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FAQs

Here are some of our most frequently asked questions.

  • Receiving a Quote
    • What if I have coverage elsewhere and want a quote comparison?

      If you provide our company with the benefit details such as employees census, booklets, renewals, 3 years of rates and claims experience, we can request quotes from the various companies that we deal with and offer a presentation that outlines any deviations from your current coverage and the rates offered. Working through this process does not obligate you to proceed with benefit coverage.

    • What is the minimum size of group we can get benefits for?

      We can get quotes and provide coverage for groups of 1 to 1000 employees.

    • What is the next step if I want to sign up for a benefit plan?

      We will work with your company and employees to complete the enrolment forms, Company Application and all other relevant paperwork. We will deliver the administration kit and employee packages to you when they have been prepared. We also provide service for your group after your plan is in place such as administration training and answering eligibility or coverage questions. We can also assist your employee with claims resolution and benefit questions.

    • What is the process for getting a quote?

      We will provide a data sheet for a listing of your employees (single/family), their dates of birth and occupations. If a wage replacement benefit is requested, we will also require their salaries. We will require some company information such as how long your company has been in business, any seasonal employee, if any employee are absent from work due to disability or illness. Our brokers will go over the options of available benefits to help you find the plan design to best suit your company.

    • What is the turnaround time for a quote?

      After all the information is gathered, and the insurance companies respond, the proposals we receive are then compiled in a comparison sheet highlighting the rates and benefits offered and are usually ready for presentation within 3 weeks.

    • Which insurance companies do you deal with?

      We use different insurance carriers depending on size and benefit options chosen.

      • Chambers of Commerce Group Benefits
      • Desjardins
      • Encon Group Benefits
      • Empire Life
      • Great West Life
      • Manulife Financial
      • Sirius Benefits
      • Sun Life Financial
  • Dental
    • Can I get a duplicate copy of a dental remittance statement previously sent to me by PEB?

      We don't provide duplicate copies of Explanation of Benefits (EOB) as our office is not designed to handle these requests. We encourage you to file the original EOB in your personal records. 

      As an alternative, you should consider signing up for online claims services available at pebplans.com. Copies of your remittances are stored in pebplans from the moment you sign up for the service. As an added feature, you can see a catalogue of your electronic statements whenever you sign into pebplans.com. For more information on registering for this service, go to pebplans.com or call our office at 250-847-2883 toll free 877-822-4209. 

    • Do you return dental receipts? Do you accept photocopies?

      Original receipts will not be returned. You will receive an "Explanation of Benefits" (EOB) statement for each claim you submit. Members are encouraged to register online and sign up for Direct Deposit and to receive EOB's online. Retain the EOB statement for income tax purposes.

      Original receipts are required to process your claim. However, in cases where you submit your claim to another insurance carrier first, we will accept the EOB from the other carrier with your claim

    • How do I notify PEB of my change of address?

      At this time, address changes need to be submitted on a Notice of Change form or online through our website. We will be happy to assist you in updating your address. 

    • How do I order an ID card?

      Call our office at 250-847-2883 or toll free 877-822-4209.

      You can also email us directly at claims@pebplans.com.

    • How do I submit a claim for orthodontic treatment?

      Submit a treatment plan. 

      At the start of the orthodontic treatment, the dentist or orthodontist will prepare a written outline of the proposed treatment. This is called a treatment plan. Pacific Employee Benefits must have a copy of this in the patient's file before we can reimburse for orthodontic claims. 

      When your orthodontist gives you the completed treatment plan form, forward it to PEB. Make sure you indicate on the form: 

      • The member's policy and ID numbers 
      • Patient's full name 
      • Patient's birth date 
      • Information on coverage under any other dental care plans

      Mail your claim to Pacific Employee Benefits, PO Box 3249, Smithers, BC, V0J 2N0 or drop off your claim personally at 3756 1st Ave, Smithers or email to claims@pebplans.com.

      Please note: We suggest that you submit your claims promptly. Pacific Employee Benefits can only pay claims we receive, with correct and complete information, within one year of the service date. 

    • How do I submit a dental claim? Where do I get a claim form?

      Claims are to be submitted on a Standard Dental Claim Form provided by your dentist.

      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)
      • A note indicating if PEB should reimburse the member or the dentist (for example, write "pay member")

      If the patient has dental coverage under more than one plan, please see our information on duplicate coverage.

