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?
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.
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.
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 on the Government of BC website.
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.
What is PharmaCare?
Pharmacare is a government sponsored program that helps B.C. residents pay for eligible prescription drugs, certain medical supplies, and pharmacy services.
You must be registered for MSP to be eligible for Pharmacare.
What is MSP?
In Canada, public health insurance is available to eligible residents. Canadian citizens and permanent residents can apply for provincial health insurance. In B.C. public health insurance is called the Medical Services Plan (MSP). It covers the cost of medically necessary insured doctor services.
Do I need to register for Pharmacare and MSP to participate in a health and dental plan?
Yes. Most plans require you to be registered for both.
How do I register for PharmaCare?
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 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.
When should I apply for coverage through PharmaCare? Can I submit old claims?
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.
Can I submit claims on my plan and my spouses?
Yes, if there is a provision for both plans to provide coverage and you are both enrolled in a plan that has family coverage and contains a provision for co-ordination of benefits.
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.
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 photocopy 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 the 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.
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 does life insurance work?
Typically, a Life Insurance benefit is either a flat dollar amount of $25,000, $50,000, $100,000 or $250,000, or a multiple of the employee’s earnings. If it is a multiple of earnings, the amount given to the designated beneficiaries of the employee may be one time, or two times the employee’s annual income.
This means that people with higher salaries in the company, have higher Life Insurance.
If paid as a flat amount, the employer still has the option to offer different Life Insurance policies to different employee classes, based on job descriptions. To respond to your needs and goals, we have the flexibility to offer differentiated Life Insurance Plans within the same group policy.
What is dependent life insurance?
Dependent Life Insurance provides financial support to the insured employee in the event of the death of the employee’s spouse or children.
Pacific Employee Benefits can add Dependent Life Insurance to a Life Insurance plan, if you choose to offer additional coverage options to your employees. Under this benefit line, the employees have some life insurance on the spouse, and 50% of that amount for each and every child. For instance, if the life insurance on the spouse is a flat amount of $10,000, the insurance on each of the children is $5,000.
What is included in critical illness insurance?
The list of eligible illnesses will be listed on your group plan benefit summary. However, most of the plans will include a payout for:
- heart attack
- coronary by-pass
- life threatening cancer
Can I use Medical EI as short term disability benefit?
Many people decide to use Medical EI as Short Term Disability benefit. If any of your employees gets sick and has to leave work because of that, there is a 2 week waiting period, followed by a 15 week benefit period. So, the employee can go on Medical EI for 15 weeks. In this case, we arrange that the Long Term Disability starts after 17 weeks of becoming disabled. Once the Medical EI ends, the Long Term Disability kicks in.
The only drawback of using Medical EI as Short Term Disability is that EI pays about 55% of the salary, up to a weekly maximum of $500; therefore, some people choose to have a stand-alone Short Term Disability benefit as it provides a better income.
Can I choose different long-term disability plans for employees?
Unlike Life Insurance, long-term disability does not allow differentiation according to employee classes. Whether you decide to sponsor a Long Term Disability plan that lasts until employees turn 65, or a 5 year Long Term Disability plan, everyone in your company will have the same policy. The LTD benefit reimbursement is based on a percentage of the employee’s salary.
What does extended health & dental cover?
These plans extend to, and partially reimburse, up to a maximum amount per person per year for specific health care expenses, such as but not limited to:
- paramedical services
- prescription drugs
- massage therapists
- medical equipment
- dental care
What are the premiums for extended health and dental?
Premiums for the Extended Health and Dental Plans are based on several factors including past claims history, nature of the company business, demographic trends, and inflation factors.
How do group RRSPs Work?
The beauty of payroll deduction is that your employees get immediate tax relief on the deduction.
This means that if employees contribute $100 into their Group RRSP, only $70 comes out of their cheque. It is up to them to decide how they want to invest their money. We fully educate your people in the available options, and help them make smart investment decisions.
To increase the potential of this plan, the employer can add a contribution to it. The contribution made by the employer is taxed, because it is rendered as employee income.
Compared to Pension Plans, Group RRSPs are much easier for the employers. There is less red tape and you have the flexibility to plan according to your budget and goals. If your company has a challenging financial year, you have the option of cutting your contribution for that year. It is very difficult to do that with a Pension Plan.
- immediate tax relief to employees
- low administrative costs
- less stringent compared to Pension Plans
- built-in flexibility for both the employer and the employees
- income splitting is available through spousal contributions
- if the employee leaves the employer, the contribution is not locked-in