Increased Assistance and Payment Options
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If your family circumstances change, we may be able to adjust your Fair PharmaCare assistance. Here are some of the circumstances that may warrant increased assistance:
We normally base your Fair PharmaCare coverage on your income information from two years ago. Our income review process ensures that families who experience hardship because of a decrease in income can access increased Fair PharmaCare coverage. Regardless of the reason for the drop in income (e.g., a change in your employment status, recent retirement, etc.), if you meet the requirements, your level of coverage can be increased immediately.
Important: You can apply for an income review only for the current year and must submit your application before December 31. You cannot apply for a review for a previous year.
To be eligible for an income review:
- Your family's net income must have decreased by 10% or more from the amount used to calculate your current level of coverage, and
- You will need to provide acceptable documentation to support your income information.
To estimate if you are eligible for an income review, see page 2 of the Income Review Application (PDF).
Divorce or Separation/Child Custody
If you and your spouse separate or divorce, both you and your spouse should contact us. We will arrange for your Fair PharmaCare family membership to reflect your current situation. If you and/or your former spouse experience a drop in income as a result of the change in your marital status, increased assistance may also be available.
It is also important that your children be included in the family of the appropriate parent (a child cannot be included in more than one family).
Note: If your family membership with the BC Medical Services Plan (MSP) changes, we will normally notify you by letter, asking you to clarify your information. It is important to respond to this letter promptly to prevent termination of your Fair PharmaCare coverage.
Spouse Who is Now Living in a Residential Care Facility
If your spouse has recently moved to a residential care facility and you are experiencing difficulty with the cost of your prescriptions, contact the Medical Services Plan (MSP) and enquire about being "deemed separate." This will enable us to exclude your spouse's income when calculating your Fair PharmaCare coverage.
If Medical Services Plan (MSP) does not approve you request, contact us. If subtracting your spouse's residential care fees from the combined income of yourself and your spouse results in an amount lower $33,000, you are eligible for increased Fair PharmaCare assistance.
Death of a Spouse
Your spouse's income is included in the calculation of your Fair PharmaCare coverage until the end of the year. This allows your spouse's prescription costs to count towards your deductible.
However, if having your spouse's income included creates financial difficulty and your income has decreased by 10% or more in the past two years, you can request that your coverage be based on more recent income information by applying for an Income Review.
For more information, please read Decrease in income of 10% or more during the past two years.
Complete the Income Review Application (HLTH 5355) (PDF). Before sending in your application, contact Health Insurance BC at the phone numbers provided on the back of the application form. Health Insurance BC will advise you of the specific supporting documents you should include with your application to confirm your decreased income.
Send your completed application form and your supporting documents to:
Health Insurance BC
Attention: Fair PharmaCare
PO Box 9685 Stn Prov Govt
Victoria BC V8W 9P2
Fax to (250) 405-3598
We will review your application and, where possible, verify your income with the Canada Revenue Agency (CRA). If your application is approved, we will advise you of your new level of coverage—usually within one month of receipt of your application.
Has more than a month has passed since you applied? You can check the status of your application. Contact Health Insurance BC between 8:00 AM and 4:30 PM, Monday to Friday.
Note: If the income information you provide with your application cannot be verified when tax information for that year becomes available, PharmaCare will recover any overpayment of assistance.
Is there a deadline for applying for increased assistance?
Yes. You must apply before December 31 of the year for which you want increased coverage.
If my family is assigned a lower deductible, will this deductible be applied retroactively? Will I be reimbursed for amounts paid over and above the lower deductible?
Yes. If your income review results in a lower deductible and family maximum, it applies to the eligible cost of any prescriptions you purchased after the later of:
- January 1, or
- the date your family registered for Fair PharmaCare, or
- the date of the most recent addition or removal of a spouse from your family Fair PharmaCare record, or
- the date your income-based Fair PharmaCare coverage was reinstated after cancellation.
If you qualify for a refund, you will be reimbursed automatically in the spring of the following year.
Many individuals and families do not have a deductible under the Fair PharmaCare plan and PharmaCare assists them with their eligible prescription costs right away.