      Mail your claim to Pacific Employee Benefits, PO Box 3249, Smithers, BC, V0J 2N0 or drop off your claim personally at 3576 1st Ave, Smithers.

      Please note: We suggest that you submit your claims promptly. Pacific Employee Benefits can only pay claims we receive, with correct and complete information, within one year of the service date.

    • How do I submit my Coordination of Benefits (COB) information?

      It's important to always keep us up to date with your latest COB information because it will ensure we adjudicate your claims with your most recent information. The best way to notify Pacific Employee Benefits when there are changes to another plan you are also covered under is to tell us when you submit your next claim. Identify in a note the specific detail(s) that changed. Be sure to advise whether the changes apply to your dental plan, extended health plan or both so we can make sure we continue to pay all your claims correctly. 

      Remember to also update your service providers if they prepare or submit claims to us on your behalf. 

      Spouse Claims
      When your spouse has a dental plan through another policy holder/employer, the claim should be handled as follows: 

      • If your dentist can submit your claim to PEB electronically, you should claim the expense through your primary plan first. You can submit your claim with a copy of the primary Explanation of Benefits (EOB) to Pacific Employee Benefits for the remaining balance.
      • If your dental office does not provide direct billing, and requires you to pay the dentist directly, your spouse should pay for the expense, take a photocopy of the receipts and then submit the original receipts to his/her own plan. Once you receive the EOB from the other plan, you can submit the photocopied receipts with the explanation of benefits to Pacific Employee Benefits to claim the remaining balance.

      Dependent Children Claims
      For dependent children, the plan that pays first is determined by the birth date of the parents, as follows: 

      • If your birth date month is prior to your spouse's in the calendar year, your plan is the first payer and your children's expenses must be claimed through your own plan first.
      • If the birth date month is the same it goes to first name alphabetically.
      • If your spouse's birth date is prior to yours in the calendar year, then your spouse's plan is the first payer for your dependent children. In that case, you must pay for their expenses, take photocopies, and submit the original receipts to your spouse's plan first. Any remaining balance can be submitted for reimbursement to Pacific Employee Benefits, along with the photocopied receipts and the explanation of benefits from the other plan.
      • The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?"

      Total reimbursement between plans will never be more than 100% of the eligible amount in the Pacific Employee Benefits Dental Fee Schedule. If you've been overpaid, contact our customer service department immediately.

    • How long does it take Pacific Employee Benefits (PEB) to process my claim?

      All Claims are processed Thursday’s cheques and EFT’s go out Fridays.

    • My spouse also has dental coverage. Which plan should we use?

      People who are covered under more than one dental plan are required to submit their claims to their own plan first. Any remaining balance may be claimed through the spouse's plan. 

    • Where do I get more information about my plan?

      Register for online access for plan and claims information for members. Or, see your employer and ask for your employee benefit booklet.

      For further information, call the Pacific Employee Benefits Customer Service department at 250-847-2883 or toll free 877-822-4209.

    • Where do I send my claim?

      Mail all claims and written inquiries to:

      Pacific Employee Benefits 
      PO Box 3249 
      Smithers, BC V0J 2N0
       

      Always remember to include your policy and ID numbers on all correspondence you send to Pacific Employee Benefits. 

    • Will PEB reimburse my dental claim via direct deposit?

      Yes. Dental claims can be reimbursed through direct deposit. Click here to sign up. You will need your transit number, branch number and account number.  

  • Health
    • Do you accept photocopies of my receipts?

      Original receipts are required to process your claim. However, in cases where you submit your claim to another insurance carrier first, we will accept the "Explanation of Benefits" (EOB) from the other carrier with your claim. 

    • Do you return receipts?

      Original receipts will not be returned. If you have coverage with another insurance carrier please photocopy your receipts prior to submitting your claim to Pacific Employee Benefits. You will receive an Explanation of Benefits (EOB) statement for each claim you submit. Members are encouraged to online claims access and sign up for Direct Deposit and to receive EOB's online. Retain the EOB statement for income tax purposes. 

    • How do I notify PEB of my change of address?

      At this time, address changes need to be submitted on a Notice of Change form or online through our website. We will be happy to assist you in updating your address. 

    • How do I obtain coverage for a Special Authority drug?

      Once you have registered for PharmaCare, and provided the drug you require is eligible for Special Authority coverage, your doctor must fill out a Special Authority Request form, and apply to PharmaCare on your behalf. The forms are available online, but most doctors' offices will have copies on site. 

