Benefits for Excluded Employees

The Flexible Benefits Guide (PDF, 886KB) is for excluded employees. Competitive compensation and benefits programs are integral to attracting and retaining employees who foster excellence. Under your Flexible Benefits Program, you can tailor your health and life insurance benefits to best meet your needs. Rather than all employees having the same benefits coverage, eligible employees get to decide how to allocate flex credits for benefits coverage. You decide what suits you best.

For a quick summary of your benefits, please review Your Choices at a Glance (PDF, 271KB).

To review your choices, use the Flexible Benefits Calculator Tool (XLSM, 56KB).

For a list of forms related to pay and benefits, visit Forms & Tools for All Employees.

Benefits are an important part of your total compensation package. Unless you waive coverage, your employer pays your Medical Services Plan (MSP) premiums. These are valued at $450 per year (more if you have coverage for two adults). There’s  no cost to you to participate in the fully funded extended health and dental plan options. The reimbursements up to plan limits you receive under the plans are paid for by the employer. In some years, this may be several thousands of dollars. The Employee Basic Group Life Insurance plan provides employee life insurance at a reasonable group premium rate, and a portion of your premium is paid by your employer. These are just some of the benefits that comprise your total compensation package. On average, your benefits add over 20% to your overall compensation.

Know Your Benefits, Know Your Options

With choice comes responsibility. You must enrol in the Flexible Benefits Program to take an active role in choosing your benefits. Take the time to learn about your options and to decide how to best apply them to your personal situation.

You'll have the opportunity to update your options every year during the Open Enrolment period and after an eligible life event.

This guide provides a comprehensive overview of your benefits program. Share the details with your family so you can make the most of your benefits program.

In the event of any conflict between the contents of this guide and the actual plans and contracts or regulations, the provisions outlined in those documents apply.

The Plans

A number of health and life insurance benefits plans make up the Flexible Benefits Program. They fall into the categories of Core and Optional plans. The difference between the two categories is that the employer provides funding towards coverage under each of the four core benefits plans. You fund your participation in the optional benefits programs.

Core Benefits

  • Medical Services Plan of B.C.
  • Extended Health Plan
  • Dental Plan
  • Employee Basic Life Insurance (mandatory)

Optional Benefits

  • Health Spending Account
  • Optional Family Funeral Benefit
  • Employee Optional Life Insurance
  • Spouse Optional Life Insurance
  • Child Optional Life Insurance
  • Employee Optional Accidental Death & Dismemberment Insurance
  • Spouse Optional Accidental Death & Dismemberment Insurance
  • Child Optional Accidental Death & Dismemberment Insurance

Your Choices

Employee Basic Life Insurance is mandatory. This means you must maintain a minimum level of coverage – you can’t waive coverage. You can waive coverage in any or all of the remaining plans. It’s your choice.

All core plans offer multiple levels of coverage ranging from coordination to enhanced coverage. Each level of coverage is called an option and has a cost (or price) associated with it. Most optional plans also offer multiple levels of coverage that can be selected by the employee.

In a given plan, the higher the option or the amount of coverage selected, the more it costs. See Your Choices at a Glance (PDF, 271KB).

Your Costs & Flex Credits

Funding dollars are called flex credits and each flex credit equals $1. Flex credits are before-tax dollars and are allocated as follows:

  1. You receive $200 annual general flex credits that you can spend however you choose (e.g., higher dental coverage).
  2. You receive the number of flex credits required towards your Medical Services Plan, coverage for the Comprehensive option for both extended health and dental, and the employer paid portion of your Employee Basic Group Life Insurance, regardless of your family status (employee only, employee plus one, employee plus two or more).
    • Waive or Coordination Option: You’ll  receive additional flex credits to use elsewhere.
    • Comprehensive Option: The cost is $0.
    • Enhanced Option: You pay for the extra coverage using flex credits or by paying monthly premiums based on your family status.

​Use the Calculator Tool (XLSM, 56KB) to determine:

  1. The total number of flex credits you receive
  2. The cost of your benefits
  3. The maximum number of flex credits you may allocate to your Health Spending Account (HSA)

You’ll see a security warning telling you that the macros have been disabled. To enable the macros, click on the "Enable Content" button located below the menu. The security warning will disappear and the worksheet will populate and be ready for you to use.

To explore your options, insert various scenarios into the worksheet. Your final balance can be determined by summing up the net prices. Any leftover flex credits will be paid out monthly as taxable cash. Should you have a balance owing, monthly deductions will be taken from your paycheque.

In your first year, your HSA allocation will be prorated over the number of months of coverage you have during that first (likely partial) year.

Employees

The Flexible Benefits Program is offered to regular excluded employees and eligible excluded auxiliary employees who have completed 1,827 hours of work in 33 pay periods in the following categories:

  • Orders in Council: Categories A, B and C
  • Managers in the six bands of the Management Classification Compensation  Framework
  • Schedule A, Crown and Legal Counsel, Executive Administrative Assistants and Senior Executive Assistants
  • Salaried Physicians
  • Deputy Ministers, Associate Deputy Ministers and Assistant Deputy Ministers
  • Officers of the Legislature

Auxiliary employees not eligible for health and welfare benefits receive a compensation allowance as calculated in accordance with the provisions in effect for the majority of Bargaining Unit employees.

You must enrol to be eligible for coverage.

You can extend your benefits to your spouse and to children who meet eligibility requirements. You must enrol your dependants to receive coverage.

Spouse

Your legal or common-law spouse (same or opposite sex) who’s living with you is eligible for coverage. By enrolling your common-law spouse in your benefits plans, you’re declaring that person as your common-law spouse and that you’ve been living in a common-law relationship or cohabitating for at least 12 months. The cohabitation period may be less than 12 months if you claimed the common-law spouse’s child/children for tax purposes. A separate declaration form isn’t required.

If your spouse is also enrolled in a benefits program, you may be able to coordinate benefits plans and receive up to the maximum eligible benefit available under both plans. Consider your enrolment choices (such as whether you just need the Coordinated benefits option).

If you separate from your spouse, they’re no longer eligible for coverage under your benefits plan. Any terms and conditions under separation and divorce agreements are the responsibility of the employee, not the employer. Once a common-law spouse has been enrolled in your benefits plan, a different common-law spouse and any eligible dependants may be enrolled in the plan 12 months after you’ve cancelled coverage for the previous common-law spouse and applicable dependants. This waiting period doesn’t apply when you’re going from legal spouse to common-law spouse, legal spouse to legal spouse, or common-law spouse to legal spouse. You’re responsible for cancelling your spouse’s coverage when they’re no longer eligible for coverage.

Dependent Children

Your children (natural, adopted, stepchildren or legal wards) are eligible for coverage if they’re unmarried/not in a common-law relationship, mainly supported by you, dependants for income tax purposes, and any of the following:

  • Under the age of 19.
  • Under the age of 25 and in full-time attendance at a school, university or vocational institution which provides a recognized diploma, certificate, or degree.
  • Mentally or physically disabled and past the maximum ages stated above, provided they became disabled before reaching the maximum ages and that the disability has been continuous. The child, upon reaching the maximum age, must still be incapable of self-sustaining employment and must be completely dependent on you for support and maintenance.
  • Residing with your former spouse who’s not eligible for health and dental coverage​.

A grandchild is not an eligible dependant unless adopted by or a legal ward of the employee or the employee’s spouse.

Dependent Children Over 19

Unless you certify that your child is in full-time attendance at a school, university or vocational institution which provides a recognized diploma, certificate or degree:

  • Extended health and dental coverage for a dependent child will automatically end on the date your child turns 19
  • MSP coverage will end at the end of their birth month

Before your child turns 19:

  1. You’ll receive Confirmation of Dependent Eligibility forms from Great-West Life (GWL) and MSP
  2. Submit your GWL form back to GWL as per instructions on the letter
  3. Submit your MSP form to the Benefits Service Centre through an AskMyHR service request using the category, Myself (or) My Team or Organization > Benefits > Submit a Health Benefit Form/Application

In subsequent years, return the GWL form back to GWL and submit an AskMyHR service request using the category, Myself (or) My Team or Organization > Benefits > Submit a Health Benefit Form/Application for MSP before September 30 advising that your child is still a full-time student.

Include your child’s name and the school they’re attending. You’re responsible for cancelling coverage for dependent children who are no longer eligible for coverage. Coverage for a dependent child with full-time student status will automatically end at age 25 unless the child has disabled dependant status.

Who's Eligible?

Benefit

Regular Employee

Auxiliary Employee

Medical Services Plan, Extended Health & Dental Plans

  • You can enrol immediately
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is no coverage for MSP and the Comprehensive option for yourself only for extended health and dental
  • Coverage begins the first day of the month following enrolment
  • You can enrol after meeting eligibility requirements
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is no coverage for MSP and the Comprehensive option for yourself only for extended health and dental
  • Coverage begins the first day of the month following enrolment

Employee Basic Life Insurance

  • Coverage begins immediately
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is 3x annual salary
  • It’s strongly recommended that you designate a beneficiary for your life insurance
  • Coverage begins upon meeting eligibility requirements
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is 3x annual salary
  • It’s strongly recommended that you designate a beneficiary for your life insurance

Optional Family Funeral Benefit

  • You can enrol immediately
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is no coverage
  • If selected, coverage begins the first of the month following enrolment
  • Eligible to enrol after meeting eligibility requirements
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is no coverage
  • If selected, coverage begins the first of the month following enrolment

Optional Life & Optional Accidental Death & Dismemberment (AD&D) Insurance

  • You can enrol immediately
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is to waive coverage; you must list which dependants you wish to cover under each insurance plan
  • If selected, coverage begins the first of the month following enrolment except where evidence of insurability and approval is required
  • Coverage will begin once approval is granted by the carrier
  • You can enrol after meeting eligibility requirements
  • You must enrol within 31 days of becoming eligible or you'll receive the default option, which is to waive coverage; you must list which dependants you wish to cover under each insurance plan
  • If selected, coverage begins the first of the month following enrolment except where evidence of insurability and approval is required
  • Coverage will begin once approval is granted by the carrier

Coverage is effective on the date that your coverage is effective, or on the first of the month following the date the enrolment form is received by the Benefits Service Centre, whichever is later, except where evidence of insurability and approval is required. Coverage will begin once approval is granted by the carrier.

Check that coverage is in place after you have enrolled by logging into Employee Self Service (Benefit Summary) and verify that the coverage is effective prior to using the services. Any questions regarding coverage can be directed to MyHR. If submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

How to Enrol for the First Time

During initial enrolment, you must enrol within 31 days of becoming eligible or you’ll receive the default options.

  1. Do your homework so you can tailor your benefits to meet your needs:
    • Read this guide carefully
    • Review your medical and dental expenses over the past year
    • Review your spouse’s coverage, if applicable
    • Use the Calculator Tool (XLSM, 56KB) to review your choices
  2. Complete these forms:
  3. Submit forms by faxing, submitting an AskMyHR service request, or mailing to MyHR within 31 days of eligibility
    • Fax: 604 320-4031
    • Attach to an AskMyHR service request selecting the category, Myself (or) My Team or Organization > Benefits > Submit a Health Benefit Form/Application
    • Mail: Benefits Service Centre
      Block E, 2261 Keating Cross Road
      Saanichton BC  V8M 2A5

You can expect your forms to be processed within 15 days. Once your applications have been processed, you can log into Employee Self Service at any time to view your Benefits Summary (except for your life insurance beneficiaries).

Choosing Life Insurance Coverage

Maintaining Employee Basic Life Insurance coverage is a condition of employment and can’t  be waived. The minimum coverage required is $25,000, and there are two other options available. The rules around when you need to provide evidence of insurability (good health) are outlined below.

Carefully consider the life insurance options available to you during initial enrolment, especially if you (or your spouse) have medical conditions that may prevent you from increasing your life insurance in the future.

Evidence of Insurability (Good Health)

Not required:

  • Any option of Employee Basic Life Insurance on initial enrolment only
  • Up to $50,000 of optional life insurance for yourself and/or your spouse on initial enrolment only
  • Child Optional Life Insurance initial enrolment and subsequent increases
  • Optional Accidental Death & Dismemberment Insurance
  • Family Funeral Benefit

Required:

  • If you choose more than $50,000 of optional life insurance for yourself and/or your spouse during your initial enrolment
  • All other increases in life insurance for yourself and/or your spouse

Remember to list your dependants and select them for the benefit on the enrolment form.

To have dependants covered under Medical Services Plan, extended health and dental, you must record their information in the “Dependent” section of the enrolment form and select the dependants you wish to cover under each benefit plan. Take the time to ensure that your dependant information is correct and that you’ve selected the right dependant(s) for coverage in each plan.

Be sure to designate beneficiaries for your Employee Basic and Optional Life Insurance.

Complete and sign a Group Life Beneficiary Designation Form (PDF, 156KB). If you don’t  designate your beneficiary by submitting the signed form, benefits will be paid to your estate in the event of your death. Beneficiary designations aren’t effective until the completed and signed original form has been received by MyHR.

If you don't enrol on time, you’ll receive a default package of benefits.

Don’t miss out on the opportunity to tailor your benefits package. Take the time to review your benefits and actively enrol. The default package (see table below) may not meet your needs. You won't be able to change your benefits until the annual Open Enrolment period or until you have an eligible life event.

