Medical Supplies & Equipment

​​​​​​Health Benefits provides coverage for certain Medical Supplies and Equipment (MS&E) for clients who receive care at home. When it is needed, using medical equipment is important for one's safety and can provide clients with greater mobility and independence.​

The MS&E benefit is administered through a partnership between Health Benefits and PBC. Clients can access detailed information about their MS&E benefits through the online PBC Member Profile.

MS&E Benefit Coverage

Health Benefits covers specific MS&E items and services under the following categories:

 Bathing and Toileting Aids;

 Braces and Splints;

 Cushions and Protectors;

 Diabetic and Heart Patient Devices;

 Foot Orthotics and Orthopedic Shoes;

 General Medical Supplies and Equipment

 Hearing Aids and Repairs;

 Hospital Beds

 Lifting and Transfer Aids;

 Limb and Body Orthotics;

 Low Vision Aids;

 Offloading Boots (Air Casts);

 Ostomy Supplies;

 Oxygen, Sleep, and Breathing Aids;

 Prosthetics and Supplies

 Surgical Stockings and Pressure Garments;

 Urinary Supplies and Devices;

 Walking Aids and Wheelchairs; and

​ Wound Care Supplies.

Clients must have a prescription or written recommendation for an eligible MS&E item to receive coverage. Most MS&E items are fully covered under the MS&E benefit. If clients are asked to pay for their item at the counter, Clients can call Health Benefits at 1-855-550-5454 to confirm if the item is covered.

Items not listed as a benefit may be covered on an exceptional basis. Clients should call Health Benefits at 1-855-550-5454 to learn more about exceptional coverage.

​​Some MS&E providers in BC are registered with PBC and can directly bill for items and services. Clients who see a provider not registered with PBC will need to pay out-of-pocket and submit a reimbursement request to PBC after their appointment. Note that reimbursement requests may be denied and are still subject to coverage criteria and maximums.
 
Clients are strongly encouraged to discuss billing with their provider before booking an appointment or purchasing items. Questions clients should ask their provider:

 Is the provider registered with PBC for billing?
​ Is the item or service fully covered by my plan?​
​​​
Approvals Before Service

Some items and services covered under the MS&E benefit require approval before MS&E providers can bill for them. Providers can submit approval requests directly to PBC. Once they receive authorization they can provide the item or service and may be able to bill PBC directly.

If PBC denies an approval request, clients have the option of appealing the decision. Clients should submit appeals to PBC. More information on appeals can be found on the Appeals page. Clients cannot appeal decisions on items and services that are considered Exclusions.

If clients decide to pay out-of-pocket for an item or service before PBC has authorized an approval request - or despite PBC denying an approval request - there is the risk they will not be reimbursed.

MS&E providers can identify which items and services require approval and which are covered under the MS&E benefit by checking their PBC Provider Portal, “PROVIDERnet." If the provider is unable to determine requirements or coverage, the client or MS&E provider should contact Health Benefits at
1-855-550-5454.

MS&E Exclusions

Some items are considered exclusions under the MS&E benefit. Clients cannot seek exception or appeal for excluded items. MS&E benefit exclusions include, but are not limited to:

 Household items;

 Home renovations (e.g., ramps, stair lifts);

 Items that are not medically necessary (e.g., items for cosmetic purposes);

 Items required for medical trials or studies; and

​ Sports equipment (e.g., treadmills, exercise items).

Authorized Providers

MS&E items must be provided by a licensed pharmacy or medical supply and equipment provider.

Appeals

When coverage for a service has been denied, clients have the right to appeal the decision. Items and services that are Exclusions cannot be appealed. See the Appeals page​ for more information about the appeals process.

Providers

Information and forms for MS&E providers can be found on the Information for Health Providers​ page.

Fact Sheet​​

For information on how to access MS&E benefits check out the Medical Supplies and Equipment Benefit Fact Sheet.

 Do you have questions?

Contact us at 

HealthBenefits@fnha.ca 

or call

1-855-550-5454 (Toll Free)​​​

 How was your experience?

We want to hear from you about your experience with FNHA Health Benefits. Please take 5-10 minutes to fill out our survey here:

Feedback 

This client satisfaction survey will help us understand BC First Nations experiences accessing FNHA Health Benefits. We will use this information to improve the quality of our services.

Download a print version of the FNHA Health Benefits Client Satisfaction Survey

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