      A full list of eligible Special Authority drugs is available at http://www.health.gov.bc.ca/pharmacare/sa/criteria/genericbrandtable.html

    • How do I order an ID card?

      Call our office at 250-847-2883 or toll free 877-822-4209.

      You can also email us directly at claims@pebplans.com.

    • How do I register for PharmaCare?

      Register for PharmaCare online at www.health.gov.bc.ca/PharmaCare or by phone at 604-683-7151 (toll-free 1-800-663-7100) Monday to Friday 8 a.m. to 8 p.m. and Saturday 8 a.m. to 4 p.m 

      You will need: 

      • Personal health number
      • Date of birth
      • Social Insurance Number
      • Your Tax Return from your Notice of Assessment from 2 years ago
      • The amount of UCCB (line 117) from your Income Tax Return from 2 years ago

      Reimbursement for a Special Authority drug is subject to your PharmaCare deductible. The amount of your PharmaCare deductible is based on your family income. After you reach your deductible, PharmaCare will pay 70% of your family's eligible costs for the rest of the year until you reach your family maximum. After you reach your family maximum, PharmaCare will cover 100% of your eligible costs. Amounts not reimbursed by PharmaCare may be eligible under your Extended Health Care plan. 

    • How do I submit a claim for Extended Health benefits?

      Here are the instructions for submitting claims under your Extended Health Care plan. 

      1. Obtain an Extended Health Claim Form
      2. Fill out the claim form
      3. Attach receipts and any required supporting documents to the claim form
      4. Send the claim form, along with receipts and any required documents to: 

      Pacific Employee Benefits
      PO Box 3249
      Smithers, BC V0J 2N0 

      Or drop the claim off in person at: 

      3756 1st Ave
      Smithers, BC  

      Please note: we are unable to return original receipts. If you will need to submit a claim to another health benefits carrier, make a photocopy of the receipts. 

    • How do I update my Coordination of Benefits (COB) information?

      It's important to always keep us up to date with your latest coordination of benefits information because it will ensure we adjudicate your claims with your most recent information. 

      The best way to notify Pacific Employee Benefits when there are changes to another plan you are also covered under is when you submit your next claim. (There is a spot on the claim form) or Identify in a note the specific detail(s) that changed. Be sure to advise whether the changes apply to your dental plan, extended health plan or both so we can make sure we continue to pay all your claims correctly. 

      Remember to also update your service providers if they prepare or submit claims to us on your behalf. 

      Patients sometimes have coverage under more than one extended health plan or more than one health benefits carrier. In these cases, the patient can submit the expense under both plans to get up to 100 percent of their expense covered. This is called coordination of benefits. 

    • How will I know if PharmaCare approves my application?

      They will notify your physician by fax or by mail, and he/she is responsible for contacting you and providing you with a copy of PharmaCare's decision document. 

    • Is there a limit to how much of a supply I can get for my prescription?

      Yes, all prescription drugs/medicines are limited to a 100-day supply, which is consistent with BC Fair PharmaCare's limit. 

    • My spouse also has extended health coverage. Which EHC plan should we use?

      People who are covered under more than one plan are required to submit their claims to their own plan first. Any remaining balance may be claimed through the spouse's plan. 

      Spouse Claims
      When your spouse has an EHC plan through another policy holder/employer, the claim should be handled as follows: 

      • Your spouse should pay for the expense, take a photo copy of the receipts and then submit the original receipts to his/her own plan. Once you receive the explanation of benefits from the other plan, you can submit the photocopied receipts with the explanation of benefits to Pacific Employee Benefits to claim the remaining balance.
      • If your spouse's EHC plan has a pay direct card, the pharmacist will submit to his/her plan electronically. The pharmacist will issue a paper receipt showing the amount that the plan pays. You can submit the paper receipt to Pacific Employee Benefits to claim the remaining balance.

      Dependent Children Claims
      For dependent children, the plan that pays first is determined by the birth date of the parents, as follows: 

      • If your birth date month is prior to your spouse's in the calendar year, your plan is the first payer and your children's expenses must be claimed through your own plan first.
      • If the birth date month is the same it goes to first name alphabetically.
      • If your spouse's birth date is prior to yours in the calendar year, then your spouse's plan is the first payer for your dependent children. In that case, you must pay for their expenses, take photocopies, and submit the original receipts to your spouse's plan first. Any remaining balance can be submitted for reimbursement to Pacific Employee Benefits, along with the photocopied receipts and the explanation of benefits from the other plan.
      • The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?"