Default Package Details

Benefit

Default

General Flex Credits

You'll receive the $200 in general flex credits (pro-rated for partial years)

Medical Services Plan

Waive

Extended Health

Comprehensive

Dental

Comprehensive

Employee Basic Life Insurance

Enhanced (3 x annual salary, $80,000 minimum)

Health Spending Account

Waive

Unallocated Flex Credits

Paid out as taxable cash

If you're transferring into the Flexible Benefits Program from the Bargaining Unit Benefits Program, you'll be enrolled in the benefits plan (and plan options) that most closely match the coverage you had previously. Previous dependants will also be covered.

Benefits costs and flex credits amounts found in this guide are annual amounts, based on a plan year starting on January 1. If your benefits start during the year, your costs and flex credits will be prorated.

Open Enrolment

Each fall, during Open Enrolment, you’re able to change benefits coverage for you and your dependants for the next benefits plan year. The exception to this rule is if you selected the Enhanced option for extended health and/or dental, in which case, you're locked into these options for two plan years.

Each year, information about changes to any of the benefits plans and instructions on how to complete Open Enrolment are sent out to eligible employees by email. If you don’t receive an email during the last week in October, please contact MyHR. If submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

It's recommended that you review your recent claims history through GroupNet, consider future expenses, and then either confirm your current choice or select a better option for you and your family using the Calculator Tool (XLSM, 56KB) and through Employee Self Service.

If you don’t make choices during Open Enrolment, your benefits will remain the same as the previous year, and you waive the opportunity to have a Health Spending Account. You won’t be able to change your benefits until the next Open Enrolment period or eligible life event.

What if I’m away during open enrolment?

If you're away during Open Enrolment, and wish to make changes to your options, contact MyHR before you leave. You can access Employee Self Service from home, or you can request enrolment forms to be sent to you. Complete the forms and mail them to the Benefits Service Centre (see the Contacts section for the mailing address). The Benefits Service Centre must receive your change form before the Open Enrolment deadline, so be sure to give yourself plenty of time.

Confirming your choices

In early December, check your confirmation statement through Employee Self Service. Report any errors immediately (but no later than December 31st at 4:00 pm) through an AskMyHR service request under the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

Eligible Life Event

During the year, you may change your benefits options after you experience an eligible life event. Eligible life events allow you to make changes to your benefits options within 60 days of the event.

Life events include:

  • Marriage or entering a common-law relationship
  • Divorce, separation, or end of a common-law relationship
  • Birth or adoption of a child
  • Loss of a child’s status as a dependant (marriage, age limit, school status, etc.)
  • Change in your child’s eligibility that allows coverage under the program
  • Your spouse gains or loses benefits coverage
  • Death of a spouse or child

How to update your dependants

To add or cancel dependants, complete and submit these forms:

Increasing Life Insurance Coverage

You or your spouse will be asked to complete an evidence of insurability form (a medical questionnaire) if you apply to increase your:

  • Employee Basic or Optional Life Insurance from the previous year
  • Spouse Optional Life Insurance

The insurance company must review your information and approve your request before increased coverage can take effect.

Effective Dates of Coverage

Changes will be effective on the appropriate date based on the timing of Open Enrolment, an eligible life event, or the approval of evidence of good health for life insurance.

  • Changes made during Open Enrolment will be effective at the start of the following plan year (January 1)
  • Changes made as a result of an eligible life event will be effective on the date of the event; if a life event is reported more than 60 days after the event, changes to your options won't be permitted at that time
  • Exceptions, back-dating and retroactive adjustments won't be made
  • Review your coverage and make changes during the Open Enrolment period or as soon as possible after the eligible life event to ensure that MyHR receives your benefits change forms no later than 60 days from the date of the event.

Everyone is unique and has different needs for benefits. There are a number of choices in the Flexible Benefits Program that enable you to create a benefits package to meet your needs.

For each benefit, you’ll either select the option that best meets your needs, or you’ll waive coverage. The exception is with Employee Basic Life Insurance – you must maintain a minimum ($25,000) level of coverage.

The following tables summarize the coverage in each option of each benefits plan, starting with the Medical Services Plan of B.C. For your convenience, we’ve included annual net pricing information with each table.

If the cost of the option you choose is less than the fully funded option, you’ll have leftover flex credits. The annual price will show a dollar amount credit (e.g., $117 CR).

If the cost of the option you choose is $0, this is the fully funded option.

If the cost of the option you choose is greater than the fully funded option, you’ll have to partially pay for that option. The annual price will show a dollar amount cost (e.g., $213).

Medical Service Plan (MSP) Options

Options

Waive

MSP Coverage

Annual Price (All Family Sizes)

$117 CR

$0

Extended Health Options
Extended Health Plan Options Waive Coordination

Comprehensive (fully funded)

Enhanced (two year lock-in)
Annual deductible No coverage $100 $90 $0
Reimbursement (for most expenses, including prescription drugs) No coverage 20% reimbursed at 20% for the first $5,000 paid in a calendar year per person and then 100% for the balance of the year (subject to some restrictions and plan maximums) 80% reimbursed at 80% for the first $1,500 paid in a calendar year per person and then 100% for the balance of the year (subject to some restrictions and plan maximums) 100%

Vision

No coverage

Adult: $250/24 months
Child: $250/12 months

Adult: $250/24 months
Child: $250/12 months

Adult: $500/24 months
Child: $500/12 months

Paramedical Services (includes acupuncture, chiropractor, massage therapy, naturopathic physician, physiotherapy and podiatry)

No coverage

All services combined:$500/year/person

$500/year/service/person

$750/year for massage/person

$1,500/year for physio/person

$500/year/other services/person

In-Province Lifetime Maximum No coverage $500,000 $500,000 $500,000

Out-of-Province Emergency (100% to lifetime maximum of $3 million)

Business travel only

Business and personal travel

Business and personal travel

Business and personal travel

You $300 CR $198 CR $0 $340
You Plus 1 Dependant $300 CR $198 CR $0 $459
You Plus 2 or More Dependants $300 CR $198 CR $0 $578
Dental Options

Options

Waive

Coordination

Comprehensive (fully funded)

Enhanced (two year lock-in)

Basic

No dental coverage

20% recall for adults: 9 months
Recall for children: 6 months

100% recall for adults: 9 months
Recall for children: 6 months

100% recall for adults & children: 6 months

Major

50%

65%

85%

Orthodontic (LTM = lifetime maximum)

50% with LTM of $2,000

55% with LTM of $3,500

55% with LTM of $5,000

You

$300 CR

$195 CR

$0

$213

You Plus 1 Dependant

$426

You Plus 2 or More Dependants

$633

Your Basic Life Insurance

Options

Core

Comprehensive

Enhanced

Life Insurance for You to Age 65

$25,000

$80,000

3x annual salary

Annual Price

$118.80 CR

$0

18 cents per $1,000 of insurance above $80,000) x 12 months

Optional Life Insurance (You must choose Enhanced Employee Basic Life Insurance to apply for this coverage)

Who

Units of

Maximum

You

$25,000

$1 million

Your Spouse

$25,000

$500,000

For All Your Dependent Children

$5,000

$20,000 (Cost for all dependent children is $11.28 per unit of $5,000)

During initial enrolment, employees have 31 days to apply for up to $50,000 of Optional Life Insurance evidence free. Evidence of insurability is required for all future increases.

Annual Rate for Each Unit ($25,000) of Coverage for Optional Life Insurance (NS=Non-smoker; S=Smoker)

Gender/Age (yrs)

Under 35

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

Female (NS)

$9

$12

$18

$30

$48

$84

$108

Female (S)

$12

$18

$30

$60

$90

$138

$192

Male (NS)

$18

$18

$24

$48

$87

$144

$189

Male (S)

$30

$36

$60

$102

$177

$294

$396

Optional Accidental Death & Dismemberment Insurance

Who

Units of

Maximum

Annual Rate Per Unit

You

$25,000

$500,000

$9.60

Your Spouse

$25,000

$500,000

$9.60

For All Your Dependent Children

$10,000

$250,000

$3.30

Optional Family Funeral Benefit - Life insurance for your spouse ($10,000) and for all dependent children ($5,000)

Annual Price

$26.52

Health Spending Account (HSA) Options

Waive

Elect

No HSA

Allocate a minimum of $100.

Individual maximum may vary.

Please use the Calculator Tool (XLSM, 56KB) to confirm your maximum prior to enrolling.

The Medical Services Plan (MSP) of B.C. insures medically-required services provided by physicians to all eligible British Columbians. All British Columbia residents must be covered under MSP. The employer covers the cost of MSP premiums for eligible BC Public Service employees and their spouses. You must enrol to be covered for MSP under the Flexible Benefits Program. See how to enrol above.

  • There are no premiums for children, employees, or employee’s spouse under 19 years of age
  • MSP premium rates will be determined by the number of adults on an MSP account (the MSP account holder and, if applicable, a spouse)

Eligibility

To be eligible for coverage, employees and their dependants must:

  • Be residents of British Columbia
  • Be Canadian citizens, permanent residents, or temporary document holders

Employees must also meet the eligibility requirements for regular and auxiliary employees.

If you and/or your dependants recently moved to B.C., MSP requires a waiting period of the remainder of the month in which your residence in B.C. is established, plus two months. In B.C., the Insurance Corporation of British Columbia (ICBC) has a partnership with MSP. Driver’s licenses and BC Care Cards are linked. The BC Care Card, which is replaced with the BC Services Card, is the card that shows you have MSP coverage with a unique lifetime identifier for health care called a Personal Health Number. 

To be enrolled in the group plan, new or returning BC Public Service employees and their dependants (if applicable) must complete a two-step process as soon as they arrive in B.C. This allows time to process the application so enrollment and coverage for you and your dependants under the group plan won't be delayed:

  • Visit an ICBC office. Let them know you're new to the province and applying for MSP coverage.
  • Provide proof of your identity. ICBC communicates with MSP to confirm you've completed this step. If you're unsure of what documents to bring, contact ICBC.

Complete the MSP Application for Group Enrolment (PDF, 580KB) and submit it through an AskMyHR service request selecting the category, Myself (or) My Team or Organization > Benefits > Submit a Health Benefit Form/Application.

New residents from other parts of Canada should maintain coverage with their former medical plan during the waiting period. Residents arriving from outside of Canada should contact a private insurance company.

First Nations & Inuit Residents

Status Native and Inuit residents usually enrol through the First Nations Health Authority. If your dependants don't qualify for FNHA coverage and you would like to add them, you must cancel your coverage with FNHA. Instead, you need to apply for MSP coverage through your employer and add your dependants through your employer. For further information about coverage for status Native and Inuit peoples, visit the B.C. Government website.

Your MSP Options

No Coverage

If you choose no coverage under the Flexible Benefits Program:

  • You must have coverage elsewhere or a self-administered account will automatically be set up for you and you'll be billed directly by Health Insurance BC.
  • You'll receive flex credits that you can use elsewhere. All employees, regardless of marital status, will receive the same number of flex credits upon waiving a benefits plan.

MSP Coverage

You can select coverage for:

  • Employee only
  • Employee plus spouse​

You must list any dependants you wish to cover. The easiest way to enrol your newborn for MSP coverage is to complete the Online Birth Registration through the Vital Statistics Agency. The agency sends your baby's information to Health Insurance BC. If you have MSP coverage through work, you must also complete the Medical Services Plan Group Change Request form and forward it to your employer.

You're responsible for any premiums you incur for any period during which you were eligible but weren't enrolled in the group plan. MSP insures services like your doctor’s visits, lab services, and diagnostic procedures, such as X-rays. For more information on benefits, visit the B.C. Government website.

Tax Consideration

If you and your spouse both have access to this benefit, only one person needs to enrol for coverage for the whole family. Because this is a taxable benefit, it's important to ensure you're only enrolled once to avoid paying unnecessary taxes. There may be a tax advantage for the lower income earner to provide coverage, but individual circumstances will vary.

The extended health plan is designed to partially reimburse you for a specific group of medical expenses which aren't covered by the Medical Services Plan or the PharmaCare program.

Overview

Great-West Life (GWL) administers your extended health plan on behalf of your employer. Detailed descriptions of expenses eligible for reimbursement under this plan are provided in the table beginning below.

There's a lifetime maximum of $500,000 per covered person. This lifetime maximum may be reinstated after paying for any one serious illness on the basis of satisfactory evidence provided by the employee to the carrier of complete recovery and return to good health.

Reimbursement

Your rate of reimbursement depends on the option you select. It's your responsibility to verify that an item or service is covered prior to purchase. Contact GWL if the item isn't listed in this guide. It's recommended that you get an expense pre-approved if the cost is over $1,000.

What's Covered by Your Extended Health Plan?

The following is a list of services that are eligible for reimbursement under the extended health plan when incurred as a result of a necessary treatment of an illness or injury and, where applicable, when ordered by a physician and/or surgeon. Check GroupNet for detailed information or contact GWL at 1 855 644-0538. The value of your entitlement will be impacted by the option you select.

