Pacific Blue Cross Transition

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As of Sept. 16: A New Health Benefits Plan for Dental, Vision and Medical Supplies & Equipment

The First Nations Health Authority (FNHA) launched a new health benefits plan that will be more convenient to use and expand benefit coverage in key areas.

On Sept. 16, the FNHA t​ransitioned dental, vision, and medical supplies and equipment (MS&E) benefits off the federal Non-Insured Health Benefits (NIHB) program. The FNHA's new partner, BC-based benefits provider Pacific Blue Cross, now administers these benefits.

FNHA clients and their health care providers will find the new system easier to use, with fewer requirements for pre-approvals and quicker turnarounds for adjudications and payments.

There is no reduction to existing coverage, and coverage is now improved for many preventive health services and special needs.

PBC Transition Fact Sheet (PDF 81 KB)​

The new plan includes:

Dental

 a dental fee guide in line with the British Columbia Dental Association's suggested rates

 more coverage for preventive dental care services, such as scaling and cleaning

 fewer restrictions on dentures

​ pay-direct claims at most dental clinics in BC​

​Dental Benefits Fact Sheet (PDF 79 KB)

​Dental Providers Bulletin – August 1, 2019 (PDF 264 KB)

Vision

 no pre-approvals required for routine eye exams or standard prescriptions (within frequency limits)

 $100 every two years for routine eye exams​

 $275 every two years for prescription eyewear ($415 for high-index lenses)

​ pay-direct claims at participating optical stores

​​Vision Care Benefits Fact Sheet (PDF 78 KB)

Vision Providers Bulletin – August 1, 2019 (PDF 304 KB)

Medical Supplies & Equipment (MS&E)

 similar coverage for all equipment and supplies

 ability to see exactly what is covered, and how much is covered

​ simpler and faster pre-approvals

Medical Supplies & Equipment Fact Sheet (PDF ​​83 KB)

Medical Supplies & Equipment and Resid​ual Drugs Providers Bulletin – August 1, 2019 (PDF 294 KB)


Transition Resources​

Posters​

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Poster A (PDF 1.13 MB)​

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Poster B (PDF 756 KB)​

​Webinar

 

Friendship Centres Webinar Slides (PDF 1.19 MB)​

How did we gather feedback?

The FNHA gathered information on how to improve dental, vision and MS&E health benefits using an approach based on its first Directive, to be "Community-Driven and Nation-Based". This principle is rooted in the goal of enhancing the autonomy and authority of First Nations.

The FNHA led 51 focus groups across the province that involved 98 communities. It also asked Health Directors and health care providers what needed to change. Discussions with health care providers included education about cultural safety and humility, which is one of the topics identified as a concern by clients and health leaders. 

Community members, Health Directors and health care providers shared similar views on how to improve the First Nations Health Benefits Program.

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Why Pacific Blue Cross?

 PBC is a not-for-profit health benefits society based in BC.

 PBC shares the FNHA's values and has signed a Declaration of Commitment to Cultural Safety and Humility in Health Services. This entails providing training in cultural safety and humility to all PBC frontline staff.

 The organization provides fast claims processing, reimbursement, as well as electronic coordination of benefits if you are covered by more than one plan.

​ As one of BC's largest benefits organizations, Pacific Blue Cross has strong relationships and fast payment systems established with health care providers. Read more about the decision to partner with Pacific Blu​e Cross.

Would you like to learn more?

Do you have questions about your benefits or what's covered by the First Nations Health Benefits Plan? Call our support line at 1.855.550.5454 or email HealthBenefits@fnha.ca.

Health Benefits Community Relations Representatives are also hosting information sessions and attending events to talk about the new plan. To find out what's happening in your region, contact your local representative or email CommunityRelations@fnha.ca.

 

Fraser ​Salish Region

James Delorme

James.Delorme@fnha.ca

778-684-1886

Interior Region

Joyce Kenoras

Joyce.Kenoras@fnha.ca

250-318-6634

Northern Region

Lindsey Larsen

Lindsey.Larsen@fnha.ca

250-960-9201​

Vancouver Coastal Region

Jenny Smith

Jennifer.Smith@fnha.ca

604-693-6588

​Vancouver Island Region

Candy-Lea Chickite

Candy-Lea.Chickite@fnha.ca

250-830-7346​

Frequently Asked Questions

1. When does administration of dental, vision and medical supplies and equipment (MS&E) benefits transition to PBC?

The transition takes place on September 16, 2019.


2. When can I start claiming under the plan?

You can start claiming under the new plan September 16, 2019. As of that date, you will be able to look up coverage and how much you are eligible to claim in your Member Profile at www.pac.bluecross.ca or through the Pacific Blue Cross Mobile App. You may also submit reimbursement claims via the website or the mobile app.


3. Do I need to register or enroll with PBC?

If you are a current FNHA client, you will be registered automatically with PBC and you will be able to claim under the new plan starting September 16.

If you would like to sign up to view your coverage and submit claims using the PBC website or Mobile App, all you will need is your Status Number to create your own PBC Member Profile at https://service.pac.bluecross.ca/member/login/.


4. Where can I find out what the FNHA's benefits plan covers?

As of September 16, plan details for dental, vision and MS&E will be available for clients on the Pacific Blue Cross website through their Member Profile (pac.bluecross.ca), or the Pacific Blue Cross Mobile App (visit pac.bluecross.ca/mobile for details). Health care providers can go to pac.bluecross.ca/provider. Plan details for all of the FNHA's health benefits, including pharmacy, mental health, and medical transportation benefits, are available on the health benefits section of the FNHA website and in the Health Benefits Information Guide.


