Secure, online access to disability claim details and resources

As part of our commitment to improving our member experience, we’ve updated Member Profile, our online claims and benefit management tool, to help our members securely and confidently manage their disability claim.

By supporting your plan members with information about this new feature, you’re helping provide transparent access to their claim status, payment dates, support resources and more—online or through our mobile app.

How to access the Disability Claims tab in Member Profile

Most of our members already have a Member Profile for fast, online extended health claims and coverage info. Here’s how your plan members can now use Member Profile to access information and resources to support them in managing an active disability claim through Member Profile:

1. Log in to Member Profile
2. Navigate to the drop-down list next to Your Coverage.
3. Select their policy number
4. Select View more claims

Help your plan members sign up for Member Profile

If one of your plan members with an active disability claim could benefit from online access to disability details and resources, it will only take them a few minutes to sign up. All they’ll need is their Policy and ID number provided by their employer or Claims Specialist. 

Questions or feedback?

Please contact the Work and Wellness team at 604 419-8040 or call the Pacific Blue Cross toll-free number at 1 877 722-2583.

Successful pilot for traumatic brain injury patients

Traumatic brain injury (TBI) is a serious condition that can affect a person’s ability to work, function and enjoy life. It can also result in long-term disability and high claim costs for plan sponsors.

Earlier this year, the Work and Wellness team at Pacific Blue Cross partnered with HealthTech Connex (HTC), a leading neurotech company, to conduct a ground-breaking project using PoNS Therapy™. This non-invasive neuromodulation device stimulates the brain through the tongue and improves balance and gait for those with traumatic brain injuries.

The project involved nine of our plan members who had prolonged disability due to head injuries. These members participated in a 14-week treatment protocol using the PoNS device at HTC’s division at the Surrey Neuroplasticity Clinic. The project also measured the cognitive performance of the participants using the NeuroCatch® Platform, another HTC innovation that assesses brain health.

The results were astounding – five of the nine members have either returned to work and remained there at the six-month checkpoint or have closed their claims as recovered and work ready. All participants reported improvements in their balance, gait, headaches, mental health and cognition. The net savings in long-term disability claim costs were estimated at $1.6M.

This project is an example of our commitment to continuous improvement, innovation and collaboration to meet our mission of improving the health and wellbeing of British Columbians.

Additional project details and whitepaper are available on our website.

New 988 Crisis Helpline for Canadians

Navigating mental health challenges can be particularly tough during the darker months when Seasonal Affective Disorder (SAD) is most present. The 988 Crisis Helpline, a nationwide service to support those in emotional distress or suicidal crisis, is a brand-new resource to share with members, colleagues and friends.

Available to all Canadians as of November 30, 2023, the 988 Crisis Helpline is a toll-free, three-digit number that connects callers or texters to trained crisis responders, no matter where they live. The 24/7 service is confidential, trauma-informed and culturally appropriate, providing immediate support, crisis intervention or referrals to community-based services.

This is a vital addition to the many mental health resources available online, as it provides an easy-to-remember and accessible way to reach out for help. There are many resources available, including our own mental health checklist for those who feel they might benefit from extra support.

If you, your plan members or someone you know is struggling with mental health challenges, they can call or text 988 anytime, from anywhere, and get the support they need.

To learn more, visit The Lifeline and 988.

Understanding the medical underwriting process

Medical underwriting involves an examination of an applicant’s medical information to determine the risk classification for Life, Disability or Critical Illness coverage. It is required in these instances:

1. When a situation causes a group applicant’s coverage to exceed the plan’s Non-Evidence Limit/ Non-Evidence Maximum.
2. When an employee applies under an existing group after the coverage window, causing them to be a late applicant.
3. When an employee or spouse applies for any Optional Group Life Insurance coverage.
4. When any new applicants apply for our Individual Products, like a Group Conversion Plan or Retirement Insurance.

It can be frustrating if the medical underwriting process takes longer than expected. Here are three tips to help the process move along in a timely manner:

1. Ensure Medical Evidence Statements are accurate and completed with the wet or approved digital signatures of the applicant. The evidence cannot be assessed without the date and signature.
2. Ensure Medical Evidence is up to date. Evidence is considered outdated 90 days from the date of signature. If we are unable to proceed due to missing information during the 90-day timeframe, we will request current evidence. If the original evidence is past 180 days, a new statement is required.
3. Ensure new employees enroll within 31 days of becoming eligible. All late applicants must be medically underwritten.

Meet Medical Underwriter, Kim B!

Now that you have some background information on the medical underwriting process, meet Kim B., who has been an underwriter for Pacific Blue Cross for over 30 years. Initially starting in Group Underwriting, Kim transitioned to the Medical Underwriting team within the Work and Wellness department, specializing in Group and Individual Medical Underwriting to include Health, Dental and a variety of Disability, Life, and Critical Illness Insurance as a Senior Medical Underwriter. Throughout her career, Kim has achieved multiple professional certifications and is consistently working to keep up to date on medical conditions and trends that affect risk assessment for insurance products.

An ordinary workday involves reviewing applications, ordering medical tests and determining risk classification for applicants. She loves that she gets to learn something new every day and apply it to her role. Outside of work, Kim enjoys photography, jewelry making, crafts and spending quality time with her friends, family and dogs.

We spoke to Kim about what a regular day looks like for our underwriters:

1. What does the process look like when you are evaluating an application?
   We start by looking at the information provided by the applicant on their Statement of Health form. We’ll go through their claims history, including medications and any past paramedical appointments, like physiotherapy or registered massage therapy. Based on the age and volume of the coverage being applied for, we may order testing (paramedical, medical, urine or blood test, or other) and ask for additional information from the applicant’s family physician.
2. How do you access and verify the medical records and history of an applicant?
   When our members fill out their application form, they provide authorization for us to see their claims history. This authorization also allows us to request any additional information from their physician or practitioner, if necessary.
3. How do you communicate the underwriting decision and the terms of the policy to the applicant and the insurer?
   We send our decisions to our Member Administration team within Group Services. Depending on where the Statement of Health came from, the team will then share the decision with plan administrators, third party administrators, brokers or advisors.
4. What is the biggest piece of advice you would give to ensure an application isn’t delayed?
   The biggest issue is missing questions or details on the forms submitted, which is why we really stress the importance of closely reviewing all the information before submitting!