Extended Health Plan Coverage

Feature

Coverage

Accidental Injury to Teeth

Dental treatment by a dentist or denturist for the repair or replacement of natural teeth or prosthetics, which is required and performed and completed within 52 weeks after an accidental injury that occurred while covered under this plan. No reimbursement will be made for temporary, duplicate or incomplete procedures, or for correcting unsuccessful procedures. Expenses are limited to the applicable fee guide or schedule.

Accidental means the injury was caused by a direct external blow to the mouth or face resulting in immediate damage to the natural teeth or prosthetics and not by an object intentionally or unintentionally being placed in the mouth.

Acupuncture

Acupuncture treatments performed by a medical doctor or an acupuncturist registered with the College of Traditional Chinese Practitioners and Acupuncturists of British Columbia. See the "Paramedical Services" section of this table for information about reasonable and customary limits.

Braces, Prosthetics & Supports

To be eligible for reimbursement, you must include a practitioner’s note for all prosthetics, braces and supports to confirm the medical need for the device. Accepted practitioners include licensed chiropractors, physiotherapists and physicians. The prescription must include the medical condition and the braces must contain rigid material.

Breast Prosthetics

See the "Mastectomy Forms & Bras" section of this table for information.

Chiropractor

Chiropractic treatments performed by a chiropractor registered with the College of Chiropractors of British Columbia. See the "Paramedical Services" section of this table for information about reasonable and customary limits. X-rays taken by a chiropractor are not eligible for reimbursement.

Contraceptives

Prescribed oral or injectable contraceptives. See the "Drugs & Medicines" section of this table for information.

Registered Clinical Counsellors

Service fees of a registered clinical psychologist or counsellor payable to a maximum of $500 per family per calendar year. The practitioner must be registered in the province where the service is rendered.

To determine if a psychologist is registered for claiming purposes, contact the College of Psychologists of B.C. at 604 736-6164 (toll free 1 800 665-0979).

To determine if a counsellor is registered for claiming purposes, contact the BC Association of Clinical Counsellors at 250 595-4448 (toll free 1 800 909-6303). Visit MyHR for information about short-term counselling available to your through the Health and Well-being Program.

Drugs & Medicines

Covered drugs and medicines purchased from a licensed pharmacy, which are dispensed by a pharmacist, physician or dentist subject to PharmaCare’s policies including reference-based pricing and lowest cost alternative.

Drugs and medicines include:

  • Injectables provided by a medical practitioner and drugs used by a medical practitioner when providing services under circumstances whereby the drug isn't otherwise provided
  • Insulin preparations, testing supplies, needles and syringes for diabetes
  • Vitamin B12 for the treatment of pernicious anaemia
  • Allergy serums when administered by a physician
  • Other drugs and medicines that require a prescription from a medical provider who's legally authorized to do so, including oral and injectable contraceptives

Reimbursements are subject to the deductible and percentage in the option you select.

Reimbursement of eligible drugs and medicines will be based on a maximum dispensing fee of $7.60 and a maximum mark-up of 7% over the manufacturer’s list price.

All plan members must sign up for PharmaCare to assist with prescription coverage, limiting the impact on your lifetime maximum.

Unless medical evidence is provided to Great-West Life that indicates why a drug is not to be substituted, GWL can limit the covered expense to the cost of the lowest priced interchangeable drug.

Prior Authorization
Great-West Life requires prior authorization to provide appropriate drug treatment and to ensure the drugs prescribed are considered reasonable treatment for the condition. For brand name drugs, your physician would have to complete a Request for Brand Name form, to provide medical evidence that the generic version has adverse side effects. For more information, see the "Prior Authorization & Specialty Drugs" section.

Emergency Ambulance Services

Emergency transportation by licensed ambulance to the nearest Canadian hospital equipped to provide medical treatment essential to the patient.

Air transport when time is critical and the patient’s physical condition prevents the use of another means of transport. Doctor’s note may be required.

Emergency transport from one hospital to another only when the original hospital has inadequate facilities. Charges for an attendant when medically necessary.

Medical Examinations

Medical examinations rendered by a physician, required by a statute or regulation of the provincial and/or federal government for employment purposes, for you and all your registered dependants, provided such charges aren't otherwise covered.

Vision Examinations

Fees for routine eye examinations to a maximum of $75 per 24 months per person between the ages of 19 and 64, when performed by a physician or optometrist.

Exams for persons under age 19 and over age 64 are covered under the Medical Services Plan. Your practitioner may charge more than what's payable by the Medical Services Plan for this service. The balance isn't covered by your extended health plan.

Hairpieces & Wigs

Hairpieces and wigs, when medically necessary, are eligible for reimbursement to a maximum of $500 per 24 months.

Hearing Aids & Repairs

Reimbursements at $1,500 per ear per 48 months for adults and 24 months for children for all coverage options. This benefit isn't subject to an annual deductible. Batteries, recharging devices, or other such accessories are not covered. 

Hospital Charges

Additional charges for semi-private or private accommodation over and above the amount paid by provincial health care for a normal daily public ward while you're confined in a hospital under active treatment. This doesn't include telephone or TV rental or other amenities.

Massage Therapy

Massage treatments performed by a massage practitioner registered with the College of Massage Therapists of British Columbia. See the "Paramedical Services" section of this table for information about reasonable and customary limits.

X-rays taken by, and drugs, medicines or supplies recommended and prescribed by a massage therapist are not covered. 

Mastectomy Forms & Bras

Mastectomy forms and bras are eligible for reimbursement to a maximum of $1,000 per 12 months.

Medical Aids & Supplies

A variety of medical aids and supplies as follows:

For diabetes:

  • Testing supplies, needles and syringes
  • Insulin injector
  • Insulin infusion pumps if other methods aren't suitable

If you switch from using testing supplies to an insulin injector, testing supplies aren't covered for the next 60 consecutive month period.

  • Light boxes including light visors used for the treatment of seasonal affective disorder
  • Oxygen, blood and blood plasma
  • Ostomy and ileostomy supplies
  • Aerochambers
  • Compression hose
  • Walkers, canes and cane tips, crutches, splints, collars and trusses (elastic or foam supports aren't covered)
  • Rigid support braces and permanent prostheses (artificial eyes, limbs and larynxes); myoelectrical limbs aren't covered, but the plan will pay an amount equal to the cost of a standard prostheses
  • Stump socks to a maximum of $200 per calendar year 

Standard durable equipment as follows:

  • The cost of renting, where more economical, or the purchase cost of durable equipment for therapeutic treatment including:
  • Manual wheelchairs, scooters, manual type hospital beds and necessary accessories
  • If the patient is incapable of operating a manual wheelchair, an electric wheelchair will be covered; otherwise, the plan will pay the equivalent of a manual wheelchair
  • Cardiac screeners and blood glucose monitors
  • Growth guidance systems
  • Breathing machines and appliances including respirators, compressors, suction pumps, oxygen cylinders, masks and regulators
  • Continuous positive airway pressure machine when prescribed for sleep apnea
  • Infant apnea monitor

Pre-authorization is recommended for items costing over $1,000 and is required for items over $5,000.

Naturopathic Physician

Naturopathic services performed by a naturopathic physician licensed by College of Naturopathic Physicians of British Columbia. See the "Paramedical Services" section of this table for information about reasonable and customary limits.

X-rays taken, and drugs, medicines or supplies recommended and prescribed by a naturopathic physician are not covered. 

Needleless Injectors

When prescribed by a physician:

  • Needleless injectors are payable up to $500/60 months
  • Charges for supplies required for the administration of insulin (needles, etc.) aren't covered for a 60 consecutive month period from the purchase date of an insulin injector 

Orthotics & Orthopedic Shoes

When prescribed by a physician or podiatrist when medically necessary, custom-fit orthotics or orthopedic shoes, including repairs, orthotic devices and modifications to stock item footwear but not including arch supports/inserts. Payable to a maximum of $400 per person per calendar year. Not all casting techniques are approved for coverage, so please confirm with GWL prior to purchase.

Custom Orthotics

When submitting claims for custom made orthotics, include the following information:

  • A prescription from the physician, podiatrist, chiropractor or nurse practitioner indicating the patient’s medical condition
  • A detailed copy of the biomechanical assessment/examination
  • Details of the casting technique used to acquire an anatomical model of the patient’s foot
  • The date the orthotics were dispensed to the patient

Custom Orthopedic Shoes

When submitting claims for custom made orthopedic shoes, include the following information:

  • A prescription from the physician, podiatrist or nurse practitioner indicating the patient’s medical condition and an explanation why stock-item orthopedic shoes can’t be used by patient
  • Details of the casting technique used to acquire an anatomical model of the patient’s foot
  • Details of the fabrication process and materials used to make the shoes
  • An invoice providing the name, address, and phone number of the dispensing clinic or provider along with a list of all charges

Out-of-Province/Out-of-Country Emergencies

Reasonable charges for a physician’s services due to an emergency are eligible for reimbursement, less any amount paid or payable by the Medical Services Plan, subject to the lifetime maximum of $3 million for out-of-province/out-of-country emergencies.

Paramedical Services
(acupuncture, chiropractor, massage therapy, naturopathic services, physiotherapy, podiatry)

Services provided by licensed paramedical practitioners. For the purposes of this plan, paramedical services are a defined group of services and professions that supplement and support medical work, but don't require a fully qualified physician. These services include: acupuncture, chiropractor, massage therapy, naturopathic physician, physiotherapy, and podiatry.

Paramedical services are subject to reasonable and customary (R&C) limits. R&C represents the standard fees healthcare practitioners would charge for a given service. They're reviewed regularly and are subject to change at any time. If your healthcare practitioner charges more than a R&C limit, you'll be responsible for paying the difference. If you have any questions about R&C limits for a given service, contact Great-West Life at 1 855 644-0538.

Physiotherapist

Professional services performed by a physiotherapist registered with the College of Physical Therapists of British Columbia. See the Paramedical services section of this table for information about reasonable and customary limits.

Podiatrist

Professional services performed by a podiatrist registered with the British Columbia Association of Podiatrists. See the "Paramedical Services" section of this table for information about reasonable and customary limits. X-rays taken or other special fees charged by a podiatrist are not covered.

Prostate-Serum Antigen Test

Once per calendar year.

Registered Clinical Psychologists

Service fees of a registered clinical psychologist or counsellor to a maximum of $500 per family per calendar year. The practitioner must be registered in the province where the service is rendered.

To determine if a psychologist is registered for claiming purposes, contact the College of Psychologists of B.C. at 604 736-6164 (toll free 1 800 665-0979).

To determine if a counsellor is registered for claiming purposes, contact the BC Association of Clinical Counsellors at 250 595-4448 (toll free 1 800 909-6303).

Visit MyHR for information about short-term counselling available to your through the Health and Well-being Program.

Smoking Cessation Products

Drugs and supplies for prescriptions and non-prescription smoking cessation.

Maximum: $300/year/person to a lifetime maximum of $1,000.

You must register with the Quittin’ Time program prior to purchasing any products.

  • Members must submit proof of registration in the Quittin’ Time Program to Great-West Life along with the first claim of the 6 month period
  • Great-West Life will activate the member’s drug card for the drug product purchased, and set the appropriate maximum and termination date for the 6 month period
  • Great-West Life will write to the member to advise them they can continue to use their drug card until the earlier of the end of the 6 month period or until they have reached their calendar year or lifetime maximum. Members will also be advised to notify Great-West Life if they switch to another smoking cessation product so their claims continue to pay correctly. 

Vision Care

This benefit isn't subject to the deductible.

Purchase and/or repair of corrective eyewear prescribed by an optometrist, ophthalmologist or physician and/or laser eye surgery. Corrective eyewear includes lenses, frames, contact lenses, prescription sunglasses, prescription safety goggles, and vision care repairs. Charges for non-prescription eyewear aren't covered. Eye exams are a separate feature. See the "Vision Examinations" section of this table for information.

Check GroupNet to verify your personal eligibility period.

Any item not specifically listed as being covered under this plan is not an eligible item under this extended health plan.

Your Extended Health Plan Options

No coverage

If you waive extended health coverage under the Flexible Benefits Program, you'll receive flex credits to use elsewhere. All employees, regardless of family status, will receive the same number of flex credits upon waiving a benefit plan. Travel medical coverage is limited to business travel only.

Coordination

This is a low-cost option which provides a low level of coverage for most services. This option has a deductible. This option may work well if you're able to coordinate your benefits with your spouse’s plan, depending on terms of their plan. If you're coordinating benefits with your spouse and you select this option, your reimbursements under this option (e.g., when you go to the pharmacy) will be the lower portion (i.e., 20%), with the more significant portion being reimbursed through your spouse’s plan after you've submitted a claim to that plan. It’s important to be aware of this so there are no surprises when you're paying for products and services. You have business and personal travel medical coverage of up to $3 million.

Comprehensive

This option provides a comprehensive level of coverage in all identified areas (e.g., prescription drugs, vision care, paramedical services and medical equipment) and is the fully funded option. This option has a deductible. You have business and personal travel medical coverage of up to $3 million.

Enhanced

This option has no deductible and a higher reimbursement rate than the other options. It includes higher coverage for vision care, massage therapy and physiotherapy. You have business and personal travel medical coverage of up to $3 million.

This option has a two-year lock-in, so if you choose it, you must remain under this option for two plan years.

