About this Benefit
Many people need medical supplies and medical equipment for short- or long-term health conditions. These supplies are an important part of supporting your health and wellness.
Health Benefits has partnered with Pacific Blue Cross (PBC) to offer a comprehensive medical supplies and equipment (MS&E) plan to First Nations in BC. A Medical Supplies & Equipment factsheet is available
here.
What My Plan Covers
Your plan covers certain 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
• gender affirming products
• 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
• wound care supplies
You can find detailed information about your MS&E benefits through your
PBC Member Profile, which you can access online or through the PBC app.
How Do I Access Coverage?
There are certain steps you can take to access your coverage, avoid out-of-pocket costs and get the items you need quickly.
1. If your doctor, nurse, or other health care provider suggests an MS&E item, be sure to ask them for a prescription or written recommendation. Once you have your prescription or written recommendation, you can take it to a pharmacy or an MS&E provider to get the medical supplies or equipment that you need.
2. Ask your pharmacist or MS&E provider if they are registered with PBC. Pharmacies and providers who are registered can bill directly. If you see a provider who is not registered with PBC, you will need to pay out of pocket and request reimbursement.
3. Make sure any prior approval requests for items or services have been approved. Some items and services under the MS&E benefit require approval before your pharmacist or provider can bill for them. Your provider can submit approval requests directly to PBC.
4. Talk to your pharmacist or MS&E provider about which items and services are covered by your MS&E plan. If an item is not covered, ask your provider for a covered alternative.
If you have any questions about your MS&E plan, how to access coverage, or why a claim was denied, call Health Benefits at
1-855-550-5454.
What My Plan Does Not Cover
Some items and services are considered Exclusions. Exclusions cannot be covered as an exception and cannot be appealed. MS&E benefit Exclusions include, but are not limited to:
• household items
• home renovations (eg, ramps, stair lifts)
• items that are not medically necessary (eg, items for cosmetic purposes) or have a covered alternative (eg, scooters)
• items required for medical trials or studies
• sports equipment (eg, treadmills, exercise items)
Appeals
When a coverage request for a MS&E item or service has been denied, you 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.
