Individual health and dental insurance for individual needs...

We all know medical and dental treatment can be expensive. And while government plans assist with the cost, they don't cover everything. If you're one of the thousands of British Columbians without benefits through your employer, our Health and Dental plan is an affordable way to protect you and your loved ones from those costs not covered by the government plans.

Our Health and Dental provides supplementary coverage to government programs by offering unique personal extended health, dental and travel options for people who are not covered by an employer group plan. Our plans give you the tools you need to plan ahead, so that if something unexpected occurs, you are prepared and can focus on healing instead of worrying about your finances.

This plan is perfect for:

• Retirees
• Part-time employees
• Contract workers
• Professionals
• People who are self-employed
• Students

Our Plan provides flexibility to fit your life and budget.

With our plan, you can build your own plan and tailor your coverage to suit you and your family's specific needs. This provides you with maximum coverage at a price you can afford. Most importantly, our plans give you peace of mind and protection for you and your family against unexpected health problems and emergencies.

The plan covers 80% of eligible expenses up to a lifetime maximum of $250,000 per covered person.

Plan Highlights:

Our plan consists of a core health plan with prescription drug and dental coverage options so you can choose the coverage you need. Certain core benefits provide a sliding scale for reimbursement. The longer you have coverage, the more coverage you enjoy.

As a plan member you can also take advantage of Personal Health Insurance Bridge. It offers you the security of keeping your individual benefits 'on hold' should you obtain full-time or temporary employment with group benefits.

Core Health Plan

• Vision Care
  
  After six months on the plan, Pacific Blue Cross covers the cost of prescription lenses, frames, contact lenses and laser eye surgery up to:

  First 24 months	25-48 months	49 months +
  $100 per person	$200 per person	$300 per person
  $30 for optometrist	$50 for optometrist	$70 for optometrist

• Registered Therapists and Health Practitioners
  
  Benefits are paid for visits to: naturopaths, massage therapists*, physiotherapists, chiropractors, speech pathologists, registered counsellor, chiropodists/podiatrists, osteopaths, psychologists, audiologists, acupuncturists, and registered dieticians* up to:

  First 24 months	25-48 months	49 months +
  $300 per person per year	$400 per person per year	$500 per person per year
  $25 per visit	$25 per visit	$25 per visit

  * Services of a massage practitioner or registered dietician require referral by a physician.

• Hospital Accommodation
  Benefits cover costs for semi-private or private hospital rooms (no age restrictions).
• Hospital Daily Cash Benefit
  If you are confined to a hospital, we will pay you $20 a day, for up to 90 days, from the 4th day of hospitalization, up to age 65.
• Local Ambulance
  Benefits cover the cost of ambulance fees in emergencies, including air ambulance and Treat No Transport.
  
  Includes payment for Treat-No-Transport, charges for treatment when an ambulance is called to the scene of an accident or place of illness and transportation to hospital is not required.
• Private Duty Care Nursing
  
  Benefits cover the cost for private duty care nursing in your home, provided the nurse is a Registered Nurse(RN) and care begins immediately following the discharge of an acutely ill bed patient from a hospital up to:

  First 24 months	25-48 months	49 months +
  $1,200 per person per year	$2,500 per person per year	$5,000 per person per year

  * Palliative care services and the services of an RN to assist with activities of daily living are not covered.

• Out of Province, In-Canada Travel
  Benefits cover 100% of Out-of-Province and In-Canada medical emergency care.
• Medical Services and Supplies
  
  Benefits cover supplies and services not covered by government plans up to:

  First 24 months	25-48 months	49 months +
  $1,200 per person per year	$2,500 per person per year	$5,000 per person per year

• Accidental Dental
  Benefits cover up to $2,500 per person for accidental damage to natural teeth.
• Accidental Death and Dismemberment
  Benefits cover the principal sum up to $25,000 (under the age of 70).
• Final Expense Benefit
  Benefits cover up to $3,000 for each person.
• Survivor Benefit
  Benefits begin 12 months following approval of application.

Prescription Drug Options

Drug coverage can be purchased as an option to your Extended Health Care plan: Both the Essential and Enhanced options provide a sliding scale for reimbursement. The longer you have coverage, the more coverage you enjoy.

• Essential Prescription Drug Option

  The Essential drug option covers 80% of the cost of PharmaCare-eligible prescription drugs. This is an increasing benefit coverage up to a predetermined maximum.
  
  

• Enhanced Prescription Drug Option

  The Enhanced drug option covers 80% of the cost of PharmaCare-eligible prescription drugs, plus prescriptions that are not eligible under the government PharmaCare plan. Drugs used for birth control are eligible under this option only. This is an increasing benefit coverage option up to a predetermined maximum.

  The Enhanced drug option can include a Direct Pay Drug card provided no pre-existing medical conditions exist at the time of application. With a Direct Pay Drug card, your pharmacist submits your claim electronically. PBC pays the pharmacy 80% of your prescription cost, and you pay the pharmacist the remaining 20%. There is no need to submit a paper claim.
  
  

Dental Options

Dental coverage can be purchased as an option to your plan: Both the Essential and Enhanced options provide a sliding scale for reimbursement. Like the prescription drug options on the extended health plan, the longer you have coverage, the more coverage you enjoy.

*applicable to Enhanced Dental Option only

• Essential Dental Plan Option

  The Essential dental plan covers eligible expenses after a three-month no-claims waiting period, up to a predetermined maximum. Eligible expenses include:

  • Diagnostic expenses (oral examinations, x-rays)
  • Preventive treatments (polishing, fluoride treatments)
  • Restorative treatments (fillings)
  • Periodontal cleaning (scaling and root planing)
  • Prosthodontic services (repairs & minor services only)
  • Oral surgery (routine extractions)

  In addition, the plan covers emergency treatment of the above services while temporarily outside of BC or the Yukon. There is no financial limit on the amount that will be paid for the services covered over the lifetime of the plan.
  
  

• Enhanced Dental Plan Option

  The Enhanced dental plan covers all of the Essential dental benefits with the addition of major restorative services, up to a combined predetermined maximum.

  The plan covers 50% of eligible expenses incurred after 12 consecutive months on the plan. The maximum amount payable for major restorative, orthodontic and denture services is limited to $500 for each covered person per year.

  Additional eligible expenses include:

  • Major Restorative services (crowns, bridges, inlays and onlays)
  • Endodontics (root canals)
  • Orthodontic coverage.(children only, benefit begins after 24 months)
  • Complete or partial dentures

Healthy Blue Living

Staying healthy is worth celebrating

Only Pacific Blue Cross offers British Columbians a discount on health insurance for maintaining a healthy lifestyle. With Healthy Blue Living you receive a 10% discount off your monthly Personal Health and Prescription Drug benefit plan rate.

To qualify, you and your spouse must meet our healthy profile:

• Are a non-smoker
• Fall within the normal Body Mass Index (BMI) range for your age.
• Maintain a healthy blood pressure.
• Have healthy cholesterol and blood sugar levels.

Do you and your spouse fit the above profile? We’ll reward you with a discount when we review your application. Children will automatically get the discount if their parents qualify.

Questions? Speak with one of our individual plan representatives