Details to Consider

  • Given your claims history and any anticipated future medical expenses, which option offers the best value? Reviewing your past claims information can help you with anticipating future expenses.
  • If you're covering dependants, which dependants will you cover? Given their claims history, which option offers the best value for you?
  • If you're able to coordinate benefits with a spouse, which option offers the best value to you?

Out-of-Province/Out-of-Country Coverage

If you’ve waived coverage for the extended health plan, you’ll only have coverage for business medical travel. If you’re covered under this extended health plan (i.e., you haven’t waived coverage), and you travel out-of-province or out-of-country on business or personal travel, you’re covered for medical emergencies, including those resulting from pre-existing conditions (except for a few exclusions) to a lifetime maximum of $3 million. Your spouse and/or dependants covered under your extended health group plan are also covered for medical emergency travel benefits while travelling for pleasure. Eligible emergency medical expenses are subject to your extended health plan annual deductible and will be reimbursed at 100%.

Eligible travel medical expenses include:

  1. Local ambulance services when immediate transportation is required to the nearest hospital equipped to provide the treatment essential to the patient.
  2. The hospital room charge and charges for services and supplies when confined as a patient or treated in a hospital. Members  should contact Travel Assistance for assistance if they have a medical emergency. See the Travel Assistance Brochure for contact information. When the patient’s medical condition permits, they'll be returned to Canada. Great-West Life's standard out of country confinement is up to a semi-private ward rate.
  3. Services of a physician and laboratory and x-ray services.
  4. Prescription drugs.
  5. Other emergency services and/or supplies, if Great-West Life would have covered the expenses in your province/territory of residence.
  6. Medical supplies provided during a covered hospital confinement.
  7. Paramedical services provided during a covered hospital confinement.
  8. Medical supplies provided out of hospital if you would have been covered in Canada.
  9. Out of hospital services of a professional nurse.
These expenses are eligible in a medical emergency only, and when ordered by the attending physician. A medical emergency is:
  • a sudden and unexpected injury
  • the onset of a condition not previously known or identified prior to departure from BC or Canada
  • an unexpected episode of a condition known or identified prior to departure from BC or Canada

An unexpected episode means it would not have been reasonable to expect the episode to occur while travelling outside of Canada. If a person was suffering from symptoms before departure from Canada, GWL may request medical documentation to determine whether, in the circumstances, it could have reasonably been anticipated that the person may require treatment while outside Canada.

Non-emergency continuing care, testing, treatment and surgery, and amounts covered by any government plan and/or any other provider of health coverage are not eligible.

Exclusions

  • Expenses incurred due to elective treatment and/or diagnostic procedures.
  • Complications related to such treatment expenses incurred due to therapeutic abortion, childbirth, or complications of pregnancy occurring after week 35, or if high risk, during pregnancy.
  • Charges for continuous or routine medical care normally covered by the government plan in your province/territory of residence.

If you're not covered under the extended health plan, you're only covered for business medical travel. It's your responsibility to purchase travel insurance for your personal needs.

Optional medical travel insurance

Great-West Life has a travel insurance website to enable you to purchase optional travel medical insurance. For more information, review Great-West Life’s Optional Emergency Travel Medical Benefit Information Sheet (PDF, 207KB). This travel medical insurance is first payer to your group plan with Great-West Life, and you’ll save 10% by purchasing it from this website.

If you have other similar coverage, such as through a credit card plan or another group or individual insurance plan, claims will be coordinated within the guidelines for out-of-province/out-of-country coverage issued by the Canadian Life and Health Insurance Association.

To apply, you'll need your Great-West Life group plan number (50088) and your identification number from your Great-West Life ID card.

This travel insurance has a maximum amount payable per covered trip of $2 million Canadian. Coverage is available for either single or annual travel policies if you're under age 80. There are exclusions for pre-existing conditions.

Travel Assistance

Travel Assistance provides assistance if you or an eligible dependant experiences a medical emergency while traveling out-of-province/out-of-country. Trained personnel who speak various languages will provide advice and coordinate services for you.

This service is available 24 hours a day, 365 days a year and assists members in locating hospitals, clinics and physicians. Travel Assistance also provides the following services:

  1. Medical advisors
  2. Advance payment when required for hospital admission
  3. Helping to locate qualified legal assistance, local interpreters and appropriate services for replacing lost passports
  4. Assisting unattended children
  5. Return of vehicle
  6. Transportation reimbursement
  7. Medical evacuation
  8. Travelling companion expenses
  9. Transportation of remains if a plan member dies while travelling.
    Expenses for preparing and transporting the plan member’s remains home are covered. The assistance company can also help make the appropriate arrangements.

Travel Assistance provides advice and coordinates services at no additional charge. However, it's not a means of paying for any healthcare expenses that you may require. The actual cost for any service(s) received is your responsibility. Some of these expenses may be claimed through Medical Services Plan of B.C., travel insurance purchased by you, or your extended health plan.

Please ensure that you have your Assure Card with you when you travel as the Travel Assistance phone numbers are listed on the back of your card. Have your Great-West Life Plan, ID, and provincial health care numbers ready for personal identification.

See the Travel Assistance page for more information.

 

Prior Authorization & Specialty Drugs

Great-West Life’s prior authorization process is designed to provide an effective approach to managing claims for specific prescription drugs.

How Prior Authorization Works

Prior authorization requires that you request approval from Great-West Life for coverage of certain prescription drugs. When a claim is submitted for any of these drugs, they’ll ask for information to help them assess the claim. Your request must be approved before your claim is paid. To ensure your claim is processed without delay, please provide all necessary information before filling a prescription.

Why we require prior authorization

Drugs that are approved for one or more medical conditions are sometimes prescribed for other conditions without being proven as an effective treatment. The practice of requesting additional information is designed to help:

  • Provide coverage for appropriate drug treatment
  • Ensure the drugs prescribed are considered reasonable treatment for the condition
  • Keep your drug plan affordable and accessible

Drugs requiring prior authorization

Great-West Life maintains a limited prior authorization drug list and the corresponding forms. Before a claim for any of these drugs is approved, they review the circumstances to determine whether the drug is a reasonable treatment for the condition for which it was prescribed. The prior authorization drug form list changes from time to time. Your group benefits plan may not provide coverage for all of the prior authorization drugs listed, as coverage depends on the terms of your plan. To view the prior authorization drug form list, visit Great-West Life to determine if a certain drug requires prior authorization. If you have questions about which drugs are covered by your plan, call your local Great-West Life Group Customer Contact Services Office at 1 855 644-0538.

How to request prior authorization

If you’re prescribed a drug that requires prior authorization, you must complete the appropriate section(s) of a Request for Information form with your prescribing doctor and submit the form to Great-West Life. Your claim can’t be considered for reimbursement until they receive this form. If you anticipate submitting a claim for a drug that requires prior authorization, take a Request for Information form to your doctor’s appointment. Completed forms can be faxed or mailed to Great-West Life:

Fax
Great-West Life
Fax: 204 946-7838
Attention: Drug Services

Mail
Great-West Life
Drug Services, P.O. Box 6000
Winnipeg MB  R3C 3A5

If your claim is approved, in most cases, additional Request for Information forms for the drug won’t be required. Future claims for the drug will be processed in the same manner as prescription drugs that don’t require prior authorization. Certain drugs may require additional approval after a specified period. In these situations, you may be asked to provide further information regarding the progress of your treatment prior authorization review. All requests for prior authorization are reviewed by Great-West Life. Their decision is based on the information provided to determine whether the prescribed drug represents reasonable treatment.

Notification regarding the claim decision

Once Great-West Life reviews your completed Request for Information form, they’ll advise you by letter as to whether or not the request for prior authorization has been approved. If the request is declined, you may wish to discuss your medication needs with your doctor or pharmacist. You have the option of paying for the total cost of the drug yourself.

Specialty Drug Program

Great-West Life’s enhanced drug coordination process coordinates eligible drugs under specific provincial programs. You may be required to apply to the provincial program for drug coverage. Some drugs included in this program are also under prior authorization.

How the Specialty Drug Program works

You go to your pharmacy to fill a prescription.

1. The drug is included in the Specialty Drug Program:

  • The claim will be paid, but you’ll need to apply to your provincial program
  • You’ll receive a letter to apply to the provincial program and respond to Great-West Life within 70 days
  • Great-West Life will coordinate your drug plan with your provincial plan

OR

2. The drug is included in the Specialty Drug program and the Prior Authorization program:

  • If your claim is denied, you’ll receive a message to apply to your provincial program
  • You’ll receive a letter to apply to the provincial program along with the applicable Prior Authorization form
  • If approved, Great-West Life will pay any amounts not eligible under the provincial program
  • If the provincial plan declines your claim, send the Prior Authorization form to Great-West Life to assess eligibility under the drug plan
  • You’ll be notified if your claim is accepted or not

Prescription Drug Coverage: BC Public Service Extended Health Plan

The following communication is to provide details of the prescription drug coverage under the extended health plan for BC Public Service employees.

What’s BC PharmaCare and how does it coordinate with your drug plan?

BC PharmaCare helps all B.C. residents with the cost of eligible prescription drugs, even if you have private drug coverage through the BC Public Service extended health plan. If you fill a prescription that’s eligible with BC PharmaCare (BC PharmaCare covers about 50% of all prescription drugs available in Canada), then BC PharmaCare will start paying for these drugs once your total annual prescription costs reach your deductible, which is based on 3% of your net family income. Your extended health plan will pay your deductible portion in accordance to the plan’s reimbursement limits until the deductible is satisfied, and then PharmaCare will start paying for you and your dependents’ eligible drugs for the rest of the calendar year.

In the example below, based on a net family income of $50,000 and total eligible family drug costs of $2,000 for the year, BC PharmaCare will start paying for eligible prescriptions after the cost of your family’s eligible drug spend has accumulated to $1,500 ($50,000 x 3%) within a calendar year.

BC Pharmacare Coordination

How does PharmaCare know how to calculate my deductible?

You must register for Fair PharmaCare in order for BC PharmaCare to access your income tax returns to calculate your deductible. If you don’t register, your deductible will be set at the maximum of $10,000, which will add unnecessary costs to your drug plan.

What if I have already notified our previous insurer, Pacific Blue Cross, that I registered with Fair PharmaCare?

If you have already registered with Fair PharmaCare, and submitted the information to Pacific Blue Cross, that information should have been transferred to Great-West Life.

What if I haven’t registered with Fair PharmaCare?

If the eligible drug costs for you and your dependant(s) have accumulated and reached a certain threshold within a calendar year, Great-West Life will notify you that you need to register for Fair PharmaCare or your drug claims will be temporarily suspended until Great-West Life receives confirmation of Fair PharmaCare registration. Learn more about Fair PharmaCare.

In addition to coordinating drug costs with BC PharmaCare, the drug plan for BC Public Service employees follows BC PharmaCare’s pricing policies which includes the Lowest Cost Alternative (LCA) Program and the Reference Drug Program (RDP).

What’s the Low-Cost Alternative (LCA) program?

When the same drug is made and sold by more than one manufacturer, the plan covers the less costly version. Drugs deemed the "lowest cost alternative" are usually (but not always) generics. The LCA drugs (usually generics) are fully covered by the plan, but the more costly brand drugs are only partially covered up to the LCA price.

For example:

  • Celexa™ is the brand version of a popular antidepressant
  • The cost of one Celexa 20mg tablet = $1.52 (partially covered)
  • The generic version of one Celexa 20mg = $0.26 (fully covered)

Your drug plan would only pay up to the cost of the generic version ($0.26) if you filled a prescription for Celexa™, subject to the terms of your group benefits plan. To get fully reimbursed, you would need to purchase the generic version which can be done by the pharmacist without authorization from your doctor.

If there’s a medical reason which requires you to take the brand name drug, ask your physician to complete a Request for Brand Name Drug Coverage form to provide the medical information for why you require the brand name drug. This form is available on the Great-West Life website.

What’s the Reference Drug Program (RDP)?

Sometimes there are several drugs that treat the same illness or condition that are very similar in effectiveness, chemical structure, and safety. There are eight therapeutic classes in the Reference Drug Program. PharmaCare reviews the cost of the drugs within each category and determines the maximum daily cost it will cover. Each therapeutic category has reference drugs which are the most cost effective; these are fully covered by the plan, in accordance to the plan’s reimbursement formula. However, the more expensive drugs within a therapeutic category are considered non-reference drugs and these will only be partially covered, up to the maximum daily price.

For example, let’s take the statins, a popular class of drugs for high cholesterol:

  • Reference statin drugs: atorvastatin and rosuvastatin are fully covered
  • Non-reference statin drugs: fluvastatin, lovastatin, pravastatin, simvastatin are only reimbursed to a daily maximum of $0.26.

The RDP currently has 8 categories:

  1. Angiotensin receptor blockers for high blood pressure
  2. Proton pump inhibitors for acid reflux and ulcers
  3. Statins for high cholesterol
  4. H2 blockers for acid reflux
  5. Calcium channel blockers for high blood pressure
  6. Angiotensin converting enzyme inhibitors for high blood pressure
  7. Nitrates to prevent chest pain
  8. Non-steroidal anti-inflammatories for pain and inflammation

Can I get fully reimbursed for a non-reference drug within the Reference Drug Program if my doctor thinks it’s medically necessary?

