Manual Claims Submissions

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Patients may submit manual claims requesting reimbursement for eligible benefits they paid for. PharmaCare will issue a cheque for verified claim amounts. Actual reimbursement amounts may be affected by a patient’s deductible and required co-pay amounts. This means that for a patient covered under Fair PharmaCare who has not met their deductible, an eligible portion of the claim amount will count towards the deductible. If a patient has not met their family maximum, the 30 percent of the claim that is the patient’s responsibility will also be subtracted from the claim amount.

Deductibles and family maximums do not apply to PharmaCare plans other than Fair PharmaCare.

Health Insurance BC (HIBC) now accepts PharmaCare Claim forms by fax. Faxes may be submitted by a patient with a secure fax line, or by the provider.

 

  1. To submit a claim, patients must fill out a PharmaCare Claim form, which can be requested by calling Health Insurance BC (HIBC), or obtained from a provider.
  2. The PharmaCare claim form must be completed and submitted before March 31 of the year immediately following benefit purchases. A single claim form can include multiple eligible purchases (up to 100) made in the same calendar year.
  3. Completed claim forms can be mailed to the address provided on the form or faxed via a secure line to HIBC.* Ensure all applicable receipts are included in the mail or clearly visible on the fax.

Send completed and signed forms with supporting documentation to HIBC:

Mail: PharmaCare
         PO Box 9655 Stn Prov Govt
         Victoria BC  V8W 9P2

Fax: 250 405-3587

*Note: When faxing a claim, use a secure and private fax number or request assistance from a provider. Faxing claims may reduce processing delays as compared to mailed claims, if HIBC requires more information. For follow-up communication from HIBC, note "PRIVATE FAX" on the submission. HIBC may then fax back requests for more information or the final PharmaCare statement.

HIBC cannot reply by fax to a public of shared fax number.

 

  1. For all Prosthetic and Orthotic manual claims, benefits invoices can be obtained through the device provider.
  2. Manual claims must include the invoice and a copy of the appropriate page of the PharmaCare-approved application form. Claims of $400 or less do not require pre-approval.
  3. Completed invoices can be submitted to HIBC by the patient or the health care provider on the patient's behalf. Ensure the invoices are completed and signed and the claim includes all supporting documentation. Claims may be mailed to the HIBC address provided on the form or faxed to HIBC on a secure line (fax number also provided on the form).

 

  • patient's name, address, and Personal Health Number (from BC Services card)
  • Provider's name and Site ID
  • PharmaCare plan type (Plan C, D, F, or G)
  • date the medication, device or service was provided
  • DIN/PIN, ingredient cost, quantity and day's supply of drug or product
  • total dispensing fee and claim amount
  • rationale behind the request
  • signature of the patient or patient's agent
  • For Prosthetic & Orthotic claims, the appropriate page of the pre-approval form (Application for Financial Assistance form) is also required, except for claims not requiring pre-approval

All the above information is often available on the provider invoice, except for the rationale and pre-approval form.

Yes. The PharmaCare claim form and all submitted receipts will be returned to the patient, including a PharmaCare Remittance Statement which details the portions of each receipt covered by PharmaCare, and the amount that PharmaCare will reimburse for each claim. The remittance will also provide the total cheque amount, if applicable.

Yes. If a patient's Fair PharmaCare annual deductible has not yet been met, some (or all) of the claim amount for an eligible benefit will go towards that deductible or family maximum.