The date is fast approaching for the launch of a new health benefits plan that will be more convenient to use and expand benefit coverage in key areas for clients of the First Nations Health Authority (FNHA).On Sept. 16, the FNHA will transition dental, vision, and medical supplies and equipment (MS&E) and select drug benefits off the federal Non-Insured Health Benefits (NIHB) program. The FNHA's new partner, BC-based benefits provider Pacific Blue Cross, will administer these benefits as of this date.
FNHA clients and their health care providers will find the new system easy to use, with streamlined requirements for pre-approvals and quick turnarounds for adjudications and payments.
There will be no reduction to existing coverage, and coverage will be expanded for many preventive health services and special needs. Here are some highlights of the new plan:
Your Pacific Blue Cross (PBC) Membership
• Your status number will be your PBC benefits membership number
• You can print your own PBC Member ID card or continue to use your status card
• There is a large network of health care providers registered with PBC. Many of these providers can offer direct billing. That means fewer out-of-pocket payments for eligible benefits
• Your pre-approvals follow you if you change health care providers
Your Member Profile
As of Sept. 16, FNHA clients may go online at www.pac.bluecross.ca or download the PBC mobile app. Using your status number, you can create a Member Profile for convenient self-service. For example, you may:
• Look up detailed coverage information
• Get reimbursed via direct deposit in as little as 48 hours
• Check your balance for your benefit
• Search for vision care providers who are registered with PBC
Remember, you will only be able to check your Member Profile from Sept. 16 onward. There will be a prize draw for clients who create a Member Profile. More details to come in the Sept. 6 e-blast!You may also continue to contact Health Benefits for information at 1.855.550.5454 or email healthbenefits@fnha.ca
Dental Plan – Highlights of Eligible Benefits
• More coverage for preventive services
• Crowns, bridges, veneers, inlays, and onlays
• 2 exams and 2 cleanings per year
• Full and partial dentures
Vision Care Plan Highlights
• No pre-approvals needed for eye exams and standard eyewear
For clients 18 and younger:
• $100 every year for eye exams
• $275 every year for standard eyewear
For clients 19 and older:
• $100 every two years for eye exams
• $275 every two years for standard eyewear
There is a process to provide additional benefit coverage for clients with complex needs.
Medical Supplies & Equipment Plan Highlights
• Streamlined process for prior authorizations
• Faster claims processing for providers means supplies or equipment for clients are available faster
• Faster processing of client reimbursements
Drug Plan Note
Most drug benefits will continue to be covered through PharmaCare Plan W, however PBC will administer some drug benefits. These will mainly be for people who aren't yet enrolled in Plan W. If this is you, please contact Health Benefits at 1.855.550.5454 to enroll in Plan W.
Where to Find More Information
Until Sept. 16, you can find information about the plan on the Pacific Blue Cross Transition page of the FNHA website. On Sept. 16, the main Health Benefits section of the website will be updated. Information will also be available as of Sept. 16 at the PBC website: www.pac.bluecross.ca
The FNHA is also publishing an updated version of its Health Benefits Information Package as well as individual fact sheets about each benefit area. These documents will be available online and in print.