If your doctor thinks that it’s medically necessary for you to take a non-reference drug because you’ve already tried a reference drug and it hasn’t been effective, you may ask your doctor to apply to BC PharmaCare’s Special Authority Program on your behalf. Once approved, you can send in the form to Great-West Life to get a pricing exception and full coverage, to plan limits, for your non-reference RDP drug. For any additional information regarding the Reference Drug Program, please refer to the BC PharmaCare website.

What if I am already at the pharmacy and realize that my doctor prescribed a non-reference drug? What can I do to get the drug changed to a fully covered drug?

You can go back to your doctor and ask them to prescribe a reference drug within that therapeutic category, or ask your pharmacist if they have the ability to adapt the prescription to a reference drug. Under very limited conditions, pharmacists in British Columbia have the ability to change certain prescriptions from one drug to another without consulting your doctor.

BC PharmaCare’s Special Authority Drugs

In addition, some drugs may be eligible for coordination with BC PharmaCare’s Special Authority (SA) Program. If you’re claiming a drug included in the (SA) Program, you may be eligible for coverage under the government plan. Great-West Life will notify you in writing asking you to apply to the government program. Once the government decision has been made, a copy of the response letter can be sent to Great-West Life at:

Great-West Life Drug Services

Mail
Box 6000
Winnipeg, MB
R3C 3A5

Fax
1 204 946-7664

The dental plan is designed to assist you with the cost of your dental care and reimburses most basic and major dental and orthodontic services.

Overview

Great-West Life (GWL) administers your dental plan on behalf of your employer. Dental coverage is available for services in B.C. and for emergency dental services while traveling anywhere outside of B.C. The plan will cover eligible expenses up to the amount it would've covered had the services been performed in B.C.

What's covered by your dental plan?

Dental services fall into three categories:

  • Basic Preventative & Restorative Services
  • Major Services
  • Orthodontic Services

Reimbursement

Your rate of reimbursement depends on the option you select.

Dentists set their own rates for service, but reimbursement of dental fees under this group plan is subject to the dental schedule published by the BC Dental Association for dentists, dental specialists, and denturists and to plan limits.

You're responsible for any fees that exceed plan limits. Always ask for pre-approval.

It's your responsibility to verify that an item or service is covered prior to treatment. Contact GWL if the item isn't listed in this guide.

Basic Services

Basic dentistry is comprised of routine services available in the office of a general practicing dentist and are necessary to restore teeth to natural or normal function.

Diagnostic Services

Procedures conducted to determine or diagnose the dental treatment required, including:

  • Standard oral exams
  • Specific oral exams
  • X-rays, including panoramic X-rays
  • A specific oral exam will be reimbursed once for any specific area, and only if a standard oral exam hasn’t been reimbursed within the previous 60 days
  • A complete oral exam will be reimbursed only once every three years, provided that the plan hasn’t reimbursed for any examination during the preceding nine months

Preventative Services

Procedures that prevent oral disease, including:

  • Cleaning and polishing teeth
  • Scaling
  • Topical fluoride – once every nine months
  • Pit and fissure sealants, preventative restorative resins
  • Fixed space maintainers intended to maintain space and regain lost space, but not to obtain more space

Restorative Services

  • Fillings – amalgam fillings and composite (white) fillings on all teeth. Specialty fillings and crowns, such as synthetic porcelain, plastic, composite resin, stainless steel, and gold may result in additional cost to be paid by the employee or dependant
  • Stainless steel crowns on primary and permanent teeth
  • Inlays and onlays

Only one inlay, onlay or other major restorative service involving the same tooth will be covered in a five-year period.

Surgical Services

All necessary procedures for extractions and other surgical procedures necessary for the treatment of disease of the soft tissue (gum) and the bones surrounding and supporting the teeth.

Endodontics

Treatment of diseases of the pulp chamber and pulp canal, including but not limited to basic root canal.

Periodontal Services

Treatment of diseases of the soft tissue (gum) and bones surrounding and supporting the teeth including occlusal adjustment, root planing, gingival curettage, and scaling.

Replacements & Repairs

  • Repair of fixed appliances and the rebase or reline of removable appliances (may be done by a dentist or by a licensed dental mechanic). Relines will only be covered once per 24-month period.
  • With crowns, restoration for wear, acid erosion, vertical dimension and/or restoring occlusion aren’t covered. Check with GWL before proceeding.
  • Temporary procedures (e.g., while awaiting repair of an appliance) aren’t covered.

Recall Check-Up Schedule

For dependent children under 19 years of age, general recall services (oral exam, polishing, scaling, and fluoride) are covered once every six calendar months.

For adults and students covered under the dental plan, age 19 and older, these services are covered once every nine calendar months under the Coordination and Comprehensive option, and six calendar months if you’re under the Enhanced option.

Major Services

Major services apply to services required for reconstruction of teeth and for the replacement of missing teeth (e.g., crowns, bridges and dentures), where basic restorative methods can’t be used satisfactorily. To determine how much of the cost will be paid by the plan, and the extent of your financial liability, you should submit a treatment plan to GWL for approval before treatment begins.

Restorative Services

  • Veneers
  • Crowns and related services
  • Specialty crowns and fillings such as synthetic porcelain plastic, composite resin, stainless steel and gold may result in additional cost to be paid by the employee or dependant

Fixed Prosthetics

Bridgework to artificially replace missing teeth with a fixed prosthesis.

Removable Prosthetics

Full upper and lower dentures or partial dentures of basic standard design and material. Full dentures can be provided by a dentist or a licensed dental mechanic. Partials can only be provided by a dentist.

No benefit is payable for the replacement of lost, broken or stolen dentures. Broken dentures can, however, be repaired under basic services.

Replacement & Repairs

Removal, repairs and re-cementation of fixed appliances.

Orthodontic Services

Orthodontic services maintain, restore or establish a functional alignment of the upper and lower teeth. The plan will reimburse orthodontic services performed after the date coverage begins.

Pre-Approval

To claim orthodontic benefits, GWL must receive a treatment plan (completed by the dentist or othodontist) before treatment starts.

Reimbursement

The carrier will pay benefits on a monthly basis. You can also submit online using GroupNet. If you pay the full amount to the dentist in advance of completed treatment, the carrier will prorate benefit payment over the months of the treatment period.

No benefit is payable for the replacement of appliances which are lost or stolen.

Treatment performed solely for splinting isn’t covered.

Your Dental Plan Options

Waive

If you waive dental plan coverage under the Flexible Benefits Program, you’ll receive additional flex credits to use elsewhere. All employees, regardless of family status, will receive the same number of flex credits upon waiving a benefits plan.

Coordination

This is a low-cost option with a lower level of dental coverage. This option may work well if you're able to coordinate your benefits with your spouse’s plan, depending on the terms of their plan. This option reimburses basic services at 20%, major services at 50%, and orthodontic services at 50% (with a lifetime maximum of $2,000 per person).

The recall schedule is every nine months for adults and every six months for children.

If you’re coordinating benefits with your spouse and you select this option, your reimbursement will be the lower portion with the more significant portion being reimbursed through your spouse’s plan after you’ve submitted a claim to that plan.

Comprehensive

This option provides a comprehensive level of dental coverage.

It reimburses basic services at 100%, major services at 65%, and orthodontic services at 55% (with a lifetime maximum of $3,500 per person). This is the fully funded option.

The recall schedule is every nine months for adults and every six months for children.

Enhanced

This option provides an enhanced level of coverage. It reimburses basic services at 100%, major services at 85%, and orthodontic services at 55% (with a lifetime maximum of $5,000 per person).

The recall schedule is every six months for adults and children.

This option has a two-year lock-in, so if you choose it, you must remain under this option for two plan years.

Details to Consider

  • If you’re covering dependants, which dependants will you cover?
  • Which features of the dental plan are most important to you and your dependants (e.g., basic services, major services, orthodontics)?
  • If you’re able to coordinate benefits with a spouse, which option offers the best value to you?

Any item not specifically listed as being covered under this plan is not an eligible item under this dental plan.

Life insurance plans help protect you and your loved ones from the financial burden of a loss. The Flexible Benefits Program provides a basic level of life insurance plus the opportunity to buy additional optional life insurance for you and your dependants.

Overview

Great-West Life (Policy 6878GL5) administers your life insurance plan on behalf of your employer. The plans available through the Flexible Benefits Program include:

  • Employee Basic Life Insurance
  • Optional Life Insurance (employee/spouse/child)
  • Optional Family Funeral Benefit
  • Optional Accidental Death & Dismemberment Insurance (employee/spouse/child)

Details to Consider

  • Do you have a spouse and/or dependants?
  • Do you have other life insurance policies?
  • What are your family’s financial needs?

The Importance of Designating a Beneficiary

Life insurance payments are non-taxable when paid to one or more designated beneficiaries, and only a named beneficiary can apply for the funeral advance. If paid to an employee’s estate, the insurance becomes part of the proceeds of the estate and may become taxable. In addition, the benefit payment is subject to probate, and can be used to pay outstanding debts, taxes and other estate costs. It generally takes longer for the benefit to be paid out through the estate. It’s highly recommended that you nominate one or more beneficiaries for your life insurance during your initial enrolment and that you keep your beneficiary designation information updated (e.g., if you get married/divorced or if you have children). The Benefits Service Centre must receive the original Group Life Beneficiary Designation Form (PDF, 156KB) before they can update your beneficiary. If they don’t  receive the original form, the beneficiary will default to your estate unless you have previously designated a beneficiary, which will then remain on file.

Changes in Insurance

All increases and additions of new benefits are subject to the actively-at-work requirement except for changes in insurance due to changes in earnings that take effect when the employee is on a Short Term Illness and Injury Plan (STIIP) or weekly indemnity. Additions to and increases in benefits coverage are subject to approval by the benefits carrier, which makes the determination based on the medical evidence (evidence of insurability) a requirement.

Converting to an Individual Plan

If your employment ends or you reach age 65, you can apply to convert to an individual life insurance plan.

Employee Basic Life Insurance

Employee Basic Life Insurance is mandatory. Coverage begins as soon as you become eligible for benefits. Coverage is effective 24 hours a day, 7 days a week.

The life insurance plan pays a benefit to your designated beneficiary or to your estate in the event of your death, whether you die from accidental or natural causes.

This policy is a term life insurance policy and has no cash value.

Initial Enrolment

During initial enrolment, you can select up to $50,000 of Employee Optional and/or Spouse Optional Life Insurance coverage without providing evidence of insurability. Thereafter, if you wish to increase your or your spouse’s life insurance coverage, you'll be required to provide an Evidence of Insurability form (PDF, 780KB) to the carrier. Applications must be approved before coverage can begin.

Plan Options

You can’t waive Employee Basic Life Insurance.

Core

This is the minimum level of coverage available. It provides $25,000 of life insurance coverage.

Comprehensive

This is the fully funded level of coverage. It provides $80,000 of life insurance coverage.

Enhanced

This is the highest level of coverage under the Basic Life Insurance plan. It provides coverage of three times annual earnings, rounded up to the next higher $1,000. The minimum is $80,000. The amount of your Employee Basic Life Insurance will be adjusted automatically if there’s  a change in your basic annual salary rate. Your premium will also change to reflect the revised amount of insurance.

If you wish to purchase Employee Optional Life Insurance, you must select this option.

Other Benefits Included in the Employee Basic Life Insurance Plan

Accidental dismemberment & loss of sight

If you suffer one of the following losses as a result of an accident, you’ll receive 100% of the principal sum (which is the amount of insurance in the option you elect: $25,000, $80,000 or three times your annual earnings) for:

  • Loss of both hands or feet
  • Loss of sight of both eyes
  • Loss of one hand and one foot
  • Loss of one hand or one foot and sight of one eye

If you suffer one of the following losses, you’ll receive 50% of the principal sum for:

  • Loss of one hand or one foot
  • Loss of sight of one eye

If benefits are paid to you because of an accidental dismemberment or loss of sight benefit claim, and you die as a result of that injury, the payment to your beneficiary will be reduced by the benefit payment you received before your death.

A claim for accidental dismemberment or loss of sight should be made in writing to MyHR. Forms and instructions will be forwarded for you and your physician to complete.

Advance payment for terminally ill employees

If you’re suffering from a terminal illness with a life expectancy of 24 months or less, you may be eligible to receive an advance payment of up to $50,000 or 50% of your Employee Basic Life Insurance, whichever is less. This payment is non-taxable. Contact MyHR to make a claim.

The remaining portion of your Employee Basic Life Insurance will be paid to your designated beneficiary upon your death. Interest payments will be charged against the advance payment.

Funeral advance

An advance of $10,000 may be expedited to the named beneficiary in the event of your death. This doesn’t apply if the estate or a minor beneficiary has been named. The balance of the Employee Basic Life Insurance benefit is payable by following claim procedures.

To apply for the funeral advance, your beneficiary should contact MyHR and provide the following information:

  • Name of deceased person
  • Date of birth of deceased person
  • Date of death of deceased person
  • Full name, address and phone number of beneficiary

After confirming that the funeral advance is payable, the Benefits Service Centre will contact Great-West Life and a cheque will be mailed directly to the beneficiary, usually within a few days of the request.

Limitations

There are no limitations or restrictions on claims for eligible employees under age 65 or eligible retired employees under age 65.