      When completing the EHC claim form, please ensure that you indicate both of the EHC plan numbers. 

      The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?" 

    • What happens after I submit my Extended Health claim?

      Pacific Employee Benefits will reimburse all eligible expenses, subject to the plan deductible and limits, at your plan percentage. Once we've processed your claim, we will mail you a cheque and/or an Explanation of Benefits (EOB) for EFT (Electronic Funds Transfer) statement. We encourage all of our members to register for online claims access. Online Claims access allows you to register for direct deposit and to receive your EOBs online. 

    • What is PharmaCare?

      The Government of British Columbia subsidizes eligible prescription drugs and designated medical supplies, protecting British Columbians from high drug costs, through the BC PharmaCare program. PharmaCare provides financial assistance to British Columbians under Fair PharmaCare and other specialty plans. 

    • What is Special Authority and how do I apply for it?

      The Special Authority program is part of the BC government's PharmaCare program. It approves funding for certain drugs following an application from your doctor. However, before your doctor can apply for this funding on your behalf, you must be registered with PharmaCare. 

    • When should I apply for coverage through PharmaCare? Can I submit old claims?

      Special Authority must be in place before you purchase a drug. Coverage cannot be provided retroactively. It's important that you apply as soon as possible. Your claims statement and your pharmacist will be let you know when a drug you have been prescribed is eligible under PharmaCare's Special Authority program. 

    • Where do I get an EHC claim form?

      There are multiple ways to obtain a claim form: 

      • from the EHC forms download page on our website
      • The benefits administrator at your employer
    • Who needs to complete and submit the Special Authority Request form?

      All forms must be completed by a licensed physician and faxed to the number indicated on the form. 

    • Why does my plan pay for some prescriptions and not others?

      All plans are designed differently and may include different benefits. For example, some plans only allow prescription drugs covered by the provincial drug plan (PharmaCare) while other plans allow prescription drugs regardless of the provincial plan's coverage. You can also refer to your policy benefit booklet for coverage information.

    • Will PEB reimburse my EHC claim via direct deposit?

      PEB will reimburse EHC claims to a bank account of your choice if you have registered for direct deposit. You can register for both direct deposit and to receive electronic claim statements through online claims access.

  • All
    • Can I get a duplicate copy of a dental remittance statement previously sent to me by PEB?

      We don't provide duplicate copies of Explanation of Benefits (EOB) as our office is not designed to handle these requests. We encourage you to file the original EOB in your personal records. 

      As an alternative, you should consider signing up for online claims services available at pebplans.com. Copies of your remittances are stored in pebplans from the moment you sign up for the service. As an added feature, you can see a catalogue of your electronic statements whenever you sign into pebplans.com. For more information on registering for this service, go to pebplans.com or call our office at 250-847-2883 toll free 877-822-4209. 

    • Do you accept photocopies of my receipts?

      Original receipts are required to process your claim. However, in cases where you submit your claim to another insurance carrier first, we will accept the "Explanation of Benefits" (EOB) from the other carrier with your claim. 

    • Do you return dental receipts? Do you accept photocopies?

      Original receipts will not be returned. You will receive an "Explanation of Benefits" (EOB) statement for each claim you submit. Members are encouraged to register online and sign up for Direct Deposit and to receive EOB's online. Retain the EOB statement for income tax purposes.

      Original receipts are required to process your claim. However, in cases where you submit your claim to another insurance carrier first, we will accept the EOB from the other carrier with your claim

    • Do you return receipts?

      Original receipts will not be returned. If you have coverage with another insurance carrier please photocopy your receipts prior to submitting your claim to Pacific Employee Benefits. You will receive an Explanation of Benefits (EOB) statement for each claim you submit. Members are encouraged to online claims access and sign up for Direct Deposit and to receive EOB's online. Retain the EOB statement for income tax purposes. 

    • How do I notify PEB of my change of address?

      At this time, address changes need to be submitted on a Notice of Change form or online through our website. We will be happy to assist you in updating your address. 

    • How do I obtain coverage for a Special Authority drug?

      Once you have registered for PharmaCare, and provided the drug you require is eligible for Special Authority coverage, your doctor must fill out a Special Authority Request form, and apply to PharmaCare on your behalf. The forms are available online, but most doctors' offices will have copies on site. 

