combined limit/yr	$1,500 combined limit/yr
VISION / 6 month waiting period / Eligible every 2 years
Prescription eyewear	$250	$300	$400
Eye exam	$60	$80	$80
MEDICAL EQUIPMENT and SUPPLIES / $5,000 per year
Hearing aids	$300/4 years/ 3 month waiting period	$400/4 years/ 3 month waiting period	$600/4 years/ 3 month waiting period
FAMILY PLANNING BENEFIT / 1 year waiting period
Fertility drugs			$5,000/yr/family⁵
Fertility treatment and adoption⁴			$5,000/yr/family⁵
¹ Maximum coverage limits apply at Preferred Pharmacy Network (PPN) providers only. Lower coverage limits apply at non-PPN providers. Find a PPN provider near you at pac.bluecross.ca/PPN. ² Practitioner services include physiotherapists, massage practitioners, chiropractors, naturopaths, chiropodists, podiatrists, osteopaths, speech pathologists, registered dieticians, and acupuncturists. ³ Mental wellness services include psychologists, clinical counsellors, and online CBT. For more information on online CBT, visit pac.bluecross.ca/member/iCBT. ⁴ Fertility treatment includes in-vitro fertilization, egg freezing, intrauterine insemination, and sperm freezing. Adoption includes agency and legal fees. For more info, visit pac.bluecross.ca/FamilyPlanning. ⁵ If per your agreement infertility is deemed to be a pre-existing condition then this benefit will reduce to a combined lifetime maximum of $2,000 for fertility drugs, fertility treatment and adoption.

Step 2 — Select your dental coverage

Select coverage will vary based on the plan level selected.

DENTAL	BRONZE	SILVER	GOLD
BASIC and ROUTINE SERVICES
Waiting period	3 months	3 months	No waiting period
Recall frequency⁵	9 months	6 months	6 months
Year 1	70%, $500	70%, $800	80%, $1,000⁶
Year 2	80%, $700	80%, $1,100⁶	90%, $1,300⁶
Year 3+	80%, $900	80%, $1,400⁶	90%, $1,600⁶
MAJOR SERVICES, DENTURES, and ORTHODONTICS
Waiting period		12 months	6 months
Year 1			60% Major only⁶
Year 2		50% Major only⁶	60% incl. Dentures, Orthodontics^6,7
Year 3+		50% incl. Dentures, Child orthodontics^6,7	60% incl. Dentures, Orthodontics^6,7
⁵ The min. frequency required between select preventative and diagnostic services (e.g., exams, polishing, fluoride). ⁶ Combined annual maximum for all dental services. ⁷ $2,000 orthodontic lifetime maximum/person. Gold orthodontic coverage is for children and adults.

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Toll free in BC:	1 800 873-2583

Personal Health Insurance

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Health and Dental

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Core Health Plan

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Core Health Plan

Step 1: Health

Virtual Care

Dental Coverage

Step 2: Dental

Dental - Basic

Dental - Major

Step 1: Health

Step 1: Health

Paramedicals

Vision

Medical equipment

Hospital accommodation

Virtual Care

Step 2: Prescriptions

Step 1 Health Choice:

Step 2: Prescriptions

Step 3: Dental

Step 3: Dental (optional)

Services

Limits

Usage

Have someone contact me about Personal Health plans

Personal Health Insurance - Health and Dental

Design your plan in two easy steps

Step 1 — Select your health coverage

PRESCRIPTION DRUGS

PROFESSIONAL SERVICES

VISION / 6 month waiting period / Eligible every 2 years

MEDICAL EQUIPMENT and SUPPLIES / $5,000 per year

FAMILY PLANNING BENEFIT / 1 year waiting period

Step 2 — Select your dental coverage

BASIC and ROUTINE SERVICES

MAJOR SERVICES, DENTURES, and ORTHODONTICS