Coverage while on long-term disability

If you become disabled while insured and are approved for Long-term Disability (LTD), your Employee Basic Life Insurance will remain in force and the premiums will be paid by the employer. Coverage will continue until age 65 or until recovery from the disability, whichever occurs first.

Coverage for retirees under age 65

You may be able to elect to continue your group life insurance as a retiree on your pension application form. See your pension application package for further details.

Optional life insurance plans

Additional life insurance is available to you if you want to supplement your Employee Basic Life Insurance and/or if you wish to insure any of your dependants.

Employee optional life insurance

This optional plan provides employee life insurance in addition to basic life insurance.

You must have selected Enhanced of Employee Basic Life Insurance to select this optional coverage.

You may select insurance in units of $25,000 up to a maximum of $1 million. The beneficiary of this coverage is the same as designated for basic life insurance unless otherwise specified.

Spouse optional life insurance benefit

This optional plan provides life insurance for your spouse. You may select insurance in units of $25,000 up to a maximum of $500,000. You’re the beneficiary of the life insurance.

Child optional life insurance benefit

This optional plan provides life insurance for any/all dependent children that you choose to cover. Evidence of insurability isn’t required, and you may select insurance in units of $5,000 up to a maximum of $20,000. You’re the beneficiary of the life insurance.

Initial enrolment

During initial enrolment, you can select up to $50,000 of Employee Optional and/or Spouse Optional Life Insurance coverage without providing evidence of insurability. Thereafter, if you wish to increase your or your spouse’s life insurance coverage, you’ll be required to provide evidence of insurability to the carrier. Application must be approved before coverage can begin.

Waiver of premium benefit on optional life insurance

If you become disabled while insured, the insurance carrier will review whether you’re eligible for a premium waiver on the optional life insurance for yourself and your covered dependants throughout the benefit period. Waiver of premium will continue during the period that you are continuously disabled, but will not continue beyond your 65th birthday.

Suicide limitation on optional insurance

Optional Employee and Spouse Life Insurance benefits aren’t paid if the insured person (you or your spouse) commits suicide within two years after optional life insurance takes effect or increases. The beneficiary will receive a refund of the premiums paid for that insurance.

Optional family funeral benefit plan

This optional plan provides spousal life insurance of $10,000 and child life insurance of $5,000 per dependent child. You’re the beneficiary of the life insurance. Evidence of insurability isn’t required.

Optional Accidental Death & Dismemberment Insurance (AD&D)

AD&D Insurance is available to supplement your Employee Basic Life Insurance coverage and/or cover any of your dependants. This benefit doesn’t provide coverage due to illness. Coverage is provided 24 hours a day, 7 days a week.

Evidence of insurability is not required.

Three plans are available:

Employee optional AD&D

You may select insurance in units of $25,000 up to a maximum of $500,000.

Spouse optional AD&D

You may select insurance in units of $25,000 up to a maximum of $500,000.

Child optional AD&D

You may select insurance in units of $10,000 up to a maximum of $250,000.

The following plan features apply to employee, spouse and/or child AD&D coverage.

The beneficiary of this coverage is:

  • In the event of employee’s death: the same as designated for basic life insurance unless otherwise specified
  • In the event of spouse’s or child’s death: the employee
  • In the event of eligible injury to employee: the employee
  • In the event of eligible injury to spouse or child: the employee

Important Definitions Regarding Losses

Loss by dismemberment means:

  • For hands and feet, complete severance through or above the wrist or ankle joints
  • For arms and legs, complete severance through or above the elbow or knee joints
  • For thumb and big toe, complete severance of one entire phalange
  • For fingers and other toes, complete severance of two entire phalanges

Loss of sight, speech and hearing means total and irrecoverable loss beyond correction by surgical or other means.

Loss of use means total and irrecoverable loss of the ability to perform every action the arm, leg or hand was able to perform before the accident occurred, beyond correction by surgical or other means. Benefits won’t be paid for loss of use of the same arm, leg or hand for which loss by dismemberment is paid.

Eligible injuries

AD&D insurance will pay a percentage of the insurance to you if you sustain certain injuries in an accident. Eligible injuries usually involve dismemberment (loss of a limb, toe, or finger) or permanent loss of use, such as paralysis or vision loss.

Benefits

The amount of AD&D Insurance you purchase is called the principal sum.

For example, if you purchase two units of $25,000 for yourself, your principal sum is $50,000. If you purchase three units of $25,000 for your spouse, your spouse’s principal sum is $75,000. Depending on the loss you, your spouse, or your child suffers as a result of an accident, a percentage of the applicable principal sum is paid as per the table of losses below.

Table of Losses

For Loss Of

Amount Payable

Life

The principal sum

Both hands

The principal sum

Both feet

The principal sum

Sight of both eyes

The principal sum

One hand and one foot

The principal sum

One hand and sight of one eye

The principal sum

One foot and sight of one eye

The principal sum

Speech and hearing in both ears

The principal sum

One arm

¾ of the principal sum

One leg

¾ of the principal sum

One hand

½ of the principal sum

One foot

½ of the principal sum

Sight of one eye

½ of the principal sum

Speech

½ of the principal sum

Hearing in both ears

½ of the principal sum

Thumb and index finger

¼ of the principal sum

Four fingers of one hand

¼ of the principal sum

All toes of one foot

1/8 of the principal sum

 

Table of Losses

For Loss of Use of:

Amount Payable

Both arms and legs (quadriplegia)

2 x the principal sum

Both legs (paraplegia)

2 x the principal sum

One arm and one leg on same side of body (hemiplegia)

2 x the principal sum

One arm and one leg on different sides of body

The principal sum

Both arms

The principal sum

Both hands

The principal sum

One hand and one leg

The principal sum

One arm

¾ of the principal sum

One leg

¾ of the principal sum

One hand

½ of the principal sum

Surgical Reattachment

50% of the dismemberment benefit is payable if a dismembered part is surgically reattached regardless if use is regained. The balance of the dismemberment benefit is paid if the reattachment fails and the reattached part is removed within one year after the reattachment is performed.

Other Benefits

If benefits are payable under this plan for a covered accident, there may be other benefits paid in addition to loss of life, dismemberment, or loss of use benefits. The other benefits are:

  • If death occurs 150 kilometres or more from home, up to $2,500 will be paid for preparation of the body and transportation to its burial place or crematory. This benefit is also available to your dependants under the family plan.
  • If your death is accidental, your spouse may be reimbursed for an occupational training program.Your child or children may be reimbursed for tuition if they enrol as a full-time student at a post-secondary institution.
  • Up to $2,000 for transportation and lodging expenses to have one family member join the covered person if they’re hospitalized more than 150 kilometres from their home.
  • Fees to enrol in an education program if a job change is required because of an accident.
  • Expenses to make the covered person’s house and vehicle wheelchair accessible.

For more information on the limitations and specifications related to these additional benefits, please contact MyHR. When submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

AD&D Limitations

No benefits will be paid for loss resulting from or associated with the following:

  • Suicide, regardless of state of mind.
  • Intentionally self-inflicted injury, regardless of state of mind.
  • Viral or bacterial infections, except pyogenic infections occurring through the injury for which loss is being claimed.
  • Disease or infirmity.
  • Medical or surgical treatment except for surgical reattachment.
  • Service (including part-time or temporary service) in the armed forces of any country.
  • War, insurrection or voluntary participation in a riot.
  • Air travel except as a passenger in a licensed aircraft flown by a pilot certified to fly the aircraft. No benefits will be paid where the aircraft is owned, leased or rented by the Province of B.C. or where the person who suffers the loss is acting as a crew member.

How to Make a Claim

To initiate a claim for any of the life insurance plans, contact MyHR. When submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees. A representative will send claiming information to the employee or the designated beneficiary and can answer any questions.

A Health Spending Account (HSA) allows you to set aside some of your flex credits to pay for eligible out-of-pocket expenses that aren't covered by your extended health and dental plans.

How It Works

During your initial enrolment and every year during the Open Enrolment period, you decide whether to establish a Health Spending Account (HSA) and indicate how many flex credits to allocate to it. During the plan year, when you have out-of-pocket expenses for eligible items or services, you can claim them against funds in your HSA.

The order in which you allocate your flex credits is important and depends on tax status of the benefits you choose.

First, you can use your flex credits for your non-taxable benefits – your extended health and dental plans. Next, you can allocate your remaining flex credits to a Health Spending Account (minimum $100).

The remaining flex credits are added to your salary, taxed, and then used to pay for your taxable benefits (Medical Services Plan coverage and/or Employee Basic Life Insurance) and any optional insurance products you elected.

  • Once flex credits are allocated to a Health Spending Account, you can only access those funds by claiming them for reimbursement of eligible expenses. You can’t cash in your account.
  • Funds in a Health Spending Account must be claimed within two plan years or you lose them. (See the "Use It or Lose It" example below).
  • If your employment ends, you can’t claim expenses incurred after your termination date. Any unused funds will be forfeited.
  • The claiming deadline for your Health Spending Account is February 28 following the year in which the expense was incurred.
  • You can claim funds from your Health Spending Account after submitting your claim to your extended health or dental plan and your spouse’s plan, if applicable.
  • Unless you have coordinated benefits with your spouse, you can claim funds from your Health Spending Account when you submit your initial claim for reimbursement; just fill out the applicable Health Spending Account information on the electronic or paper claim. Check GroupNet for your Health Spending Account balance.
  • To be eligible for reimbursement under a Health Spending Account, the item or service must be recognized as a medical expense under the Canada Revenue Agency income tax guideline.

Example: use it or lose it

Greg put $200 flex credits into his Health Spending Account for plan year 2019. Greg can claim funds against eligible out-of-pocket expenses incurred throughout 2019, up to and including December 31, 2020. GWL must receive claims by February 28 following the year in which the expense was incurred.

It’s recommended that you submit claims immediately after treatment. Late claims won’tbe accepted by GWL.

The list of eligible expenses and dependent family members follows the Canada Revenue Agency income tax guidelines, which are broader than under your benefits plans, enabling you to claim more items to your Health Spending Account.

Details to Consider

Review your previous claims history and try to determine if you have upcoming expenses (e.g., new glasses). Given this information, are you likely to have out-of-pocket expenses? Is it worthwhile to you considering the risk involved and the extra effort required?

If you conclude that you’d like to allocate some flex credits to a Health Spending Account, what allocation would work best for you? Remember, you can’t cash in your Health Spending Account, so choose an amount that you know you’ll be able to claim.

Your Health Spending Account Options

Waive

No flex credits will be allocated to a Health Spending Account. Any leftover flex credits will be paid out as taxable cash.

Elect a Health Spending Account

Flex credits are allocated to a Health Spending Account in your name to be used for reimbursement of eligible expenses. The minimum is $100; the maximum is the flex credits left over after paying for your extended health and dental coverage.

Any leftover flex credits will be paid out as taxable cash.

When you're ready to make an extended health, drug, dental or life insurance claim, choose the method that works best for you.

Electronic claims are usually processed within the next business day. Paper claims are processed within 5 calendar days.

GroupNet

GroupNet is Great-West Life's self-service website for your extended health and dental plans.

  • Submit eClaims
  • Update direct deposit banking information
  • View your coverage at a glance
  • Track your eligibility and limits
  • Print replacement ID cards

When you log into GroupNet, you'll see your group plan number (50088) and your travel assistance plan number (170688).

The Assure Card is your benefits ID card that has your Great West Life Plan and ID number on it. If you haven’t received your ID card in the mail, you can register with GroupNet and print out a card. Register using Plan number 50088 and your ID number. If you don’t know your ID number, or if you have problems registering with GroupNet, please call GWL. You, your spouse and any dependent children over 19 will be issued an Assure Card. Any dependent children under 19 don’t receive a card, but you’ll see them listed under your group coverage through GroupNet.

Please ensure that your address is up to date with your employer and in GroupNet for Plan Members. If you have access to Employee Self Service (ESS), you can update your address online. If you don’t have access to ESS, call MyHR (1 877 277-0772) and a Service Representative will be able to update your information in PeopleSoft.

Pay Direct

Pharmacies, dentists, chiropractors, physiotherapists, naturopathic doctors, podiatrists, psychologists, massage therapists and optical stores/optometrists/ophthalmologists can register for Pay Direct through GWL.

If your service provider has signed up, simply show your Assure Card (and the card for your spouse’s program, if you can coordinate benefits) and you’ll pay only the portion of the expense that’s not covered under your benefits plan. Electronic claims are usually processed within the next business day. Paper claims are processed within 5 calendar days.

Extended Health & Drugs

To make a claim for reimbursement, you can submit a paper or electronic claim.

Find the paper claim form on MyHR or GroupNet, and follow the submission instructions carefully. If you have a Health Spending Account, you can use the same form to submit eligible expenses. Make a photocopy of your expense receipt because the originals can’t be returned to you.

Submit eClaims on GroupNet. If you have a Health Spending Account, you can use the same process to submit eligible expenses. Keep your original expense receipts if you are asked to submit them.

Once a claim is processed, you’ll receive a direct deposit if you’ve provided your banking information to GWL through GroupNet.