5. If I have questions about the new FNHA benefits plan for dental, vision and MS&E, who should I contact for information?

For clients

Contact First Nations Health Benefits at 1-855-550-5454. This is the number to use before and after September 16. You may also use this number if you have questions about other health benefits.

For health care providers

As of September 16, providers may contact PBC at 1 877 PAC-BLUE (1-877-722-2583). For contact information about other benefit areas, such as Medical Transportation and Mental Health, please call us at 1-855-550-5454.


6. If I'm requesting additional coverage, do I still need to send an “Exception" request?

Yes. The only difference is that, as of September 16, exception requests for dental, vision and MS&E will be sent to PBC. Medical transportation and mental health Exception requests will still go to the FNHA. These requests are normally sent by the health care provider.


7. Will there be any reduction to my benefit coverage?

No. We want you to know that:

• ​None of your existing dental, vision and MS&E benefits coverage will be reduced on September 16.

• Claims will be processed faster and many services will no longer require prior approvals.

• Coverage amounts will increase for many services.


8. Will my benefit coverage re-set every September 16?

No, for vision care and MS&E, it will be based on the calendar year. Annual coverage limits will renew in January for vision and MS&E.

For dental, depending on the benefit item, the coverage will re-set every calendar year or every 12 or 24 months after date of service (rolling term). Please review the PBC Fee Schedule and the FNHA Dental Fee Supplement to find the rules and criteria.

The deadline to file a claim is 12 months from date of service.


9. On September 16, can I get dental work done, even though I've claimed already in the past year?

Claiming amounts will not reset to zero. Your claiming history will carry over to the new plan if you have partially used a benefit that is covered. Depending on the benefit item, annual coverage limits reset in January of the calendar year or every 12 or 24 months after the date of service. Please review the PBC Fee Schedule and the FNHA Fee Supplement to find the rules and criteria.

On September 16, you will be able to sign in to www.pac.bluecross.ca  to see all of the benefit claiming amounts and exactly how much you are eligible to spend for each benefit. If the new plan pays more or offers a higher frequency of treatment, this will show in your coverage.


10. On September 16, can I get a new pair of glasses, even though I've claimed already in the past year?

Claiming amounts will not reset to zero if you have partially used a benefit that is covered under the plan. Your claiming history will carry over to the new plan. Annual coverage limits reset in January of each calendar year.

What about eyewear? 

• On September 16, if you have not purchased a pair of eyeglasses in the past 24 months, then you would be eligible to claim up to $275 for a new pair.

•​ If you purchased a new pair of glasses within the past 24 months, then you would need to wait until the 2-year eligibility limit resets to get the entire $275 toward a new pair.

On September 16, you will be able to sign in to www.pac.bluecross.ca to see all of the benefit claiming amounts and exactly how much you are eligible to spend for each benefit. If the new plan pays more or offers a higher frequency of treatment, this will show in your coverage.


11. I am already covered by another workplace or spousal benefits plan. Can I keep my other coverage?

Yes. If you have access to another public or private benefits plan, such as a PBC spousal plan, your claim must be submitted first to that plan for coverage. PBC can coordinate your claims so you get the most coverage from the two plans. The FNHA plan will pay the amount that's eligible after your workplace or spousal plan pays the initial claim. If you lose your other benefits coverage, you can let us know so that your claims would then be submitted directly to the FNHA benefits plan.

Most dental offices can coordinate coverage between two plans automatically; however, some providers may need to coordinate and submit manually. If there is any additional expense left over after your coverage is coordinated, you would pay the leftover amount.


12. Do providers know that our dental, vision and MS&E benefits are transitioning to PBC? How have they been informed?

The FNHA and PBC have been working together to notify health care providers about the changes. We are contacting providers through their associations, at conferences and meetings, and through existing PBC and FNHA channels of communication.

PBC covers approximately 1 in 3 British Columbians and its processes are well-known to health care providers across BC. PBC has a strong reputation for timely and efficient claims processing.


13. Do I have to explain the health benefit changes to my provider?

The FNHA and PBC have notified health care providers about the changes. If for any reason you are denied a claim that was approved under your plan before, you or your health care provider can call 1-855-550-5454 for assistance.


14. How do I find out if my provider can directly bill PBC?

Ask your provider if they can bill directly. You can use the Provider Lookup Tool to find direct-billing providers by type (e.g., “Optometrist"):

https://service.pac.blue​cross.ca/acesweb/pages/Authentication/ProviderSearch.aspx

Please note:

1. Some providers can directly bill PBC but may choose not to do so.

2. Pharmacists and dental providers do not appear in the tool. Almost all dental offices and pharmacies in BC have the ability to direct bill to PBC.

3. This Provider Lookup Tool is for all PBC benefit plans, not just the FNHA plan. If you have PBC coverage through a workplace plan, you can use the tool to look up a range of different providers who offer direct billing.​ 

​Read more Health Benefits FAQs here​.

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Download an Info​sheet Poster ​PDF here (977 KB)


 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:

​Feedba​ck ​

​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.​​​

Downlo​ad a print version of the FNHA Health Benefits Client Satisfaction Survey​

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Click here

​Client Satisfaction Survey FAQs

​Click here
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