Glossary


All Health Expenses

All Health Expenses is a grouping of coverage for services and items that are used with less frequency. This includes:

  • Hospital (Semi-private room)
  • Ambulance
  • Diabetic, colostomy and ileostomy
  • Nursing care
  • Medical equipment and aids
  • Dental repairs

Note: As per our standard Pacific Blue Cross contract terms, chiropractic x-rays are included. Also, out-of-country referral ($25,000 lifetime maximum) is included but terminates at age 65.

Co-insurance
The percentage of the health or dental product or service cost for which you will be reimbursed. The member will be responsible for the remaining percentage.
Rx formulary

A formulary is a managed list of drugs. This plan reimburses Members for drugs that fall under a Pacific Blue Cross managed list of drugs (Pacific Blue Cross Rx formulary). Certain drug claims will require prior authorization from Pacific Blue Cross or special authorization from BC PharmaCare. Lifestyle drugs for fertility, smoking cessation, anti-obesity and erectile dysfunction are not covered.

Paramedicals

These are services performed by registered practitioners and include:

  • Acupuncture
  • Chiropractic services
  • Massage therapy
  • Naturopathy
  • Osteopathy
  • Physiotherapy
  • Podiatry/Chiropody
  • Psychology
  • Speech pathology
Deductible

A dollar amount that Members must pay out-of-pocket prior to receiving reimbursement.

Recall frequency

The minimum amount of time that must pass between dental recall appointments (exam, polishing, etc).

Elimination period

After the onset of a disability, this is the amount of waiting time before you are eligible to receive the benefit.

Critical illnesses

Critical illness insurance protects you financially if you get a serious illness. Upon diagnosis you will get a lump sum payment can help you with cash flow, additional costs for treatment, or whatever you deem necessary. Our Critical Illness plan covers 23 of some of the most common critical conditions: Cancer (Life Threatening), Aortic Surgery, Coronary Artery Bypass Surgery, Heart Attack, Heart Valve Replacement or Repair, Stroke, Blindness, Deafness, Loss of Speech, Loss of Limbs, Occupational HIV, Severe Burns, Dementia including Alzheimer’s Disease, Benign Brain Tumour, Coma, Kidney Failure, Motor Neuron Disease, Multiple Sclerosis, Organ Transplant on Waiting list, Major Organ Transplant, Paralysis, Parkinson’s Disease and Specified Atypical Parkinsonian Disorders, Loss of Independent Existence.

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