All plan members are required to sign up for PharmaCare to assist with prescription drug coverage, limiting the impact on your lifetime maximum. In addition, some high-cost drugs will require you to apply for PharmaCare special authority before you can be reimbursed.

For information regarding drugs and medicines, please refer to the Extended Health Plan section.

Dental

Most dental offices will bill GWL directly when you present your Assure Card (and the card for your spouse’s program if you have coordinated benefits), and you’ll pay only the portion of the service not covered by your benefits plan. If your dentist can’t bill GWL directly (i.e., you have to pay full cost at the dental office), or if you wish to claim to your Health Spending Account, you can submit a paper claim.

Find the paper claim form on MyHR or GroupNet, and follow the submission instructions carefully. Make a photocopy of the expense receipt because the originals can’t be returned to you.

Monthly orthodontic claims may be claimed through GroupNet.

Deadlines

It’s recommended that you submit claims immediately after treatment. Late claims won’t be accepted by GWL. Extended health claims, including drug claims and dental claims, must be received no later than 15 months from the date the expense was incurred.

For all claims questions, contact Great-West Life at 1 855 644-0538.

Coordinated Benefits

If your spouse is also enrolled in a benefits program, you may be able to submit your extended health and dental receipts to both plans and get up to 100% of your eligible expenses reimbursed. If your spouse has Comprehensive coverage through the Flexible Benefits Program or another benefits plan, consider choosing the Coordination option to receive optimal coverage.

Insurance companies follow the guidelines below to determine which plan pays first and how benefits are calculated.

When you make a claim under coordinated plans, photocopy your receipt(s) and submit your claim to your plan first.

Once approved, you'll receive an explanation of benefits statement. Now you can submit a claim to your spouse’s plan, along with the explanation of benefits statement and photocopies of your receipt(s).

Spouses will submit to their plan first and to your plan second.

If you have dependent children, the order of submission is determined by your birthdays. If your birthday is earlier in the calendar year than that of your spouse, you’ll submit your children’s claims to your plan first.

If you and your spouse have coordinated benefits and you’re both covered under GWL, you can submit to both plans at the same time by filing an eClaim through GroupNet.

If not, you can submit an Extended Health Claim Form (PDF, 562KB) or an Extended Dental Plan Claim Form (PDF, 613KB).

If you have a Health Spending Account, use an Extended Health Claim Form (PDF, 562KB) or an Extended Dental Plan Claim Form (PDF, 613KB) to submit eligible expenses. The Health Spending Account is the last plan to claim from. Please note the deadline when submitting claims.

When coordinating benefits, please ensure the same names are being used on both plans (e.g., legal names) so there are no delays with the coordination of benefits with the carrier. If the names don’t  match, there may be a delay in payment or payment may be missed.

A retiree plan will always pay after any group plan that covers you as an employee.

Life Insurance

To initiate a claim for any of the life insurance plans, you, your supervisor, or your designated beneficiary can contact MyHR. If submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees. A representative will send claiming information and will be available to answer questions.

A key advantage of the Flexible Benefits Program is that it provides benefits in a tax effective manner. Flex credits are allocated to you by the employer to pay for your benefits coverage. How you allocate your flex credits determines whether they’re used tax free or are taxed as income by Canada Revenue Agency. Some benefits are non-taxable benefits, meaning you don’t have to pay tax on the cash value of that benefit.

Your Flexible Benefits Program comprises the following benefits plans, listed according to their tax treatment.

Non-Taxable Benefits

  • Extended Health Plan
  • Dental Plan
  • Health Spending Account

Taxable Benefits

  • Medical Services Plan
  • Employee Basic Life Insurance
  • Optional Accidental Death & Dismemberment Insurance

To maximize tax effectiveness, only non-taxable benefits are paid for using flex credits (i.e., flex credits are applied to the cost of the option you choose). Taxable benefits are paid through payroll deduction.

How is this more tax effective?

If flex credits were used for your Medical Services Plan or life insurance, those flex credits would create a taxable benefit. You would generate additional taxes, but you don’t create a taxable benefit by using after-tax income to pay for the taxable benefits.

What if I have flex credits left over?

You have choices:

  • You can allocate them to an HSA, where you can use them, tax free, to pay for eligible medical expenses not otherwise covered by the group plan;
  • You can choose to take any unused flex credits as taxable cash, which will be distributed in equal monthly installments. These flex credits are treated as regular income for the purposes of income tax and statutory declarations.

The BC Public Service recognizes that each of us, throughout our career in the BC Public Service, may experience various work events (e.g. becoming a new employee, travelling out of the country, leaving the public service, etc.) that impact our benefits coverage. The following is a list of common work status changes and the effects on benefits coverage. If you have any questions, contact MyHR. If submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

What Happens If?
Question Answer

I transfer from a regular to an auxiliary position?

Your benefits coverage ends at the end of the month of your date of transfer and you must re-qualify for benefits. Any balances remaining in your Health Spending Account or taxable cash are forfeited.

I'm on a temporary assignment to an excluded position from my base position, which is a Bargaining Unit position?

You’re eligible for flexible benefits effective the first of the month following the start of your temporary assignment to the excluded position. Your temporary assignment must be 21 days or longer to be eligible. When you return to your Bargaining Unit position, you return to the Bargaining Unit benefits plan. Your Health Spending Account or taxable cash terminates at the end of the month. Any balances remaining are forfeited.

If you’re enrolled in any of the Optional Life Insurance plans, your coverage transfers between the two benefit plans. A change in employment isn’t considered an eligible life event, therefore no changes can be made to your life insurance coverage as a result of a job change.

Your extended health and dental claims history (e.g., payment towards your deductible, eligibility periods for things like vision care) will remain with you throughout your employment. You should always confirm your eligibility for reimbursement prior to purchasing.

I transfer to a Bargaining Unit position?

When you transfer to your Bargaining Unit position, you’re are covered under the Bargaining Unit benefits plan. Your flexible benefits coverage terminates at the end of the month of your transfer. Your Health Spending Account or taxable cash terminates at the end of the month. Any balances remaining are forfeited.

Your extended health and dental claims history (e.g., payment towards your deductible, eligibility periods for things like vision care) will remain with you throughout your employment. You should always confirm your eligibility for reimbursement of a product or service prior to purchasing it.

If you're enrolled in any of the Optional Life Insurance plans, your coverage transfers between the two benefit plans. A change in employment isn't considered an eligible life event, therefore no changes can be made to your life insurance coverage as a result of a job change.

I transfer from a Bargaining Unit position to an excluded position and don't enrol in the Flexible Benefits Program?

When you transfer into an excluded position, you have 31 days to enrol in the Flexible Benefits Program. We recommend that you complete your enrolment forms. It’s your opportunity to choose the best options available to you and any eligible dependants.

If you don’t enrol, you’ll be enrolled (by default) in the benefit plans that most closely match your coverage under the Bargaining Unit plan. Any dependants covered under the Bargaining Unit plans will also be covered under the Flexible Benefits Program. Any unused flex credits will be paid out in monthly instalments as taxable cash. You’ll have to wait until the next Open Enrolment period (or until you experience an eligible life event) to make any changes.

Your extended health and dental claims history (e.g., payment towards your deductible, eligibility periods for things like vision care) will remain with you throughout your employment. You should always confirm your eligibility for reimbursement prior to purchasing.

I'm away during the Open Enrolment period?

If you'll be on a short-term leave with pay or on vacation during the Open Enrolment period and wish to make changes to your options, contact MyHR before you leave. If you are submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees. You can access Employee Self Service from home, or you can request enrolment forms to be sent to you. Simply complete the forms and mail them to MyHR prior to the deadline. 

I'm on Short Term Illness and Injury Plan (STIIP)?

You're eligible to continue in the flexible benefits options you have at the time you commence STIIP. You can participate in Open Enrolment and make changes if you have an eligible life event. Please contact MyHR. ​If you're submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

I'm approved for Long Term Disability (LTD)?

Benefits in place prior to being approved for LTD will remain in place during the LTD period. During Open Enrolment, no action is required. Your existing benefits coverage will carry forward to the next plan year and $200 flex credits will be allocated to your Health Spending Account. You'll be advised of any changes to the benefits plans.

I commence a rehabilitation trial?

If you return to work on a rehabilitation trial after being on LTD, your LTD claim continues to be active, and there are no changes to your benefits coverage.

I return to work from Long Term Disability?

If you return to work during the same plan year (calendar year), you’re reinstated in the options you selected within the Flexible Benefits Program and are eligible to make changes at the next Open Enrolment or eligible life event windows. If you return to work in a different plan year (calendar year), you’ll have the opportunity to make new selections in the Flexible Benefits Program at that time.

I'm on a leave with pay?

During these leaves, you may participate in Open Enrolment and make changes after eligible life events. Contact AskMyHR by submitting a service request using the category Myself (or) My Team or Organization > Benefits > Excluded Employees.

I'm on a leave without pay? You can’t make changes to your options while you’re on a leave without pay. You may continue in the benefits plan options that you have at the time you commence your leave by paying the benefit premiums, otherwise coverage will terminate until you return to work. If you return to work during the same plan year (calendar year), you’ll be reinstated in the options you selected within the Flexible Benefits Program and would be eligible to make changes at the next Open Enrolment or eligible life event windows. If you return to work in a different plan year (calendar year), you’ll be able to make your new selections in the Flexible Benefits Program at that time. If you choose not to continue your Employee or Spouse Optional Life Insurance during your leave, and your leave extends beyond 90 days, you’ll be required to provide evidence of insurability if you wish to reinstate these benefits.

I'm on a Maternity/Parental/ Pre-Placement Adoption Leave?

You may participate in Open Enrolment during your leave. You’ll receive information by mail prior to Open Enrolment.

The birth of a child is an eligible life event. As such, you have 60 days from the birth of your child to update your benefits coverage (except for changes related to the optional Health Spending Account, which can only be made during Open Enrolment). After 60 days, you can still add your child to your coverage, but you can’t change your options.

If you choose, you may waive Medical Services Plan and/or extended health and dental plan coverage during your leave. Employees often consider this if they have coverage under their spouse’s plan or if they want to minimize repayment of benefits if they're unsure about returning to work after their leave.

Maintenance of Employee Basic Life Insurance and Long Term Disability coverage is mandatory during your leave. If you don’t satisfy the return to work requirements after your leave, you’ll be required to pay for these and any other benefit premiums paid on your behalf during your leave. For more information, visit MyHR.

I travel out of province?

See "Out-of-Province Travel Within Extended Health Benefits" above.

My employment terminates and I’m rehired within 90 days to an excluded position that's eligible for flexible benefits?

When your flexible benefits are reinstated, you'll receive the same coverage you had prior to termination. You can't make changes until the next Open Enrolment period or eligible life event windows.

I'm actively working and I reach the age of 65?

Coverage for Medical Services Plan, extended health and dental doesn’t change when you turn 65. However, you’re no longer eligible for Employee Basic Life Insurance or for any of the optional life insurance or optional Accidental Death & Dismemberment Insurance plans.

To learn more about converting to individual benefits plans, see “Converting to Individual Benefits” within “When Does Coverage End?” below. Note that Long Term Disability also ends at age 65.

I retire from the BC Public Service?

Your coverage ends at the end of the month in which you're on pay prior to retirement.

Retirement benefits are administered through the BC Public Service Pension Plan. The benefits coverage available under the Public Service Pension Plan is different from this program. Review retirement benefits criteria at the BC Pension Corporation website. MSP isn't a benefit available to retirees under the Public Service Pension Plan. Health Insurance BC will direct bill you once your coverage ends under the group plan.

I resign from the BC Public Service?

Your extended health and dental coverage terminates on your last day of work. All other flexible benefits terminate on the last day of the month of your date of termination. Any balances remaining in your Health Spending Account or taxable cash are forfeited.

I die?

Employee Coverage
Flexible benefits coverage will terminate at the end of the month in which the death occurs.

Medical Services Plan Coverage for Dependants
Dependant coverage will terminate at the end of the month in which the death occurs. Cancellation of the dependant coverage will generate an individual account for any covered dependants. Dependants are advised to contact the Medical Services Plan at 1 800 663-7100 to confirm coverage and contact information so there's no lapse in coverage.

Extended Health, Dental Plan & Health Spending Account Coverage for Dependants
Extended health, dental plan and HSA terminates at the end of the month following the month in which the employee dies (e.g., extended health, dental plan and HSA terminates on April 30 when the employee’s death occurs in March). Dependants can purchase individual extended health and dental plan coverage when the group coverage ends through Great-West Life. Of course, family members are free to purchase coverage from any health insurance carrier they choose.

Optional Life & Optional AD&D Coverage for Dependants
Coverage ends at the end of the month in which the death occurs. Covered dependants can apply for individual coverage. See “Converting to Individual Benefits” within “When Does Coverage End?” below for further information. 

Medical Services Plan of B.C.