      A full list of eligible Special Authority drugs is available at http://www.health.gov.bc.ca/pharmacare/sa/criteria/genericbrandtable.html

    • How do I order an ID card?

      Call our office at 250-847-2883 or toll free 877-822-4209.

      You can also email us directly at claims@pebplans.com.

    • How do I register for PharmaCare?

      Register for PharmaCare online at www.health.gov.bc.ca/PharmaCare or by phone at 604-683-7151 (toll-free 1-800-663-7100) Monday to Friday 8 a.m. to 8 p.m. and Saturday 8 a.m. to 4 p.m 

      You will need: 

      • Personal health number
      • Date of birth
      • Social Insurance Number
      • Your Tax Return from your Notice of Assessment from 2 years ago
      • The amount of UCCB (line 117) from your Income Tax Return from 2 years ago

      Reimbursement for a Special Authority drug is subject to your PharmaCare deductible. The amount of your PharmaCare deductible is based on your family income. After you reach your deductible, PharmaCare will pay 70% of your family's eligible costs for the rest of the year until you reach your family maximum. After you reach your family maximum, PharmaCare will cover 100% of your eligible costs. Amounts not reimbursed by PharmaCare may be eligible under your Extended Health Care plan. 

    • How do I submit a claim for Extended Health benefits?

      Here are the instructions for submitting claims under your Extended Health Care plan. 

      1. Obtain an Extended Health Claim Form
      2. Fill out the claim form
      3. Attach receipts and any required supporting documents to the claim form
      4. Send the claim form, along with receipts and any required documents to: 

      Pacific Employee Benefits
      PO Box 3249
      Smithers, BC V0J 2N0 

      Or drop the claim off in person at: 

      3756 1st Ave
      Smithers, BC  

      Please note: we are unable to return original receipts. If you will need to submit a claim to another health benefits carrier, make a photocopy of the receipts. 

    • How do I submit a claim for orthodontic treatment?

      Submit a treatment plan. 

      At the start of the orthodontic treatment, the dentist or orthodontist will prepare a written outline of the proposed treatment. This is called a treatment plan. Pacific Employee Benefits must have a copy of this in the patient's file before we can reimburse for orthodontic claims. 

      When your orthodontist gives you the completed treatment plan form, forward it to PEB. Make sure you indicate on the form: 

      • The member's policy and ID numbers 
      • Patient's full name 
      • Patient's birth date 
      • Information on coverage under any other dental care plans

      Mail your claim to Pacific Employee Benefits, PO Box 3249, Smithers, BC, V0J 2N0 or drop off your claim personally at 3756 1st Ave, Smithers or email to claims@pebplans.com.

      Please note: We suggest that you submit your claims promptly. Pacific Employee Benefits can only pay claims we receive, with correct and complete information, within one year of the service date. 

    • How do I submit a dental claim? Where do I get a claim form?

      Claims are to be submitted on a Standard Dental Claim Form provided by your dentist.

      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)
      • A note indicating if PEB should reimburse the member or the dentist (for example, write "pay member")

      If the patient has dental coverage under more than one plan, please see our information on duplicate coverage.

      Mail your claim to Pacific Employee Benefits, PO Box 3249, Smithers, BC, V0J 2N0 or drop off your claim personally at 3576 1st Ave, Smithers.

      Please note: We suggest that you submit your claims promptly. Pacific Employee Benefits can only pay claims we receive, with correct and complete information, within one year of the service date.

    • How do I submit my Coordination of Benefits (COB) information?

      It's important to always keep us up to date with your latest COB information because it will ensure we adjudicate your claims with your most recent information. The best way to notify Pacific Employee Benefits when there are changes to another plan you are also covered under is to tell us when you submit your next claim. Identify in a note the specific detail(s) that changed. Be sure to advise whether the changes apply to your dental plan, extended health plan or both so we can make sure we continue to pay all your claims correctly. 

      Remember to also update your service providers if they prepare or submit claims to us on your behalf. 

      Spouse Claims
      When your spouse has a dental plan through another policy holder/employer, the claim should be handled as follows: 

      • If your dentist can submit your claim to PEB electronically, you should claim the expense through your primary plan first. You can submit your claim with a copy of the primary Explanation of Benefits (EOB) to Pacific Employee Benefits for the remaining balance.
      • If your dental office does not provide direct billing, and requires you to pay the dentist directly, your spouse should pay for the expense, take a photocopy of the receipts and then submit the original receipts to his/her own plan. Once you receive the EOB from the other plan, you can submit the photocopied receipts with the explanation of benefits to Pacific Employee Benefits to claim the remaining balance.