However, some families have a deductible based on their family net income. PharmaCare offers a payment option to help these individuals and families.
Once enrolled in the Monthly Deductible Payment Option, families pay their Fair PharmaCare deductible in monthly installments and receive PharmaCare assistance with eligible prescription costs right away.
Who is eligible to enrol in the Monthly Deductible Payment Option?
- are registered for Fair PharmaCare
- do not have private health insurance that includes a drug benefit plan
- have a deductible greater than $0
Note that the option will not benefit you if your annual prescription costs are less than your deductible or if your deductible is $0.
Enrolment in the Monthly Deductible Payment Option is not permitted for families who have private health insurance coverage that includes a drug benefit plan. If your private health insurer contributes to your prescription costs, enrolling in the Monthly Deductible Payment Option could complicate or delay your private health benefits.
If you enrol and later begin receiving private health insurance that includes a drug benefit plan, you need to cancel your enrolment.
How does the Monthly Deductible Payment Option work?
Here is an example of how the Monthly Deductible Payment Option might benefit a family:
Brenda and John's prescription costs are about $2,200 each year. Their Fair PharmaCare deductible, based on their combined annual income, is $1,200. Currently, Brenda and John have to pay the $1,200 deductible towards eligible prescription costs before PharmaCare begins contributing 70% of the cost of each prescription.
Under the Monthly Deductible Payment Option, Brenda and John would pay $100 towards their deductible each month. PharmaCare would begin paying 70% of eligible prescription costs from the date their enrollment was processed. Brenda and John would pay only 30% of their eligible prescription costs at the pharmacy until their annual family maximum is reached.
What will I pay at the pharmacy after I enrol?
Once you are enrolled, your prescription claims will be processed as though you had met your deductible; that is, you will be responsible for the co-payment amount until your payments towards eligible prescription costs reaches your annual family maximum. Note: Individuals remain responsible for payment for non-benefit products.
Your monthly payments will not be shown on pharmacy receipts. You will receive a tax receipt at the end of the year so you can claim your monthly payments as medical expenses on your income tax return.
What if I get private health insurance with a drug benefit plan partway through the year?
You need to cancel your enrolment by contacting PharmaCare.
If I enrol but then discover the option is not to my benefit, can I cancel my enrolment?
Yes. You can cancel your enrolment at any time by contacting PharmaCare.
If you cancel, early in the following year, PharmaCare will reconcile your account for the preceding year and a statement will be issued. You will receive a refund if you have paid more than your required contribution under the Fair PharmaCare plan. You must keep both the statement and your prescription receipts if you wish to submit your prescription costs as medical expenses on your income tax return.
What happens if my prescription costs end up being lower than my deductible?
Early in the following year, PharmaCare will reconcile your account for the preceding year and a statement will be issued. You will receive a refund if you have paid more than your required contribution under the Fair PharmaCare plan. You must keep both the statement and your prescription receipts if you wish to submit your prescription costs as medical expenses on your income tax return.
What methods of payment can I use to make monthly payments?
If you choose to enrol in the Monthly Deductible Payment Option, you can elect to:
- receive a bill each month (payable on the 15th of the month); or
- have your monthly payment automatically debited from your account at a bank or financial institution.
If I enrol, do I need to report changes in my family structure to PharmaCare?
Yes. In cases of marriage, separation or divorce, advise us of the change in your family structure. Our staff will review the options with you (for example, modification to your monthly payment amount or account reconciliation).
When should I enrol?
You may enrol in the Monthly Deductible Payment Option for the current calendar year by contacting Health Insurance BC anytime up to the last business day of September.
After September 30, you can request enrollment for the following year.
How long does it take to enrol?
When you call PharmaCare, our staff will first help you to ensure that the Monthly Deductible Payment Option is right for you. If it is, we will mail you an enrolment package. After you receive and review the enrolment documents, you will then mail or fax the necessary form(s) to Health Insurance BC.
Your enrolment will be processed two to three business days after we receive the forms.
How do I enrol?
For more information, or to enrol in the Monthly Deductible Payment Option, contact Health Insurance BC.