Coverage ends on the last day of the month in which any of the following occurs:

  • Your employment ends
  • You request that coverage end
  • You take a leave of absence without pay for more than a calendar month (if you don’t pay the required premiums)
  • The last day of the month in which you change from regular to auxiliary status

Extended Health & Dental Plans

Coverage ends on one of the following:

  • Your last day of employment
  • The day you request that coverage end
  • The last day of the month of a leave of absence without pay for more than a calendar month (if you don’t pay the required premiums)
  • The last day of the month in which you change from regular to auxiliary status or from an excluded to a Bargaining Unit position
  • The last day of the month in which you’re on pay prior to retirement

Employee Life & AD&D Insurance

Coverage ends on the date the policy terminates or the last day of the month in which any of the following occurs:

  • Your employment ends
  • You turn 65
  • You change from regular to auxiliary status or from an excluded to a Bargaining Unit position
  • You retire under the provisions of the Pension Public Service Act, unless you elect to continue coverage to age 65
  • After the month in which a premium isn’t received by you or by your employer on your behalf
  • You cease to satisfy the actively-at-work requirement

Coverage for Eligible Dependants

Benefits coverage ends on one of the following:

  • The same date that your insurance terminates
  • The date you request coverage end
  • The date they cease to qualify as an eligible dependant
  • In the event of the employee’s death, extended health, dental and the Health Spending Account (if applicable) for dependants is maintained until the end of the month following the month of the employee’s death; however, Medical Services Plan coverage for dependants terminates at the end of the month of the employee’s death

Converting to Individual Benefits Plans

The conversion policy enables you to convert to individual extended health, dental and life insurance plans when your group coverage ends.

Converting to an individual plan may benefit you if you don’t qualify for other insurance due to an existing medical condition.

You can apply to convert to some or all of these plans.

You must apply and pay your first premium within 60 days of the end of the month in which your group coverage ends. This conversion can’t be made retroactive. If you miss this deadline, you’re no longer eligible for conversion.

Converting Your Individual Life Insurance Plans

If your employment ends or you reach age 65 and are no longer eligible for group life coverage, you may convert your coverage to an individual policy, limited in both amount and plan, without a medical examination. Or, you may take a medical examination (paid for by the carrier) and choose any insurance plan offered by the company. If you don’t meet the medical requirements, you can still convert your coverage to an individual policy, limited in both amount and plan.

The amount of the individual policy where no medical examination is taken may be any amount up to the amount of coverage combined (maximum $200,000) in force at the time your group coverage ends.

The premium for the individual policy will depend on your age and on the type of policy you select. It’s not the same rate as paid while covered under the group plan. To start the conversion process for life insurance, contact MyHR. If you're submitting an AskMyHR service request, select the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

Converting Your Spouse’s Optional Life Insurance

Provided your spouse is under age 65, you may also convert their optional life insurance to an individual plan at the same time as you are converting your own coverage. The same application deadline applies.

If your spouse is older than you when you turn 65, your spouse is ineligible for conversion to an individual plan.

To start the conversion process for life insurance, submit an AskMyHR service request using the category, Myself (or) My Team or Organization > Benefits > Excluded Employees.

Individual Extended Health & Dental Plans

When your group coverage ends, an individual health and dental plan is available through Great-West Life. Visit their Health & Dental Insurance page for more information. If you would like to purchase an individual extended health and dental plan, contact Great-West Life

Individual plans will be different than the group plan.

Excluded Benefits Guide Glossary
Term Definition

Actively-at-Work Requirement

To satisfy this requirement, an employee must:

  • Be fully capable of performing their regular duties; and
  • Be either:
    • Working at the employer’s place of business or a place where the employer’s business requires them to work
    • Absent due to vacation, weekends, statutory holidays or shift variances

Annual Earnings

For the purposes of Employee Basic Life Insurance, annual earnings are defined as 12 times your current monthly base rate of pay for your current classification, calculated as bi-weekly salary times 26.0893. Annual earnings are the employee’s basic annualized salary paid by the employer, including salary protection, classification adjustments and some temporary market adjustments. Overtime, allowances, bonuses, or any other additions to pay aren’t included.

Annual Price

The final price after flex credits have been deducted from costs.

Auxiliary Employee

An employee who's employed for work that isn't of a continuous nature. Refer to your Terms and Conditions of Employment for Excluded Employees for information on eligibility requirements for benefits.

Bargaining Unit Employee

The Bargaining Unit consists of those public service employees who are members of one of the following Bargaining Units: the British Columbia Government and Service Employees’ Union (BCGEU), the Communications, Energy and Paperworkers Union of Canada, (CEP), the Professional Employees Association (PEA), the British Columbia Nurses Union (BCNU).

Beneficiary

The person(s)/registered charity named to receive the insurance benefit if the employee dies while insured. If the employee dies without designating a beneficiary, payment will be made to the employee’s estate.

The employee is the beneficiary for Spouse and Child Optional Life Insurance. 

Carrier

The service provider that adjudicates the claims on behalf of the employer:

  • Great-West Life is the carrier for extended health and dental
  • Great-West Life is the carrier for life insurance products

Claim

A request to the insurance provider for payment under the benefits plan.

Common-law Spouse

A common-law spouse is a person of the same or opposite sex where the employee has signed a declaration or affidavit that they have been living in a common-law relationship or have been co-habiting for at least 12 months. The period of co-habitation may be less than 12 months where the employee has claimed the common-law spouse’s child/children for taxation purposes.

By enrolling your common law spouse in your benefits program, you're declaring that person as your common law spouse. A separate form (declaration) is not required. 

Complete Oral Exam

Clinical examination and diagnosis of hard and soft tissues, including carious lesions, missing teeth, determination of sulcular depth and location of periodontal pockets, gingival contours, mobility of teeth, recession, interproximal tooth contact relationships, occlusion of teeth, TMJ, pulp vitality tests, where necessary and any other pertinent factors.

Conversion Policy

A policy that enables members to convert to individual benefits plans (extended health and dental, life insurance) when coverage ends.

Coordination of Benefits

A provision in a group insurance policy describing which insurer pays a claim first when two policies cover the same claim. This provision applies only to extended health and dental plans. Under this provision, the total benefit amount that an individual can claim is 100% of the cost of the eligible expense incurred (i.e., the combined reimbursements across all plans can’t exceed the total cost of the expense).

Deductible

The amount you must pay each year before the plan starts to reimburse eligible medical expenses.

Qualifying Disability (optional life insurance only)

An employee is considered disabled if disease or injury prevents them from being gainfully employed. Gainful employment means work:

  • That a person is medically able to perform;
  • For which they have at least the minimum qualifications;
  • That provides income of at least 60% of their indexed annual earnings*; and
  • That exists either in the province or territory where they worked when they became disabled or where they currently live. The availability of work will not be considered in assessing disability.

*Indexed annual earnings are pre-disability earnings that have been adjusted to reflect changes in the Consumer Price Index. 

Dispensing Fee

The fee charged by pharmacies to dispense a medication.

Eligible Employee

Employees who may participate in the Flexible Benefits Program. This includes regular excluded employees, whether full or part-time (unless expressly excluded) and auxiliary excluded employees upon meeting eligibility criteria (e.g., completion of 1,827 hours of work in 33 pay periods). See the Terms & Conditions of Employment for detailed information on eligibility criteria.

Eligible Expenses

Charges for services and/or supplies that have been specifically included in the extended health and dental contract as a benefit. An expense is incurred on the date the service is provided or the supply is received.

Any payment to a pharmacy or practitioner which represents an amount more than the recognized fee schedules isn't included in the definition of an eligible expense. 

Eligible Life Event

A specific event or change that allows you to make changes to your benefits options within 60 days of the event. Eligible life events include events such as a birth or death of a dependant, a change in marital status, or the loss of a spouse’s benefits coverage.

Employer

BC Public Service or an employer participating in the public service benefits program.

Estate

The whole of one’s possessions (assets and liabilities) left by an individual upon their death.

Evidence of Insurability

The documentation of the good health of the employee and/or their dependants in order to be approved for some types of coverage. This is also called evidence of good health.

Explanation of Benefits Statement

The statement you receive from health/dental insurance carrier that itemizes how you're being reimbursed for the expenses that you submitted.

Fee Schedule

The dental fee schedule published by the BC Dental Association for dentists (general practitioners), dental specialists, and denturists that contains eligible dental services, financial limits, treatment frequencies, and fees in effect on the date the dental service was performed.

This plan will cover costs based on the fee guide. It's not mandatory for dental offices to follow the fees suggested in the fee guide. 

Flex Credits

Funding dollars provided by the employer. They're used to buy benefits coverage. Flex credits are before tax dollars.

Full-Time Attendance

A child is considered a full-time student when they meet the attendance requirements specified by the educational institution. If not specified, full-time attendance means that the child is enrolled for at least 15 hours of instruction per week, per term, and is physically present on campus OR virtually present on campus by way of regularly scheduled, interactive, course-related activities conducted online. Students must be able to demonstrate, if requested, that they meet full-time attendance requirements. 

Fully Funded Option

Employer provided flex credits cover the full cost of benefits coverage for this option.

Health Spending Account (HSA)

An individual employee account that provides reimbursement of eligible healthcare expenses not otherwise covered under your group benefits plan. Plan members may allocate some of their flex credits (before tax dollars) to an HSA, and claim them later, tax free, against eligible out-of-pocket expenses.

Individual Benefit Plans

Benefits plans that an individual purchases for themselves.

Lowest Cost Alternative Program

Under PharmaCare, drugs deemed the lowest cost alternative are usually (but not always) generic drugs. Generic drugs contain the same active ingredients and are manufactured to the same standards set by Health Canada, and to the same strict regulations established by the Food and Drugs Act. Only minor ingredients like dyes, coatings or binding agents may vary. The real difference is in price; generic drugs cost 30-50% less, on average.

Minor

A person who's under 19 years of age.

Net Price

The final price after flex credits have been deducted from costs.

Non-Taxable Benefits

Non-cash benefits, like extended health and dental, provided to employees by their employer. Employees aren't required to pay the tax on the cash value of the benefit.

Open Enrolment

Annual enrolment period where you can update your benefit choices, with changes taking effect on January 1 of the next calendar year.

Paramedical Services

A defined group of services and professions that supplement and support medical work but don’t require a fully qualified physician. These services include: acupuncture, naturopathic physician, chiropractor, physiotherapy, massage therapy, and podiatry.

PharmaCare

PharmaCare helps British Columbians with the cost of eligible prescription drugs and designated medical supplies. It’s one of the most comprehensive drug programs in Canada, providing reasonable access to drug therapy through seven drug plans.

Assistance through PharmaCare is based on income. The lower your income, the more help you receive. There’s no cost to register and there are no premiums. More information is available on the B.C. Government website.

Pre-Authorization

Confirmation with GWL regarding eligible medical/dental expenses and reimbursement percentage.

Premium

The amount paid by the employee or the employer to maintain insurance coverage.

Principal Sum

An amount equal to the employee’s life insurance.

Reasonable & Customary (R&C) Limits

Represents the standard fees health care practitioners would charge for a given service. R&C limits are reviewed regularly and are subject to change at any time. If your health care practitioner charges more than the R&C limit for that item or service, you'll be responsible for paying the difference.

If you have any questions about R&C limits for a given service, contact Great-West Life at 1 855 644-0538. 

Reference-based Pricing

A process where drugs that are deemed therapeutically equivalent are grouped together, and then the cost of the lowest-priced drug in the group (typically a generic drug) is used as the reimbursement level for all drugs in the group.

Regular Employee

An employee who's employed for work that is of a continuous full-time or continuous part-time nature.

Rehabilitation Trial

A trial period of employment for assessment and/or rehabilitation purposes.

Reimbursement

The amount you're paid back for an expense that you incur. Reimbursements can be partial or total.

Specific Oral Exam

The examination and evaluation of a specific condition in a localized area.

Statutory Benefits

Benefits that are fixed, authorized, or established by statute; the employer is required by the law (Employment Standards Legislation) of the province to provide these benefits to employees.

Taxable Benefits

Non-cash benefits, like Employee Basic Life Insurance (employer’s portion) and Medical Services Plan coverage provided to employees by their employer. Employees are required to pay the tax on the cash value of the benefit.

Term Life Insurance

Life insurance protection provided during your term of employment. Term life insurance has no cash value.

Weekly Indemnity

A benefit payable to eligible auxiliary employees who are ill and who don’t qualify for coverage under the Short Term Illness and Injury Plan. See your Terms & Conditions of Employment on MyHR for further information.

 

Contacts

For questions about extended health and dental claims, contact Great-West Life.

GWL Mailing Address
PO Box 3050, Station Main
Winnipeg MB  R3C 0E6

GWL Phone: Toll-free 1 855 644-0538

Visit Great-West Life's website.

To check your benefits or to submit a claim, visit GroupNet.

Optional emergency travel medical benefits

Visit Great-West Life's website.

Phone: Toll-free 1 800 565-4066

How to submit forms without access to Employee Self Service

Submit forms to the Benefits Service Centre (BSC) as directed.

BSC Mailing Address
Benefits Service Centre
Block E-2261 Keating Cross Road
Saanichton BC  V8M 2A5

BSC Fax
604 320-4031

Other Questions

Contact MyHR.

This guide describes the Flexible Benefits Program for eligible excluded employees in the BC Public Service. While all efforts have been made to make the guide comprehensive, it doesn’t  contain all the details in the official documents that legally govern the operation of each of the benefit plans within the Benefits Program. These plans are subject to change from time to time. In the event of any discrepancy or misunderstanding, benefits will be paid according to the applicable contracts, policies, plan documents, and legislation.