Question: Do our PBC extended health benefits include osteopath services? 

Answer: No, the paramedical coverage included in our Health Spending Accounts does not include osteopath services. According to Pacific Blue Cross, few extended health plans include this benefit. If our members would like to see this or other coverage included in our benefits, please contact the Benefits Committee. You can email Joan Sharp at jsharp@sfu.ca.

Question: As SFU retirees over the age of 65, are we eligible for the Canadian Dental Care Plan (CDCP)?

Answer: 65-year-olds are now eligible to apply for the CDCP. However, there are other restrictions that make us ineligible. To qualify for the CDCP, you must have an adjusted family net income of less than $90,000. More importantly to our members, you must not have access to dental insurance. This is defined as no access to dental insurance through your employer benefits or through your pension benefits or those of a family member. Any level of dental coverage through your pension benefits is considered access to dental coverage, even if you opt out of dental coverage. 

https://blog.ab.bluecross.ca/news/what-you-need-to-know-about-the-canadian-dental-care-plan/

Question: My prescription is not among the drugs listed in the Pacific Blue Cross Blue RX formulary under SFU retirees’ extended health coverage. The drug is similar to other medications on Health Canada’s list of approved drugs. How can I appeal denial of payment for my medication?

Answer: One of our members wrote to the Benefits Review Committee, Pacific Blue Cross, PO Box 7000, Vancouver, BC, V6B 4E1, appealing the lack of coverage for an eyedrop prescription. He provided the following reasons:

• According to documentation on the Blue RX plan, Blue RX covers brand-name and generic prescriptions for drugs used to treat all major diseases and conditions. This drug is a generic version of the drugs that already appear on the Blue RX formulary.
• From the Blue Rx plan, “There are a very small number of drugs that are not covered under Blue RX. These excluded drugs typically have similar therapeutic benefits to ones already covered by Blue RX but are much more costly.” The rejected drug is a generic version of other approved drugs, likely with a smaller cost.

Outcome: The claim was paid for our member and the drug was added to the Blue RX formulary.