      Dependent Children Claims
      For dependent children, the plan that pays first is determined by the birth date of the parents, as follows: 

      • If your birth date month is prior to your spouse's in the calendar year, your plan is the first payer and your children's expenses must be claimed through your own plan first.
      • If the birth date month is the same it goes to first name alphabetically.
      • If your spouse's birth date is prior to yours in the calendar year, then your spouse's plan is the first payer for your dependent children. In that case, you must pay for their expenses, take photocopies, and submit the original receipts to your spouse's plan first. Any remaining balance can be submitted for reimbursement to Pacific Employee Benefits, along with the photocopied receipts and the explanation of benefits from the other plan.
      • The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?"

      Total reimbursement between plans will never be more than 100% of the eligible amount in the Pacific Employee Benefits Dental Fee Schedule. If you've been overpaid, contact our customer service department immediately.

    • How do I update my Coordination of Benefits (COB) information?

      It's important to always keep us up to date with your latest coordination of benefits information because it will ensure we adjudicate your claims with your most recent information. 

      The best way to notify Pacific Employee Benefits when there are changes to another plan you are also covered under is when you submit your next claim. (There is a spot on the claim form) or Identify in a note the specific detail(s) that changed. Be sure to advise whether the changes apply to your dental plan, extended health plan or both so we can make sure we continue to pay all your claims correctly. 

      Remember to also update your service providers if they prepare or submit claims to us on your behalf. 

      Patients sometimes have coverage under more than one extended health plan or more than one health benefits carrier. In these cases, the patient can submit the expense under both plans to get up to 100 percent of their expense covered. This is called coordination of benefits. 

    • How long does it take Pacific Employee Benefits (PEB) to process my claim?

      All Claims are processed Thursday’s cheques and EFT’s go out Fridays.

    • How will I know if PharmaCare approves my application?

      They will notify your physician by fax or by mail, and he/she is responsible for contacting you and providing you with a copy of PharmaCare's decision document. 

    • Is there a limit to how much of a supply I can get for my prescription?

      Yes, all prescription drugs/medicines are limited to a 100-day supply, which is consistent with BC Fair PharmaCare's limit. 

    • My spouse also has dental coverage. Which plan should we use?

      People who are covered under more than one dental plan are required to submit their claims to their own plan first. Any remaining balance may be claimed through the spouse's plan. 

    • My spouse also has extended health coverage. Which EHC plan should we use?

      People who are covered under more than one plan are required to submit their claims to their own plan first. Any remaining balance may be claimed through the spouse's plan. 

      Spouse Claims
      When your spouse has an EHC plan through another policy holder/employer, the claim should be handled as follows: 

      • Your spouse should pay for the expense, take a photo copy of the receipts and then submit the original receipts to his/her own plan. Once you receive the explanation of benefits from the other plan, you can submit the photocopied receipts with the explanation of benefits to Pacific Employee Benefits to claim the remaining balance.
      • If your spouse's EHC plan has a pay direct card, the pharmacist will submit to his/her plan electronically. The pharmacist will issue a paper receipt showing the amount that the plan pays. You can submit the paper receipt to Pacific Employee Benefits to claim the remaining balance.

      Dependent Children Claims
      For dependent children, the plan that pays first is determined by the birth date of the parents, as follows: 

      • If your birth date month is prior to your spouse's in the calendar year, your plan is the first payer and your children's expenses must be claimed through your own plan first.
      • If the birth date month is the same it goes to first name alphabetically.
      • If your spouse's birth date is prior to yours in the calendar year, then your spouse's plan is the first payer for your dependent children. In that case, you must pay for their expenses, take photocopies, and submit the original receipts to your spouse's plan first. Any remaining balance can be submitted for reimbursement to Pacific Employee Benefits, along with the photocopied receipts and the explanation of benefits from the other plan.
      • The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?"

      When completing the EHC claim form, please ensure that you indicate both of the EHC plan numbers. 

      The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?" 

    • What happens after I submit my Extended Health claim?

      Pacific Employee Benefits will reimburse all eligible expenses, subject to the plan deductible and limits, at your plan percentage. Once we've processed your claim, we will mail you a cheque and/or an Explanation of Benefits (EOB) for EFT (Electronic Funds Transfer) statement. We encourage all of our members to register for online claims access. Online Claims access allows you to register for direct deposit and to receive your EOBs online. 

