If a member has a confirmed COVID-19 diagnosis, claims will be processed and paid based on the regular guidelines. We are currently requesting members with a clinical diagnosis to complete a Plan Member Confirmation of Illness Form in place of a formal physician’s statement.

Members who have been advised to self-monitor for symptoms if they may have been exposed to someone who is infected and are asymptomatic are not eligible for disability benefits. We will suggest they consult the HR department of their organization or apply for EI benefits.

If your organization decides to suspend operations temporarily and your staff are asymptomatic, they will not be eligible for benefits.

As the member is already out of country when they become ill and would be hospitalized for treatment that is medically necessary, the terms of the policy would be met. While the policy may already have 0-day elimination for hospitalization, as an industry, we have agreed to waive the elimination period for eligible COVID-19 claims. If the claim is allowed, the elimination period will be waived but the maximal period considered would be 14 days, subject to the other provisions of the policy.

Quarantine is the medically necessary treatment for diagnosis of COVID-19. Thus, as an industry, we have determined that we will assess self-quarantine claims and consider up to the 14-day maximum. While the member is out of country, they would be following instructions of physicians, therefore, this would meet the terms of the policy.

If the claim is allowed, the elimination period will be waived, but the maximal period considered would be 14 days subject to the other provisions of the policy. In this case, the fact that the diagnosis has been made implies that the quarantine has been medically directed (vs. self-quarantine, which is not medically directed).

An STD claim for quarantine and mild symptoms with no positive COVID-19 test does not meet the definition of disability under the policy and does not qualify for disability benefits. The claim will be denied, and the individual will be redirected to EI.

An STD claim for quarantine and mild symptoms that do not meet the definition of disability under the policy and no positive COVID 19 test does not qualify for disability benefits therefore the claim will be denied and the individual will be redirected to EI.

An STD claim for a directed quarantine with no symptoms is not payable. Individuals should be referred to EI for benefits.

If your Group Benefits plan includes Extended Health Care, COVID-19 would be a recognized illness under that program. Each contract is unique, to find details on what’s covered, refer to your specific contract details. A Pacific Blue Cross representative is the best person to respond to questions about your specific contract and the coverage it provides.

There is research and development underway for a COVID-19 vaccine, but it’s too early to predict if it will be needed or it would be made available to the public. Your Extended Health Care contract will indicate which vaccines, if any, are a covered expense.

It’s always recommended that you refer to your specific plan and that members know the details before they travel. Your policy may include: 1) Emergency Out-of-province/Territory Emergency Medical Expenses, 2) Trip Cancellation and includes 3) Emergency Travel Assistance and 4) Government Integration. These are four distinct provisions under your Group Benefits program. The questions and answers below are intended to help you understand these four benefits in the context of COVID-19.

All members should contact Medi-Assist at 1 888 699–9333 within Canada and the US. and (collect) 1 604 419-4487 from all other countries to advise that they need to seek medical treatment. This should always be done in advance of seeking treatment, if possible. If it's not possible to contact Medi-Assist before you seek medical attention, you or a travelling companion that is able to provide all the medical and policy details on your behalf should call within 5 days. Medi-Assist is an emergency travel assistance company that is trained to provide travelers with the help they need to arrange their medical treatment in any situation while in another country and will work with PBC to ensure members can access the benefits they have in accordance with their policy.

When travelling, if you or a covered member of your family has a medical emergency and gets sick (with COVID-19 or another illness), your Out-of-province/Territory Emergency Medical Expenses coverage will pay for your emergency medical treatments, subject to the terms of your contract. For medical expenses, Pacific Blue Cross will facilitate ”government integration” and apply any reimbursement you are eligible for from the Medical Services Plan (MSP) for your emergency medical expenses while you were travelling. All you have to do is fill out the form and we will take care of the rest.

If you or a family member experience a medical emergency and get sick while travelling, you would be eligible for coverage under your emergency Out-of-province/Territory Emergency Medical Expenses benefit for emergency medical expenses such as but not limited to medication, physician visits and hospitalization, subject to the terms of your contract. In addition, your Group Benefits insurance policy includes daily subsistence for the patient or a family member when hospitalization requires you to stay beyond your return date. This coverage will cover your costs for food, accommodations, and return transportation home (i.e. if you miss your originally scheduled flight), subject to the terms of your contract.

If you are placed in medical quarantine or determine you need to self-isolate while travelling but are not sick or not having a medical emergency your plan would not provide any coverage for daily subsistence costs. This is because Emergency Travel Assistance is intended to protect you if you have a medical emergency or get sick.

For information about further financial assistance that may be available if you are quarantined with COVID-19 while travelling, visit the Canadian Government website.

If you are quarantined but nearing the maximum number of days of eligible coverage, your Out-of-province/Territory Emergency Medical Expenses coverage will be extended upon approval by Pacific Blue Cross until you are released from quarantine and able to secure safe passage home. This applies as long as you are under quarantine – whether you have been diagnosed or not. Coverage is based on the specific terms of your Group Benefits insurance policy.