    • What if I have coverage elsewhere and want a quote comparison?

      If you provide our company with the benefit details such as employees census, booklets, renewals, 3 years of rates and claims experience, we can request quotes from the various companies that we deal with and offer a presentation that outlines any deviations from your current coverage and the rates offered. Working through this process does not obligate you to proceed with benefit coverage.

    • What is PharmaCare?

      The Government of British Columbia subsidizes eligible prescription drugs and designated medical supplies, protecting British Columbians from high drug costs, through the BC PharmaCare program. PharmaCare provides financial assistance to British Columbians under Fair PharmaCare and other specialty plans. 

    • What is Special Authority and how do I apply for it?

      The Special Authority program is part of the BC government's PharmaCare program. It approves funding for certain drugs following an application from your doctor. However, before your doctor can apply for this funding on your behalf, you must be registered with PharmaCare. 

    • What is the minimum size of group we can get benefits for?

      We can get quotes and provide coverage for groups of 1 to 1000 employees.

    • What is the next step if I want to sign up for a benefit plan?

      We will work with your company and employees to complete the enrolment forms, Company Application and all other relevant paperwork. We will deliver the administration kit and employee packages to you when they have been prepared. We also provide service for your group after your plan is in place such as administration training and answering eligibility or coverage questions. We can also assist your employee with claims resolution and benefit questions.

    • What is the process for getting a quote?

      We will provide a data sheet for a listing of your employees (single/family), their dates of birth and occupations. If a wage replacement benefit is requested, we will also require their salaries. We will require some company information such as how long your company has been in business, any seasonal employee, if any employee are absent from work due to disability or illness. Our brokers will go over the options of available benefits to help you find the plan design to best suit your company.

    • What is the turnaround time for a quote?

      After all the information is gathered, and the insurance companies respond, the proposals we receive are then compiled in a comparison sheet highlighting the rates and benefits offered and are usually ready for presentation within 3 weeks.

    • When should I apply for coverage through PharmaCare? Can I submit old claims?

      Special Authority must be in place before you purchase a drug. Coverage cannot be provided retroactively. It's important that you apply as soon as possible. Your claims statement and your pharmacist will be let you know when a drug you have been prescribed is eligible under PharmaCare's Special Authority program. 

    • Where do I get an EHC claim form?

      There are multiple ways to obtain a claim form: 

      • from the EHC forms download page on our website
      • The benefits administrator at your employer
    • Where do I get more information about my plan?

      Register for online access for plan and claims information for members. Or, see your employer and ask for your employee benefit booklet.

      For further information, call the Pacific Employee Benefits Customer Service department at 250-847-2883 or toll free 877-822-4209.

    • Where do I send my claim?

      Mail all claims and written inquiries to:

      Pacific Employee Benefits 
      PO Box 3249 
      Smithers, BC V0J 2N0
       

      Always remember to include your policy and ID numbers on all correspondence you send to Pacific Employee Benefits. 

    • Which insurance companies do you deal with?

      We use different insurance carriers depending on size and benefit options chosen.

      • Chambers of Commerce Group Benefits
      • Desjardins
      • Encon Group Benefits
      • Empire Life
      • Great West Life
      • Manulife Financial
      • Sirius Benefits
      • Sun Life Financial
    • Who needs to complete and submit the Special Authority Request form?

      All forms must be completed by a licensed physician and faxed to the number indicated on the form. 

    • Why does my plan pay for some prescriptions and not others?

      All plans are designed differently and may include different benefits. For example, some plans only allow prescription drugs covered by the provincial drug plan (PharmaCare) while other plans allow prescription drugs regardless of the provincial plan's coverage. You can also refer to your policy benefit booklet for coverage information.

    • Will PEB reimburse my dental claim via direct deposit?

      Yes. Dental claims can be reimbursed through direct deposit. Click here to sign up. You will need your transit number, branch number and account number.  

    • Will PEB reimburse my EHC claim via direct deposit?

      PEB will reimburse EHC claims to a bank account of your choice if you have registered for direct deposit. You can register for both direct deposit and to receive electronic claim statements through online claims access.

Contact Us

Email: service@pebplans.com

Toll-free: 1-877-822-4209

Toll-free fax: 1-888-787-0727

Support

We are here when you need us.

Talk to an advisor 8:30am to 4:30pm PST.
Toll-free: 1-877-822-4209