Flexible Benefits Guide2015

PLAN YEAR 2015
Flexible Benefits Guide
A GUIDE TO YOUR BENEFITS FOR

EXCLUDED EMPLOYEES IN THE BC PUBLIC SERVICE
Table of contents
Introduction 2
Life insurance plans
Program overview
Employee basic life insurance
Who is eligible for benefits?
Optional life insurance plans
When does coverage begin?
How to enrol
Optional accidental death and

dismemberment insurance
How to update your coverage
10
33
Health Spending Account
43
45
Open enrolment
How to make a claim
Eligible life event
Extended health
Work status changes
12
Drugs
Choices at a glance
16
Dental
Medical Services Plan
19
Life insurance
Extended health plan
20
Taxation
47
Your extended health plan options
When does coverage end?
48
Out-of-province coverage
What is covered by your extended health plan?
Dental plan

What is covered by your dental plan?
Your dental plan options
29
Converting to individual benefits plans
Other benefits programs
50
Contacts and resources
51
Glossary 52
Introduction
Welcome to the Flexible Benefits Program for excluded employees. The BC Public
Service recognizes that competitive compensation and benefit programs are
integral to our ability to attract and retain employees who foster excellence
in the public service. Under your Flexible Benefits Program, you can tailor your
health and life insurance benefits to best meet your needs.
Value of your benefits program
Benefits are an important part of your total compensation package. Unless you waive coverage, your employer
pays your Medical Services Plan premiums, which are valued at almost $800 per year (more if you have a
family). There is no cost to you to participate in the funded extended health and dental plan options, and the
reimbursements you receive under the plans are paid for by the employer. In some years, this may be several
thousands of dollars. The employee basic life insurance plan provides employee life insurance at a reasonable
group premium rate and a portion of your premiums are paid by your employer. These are just some of the
benefits that comprise your total compensation package. Other benefits programs are listed on page 50.
Important
This guide provides a
comprehensive overview of your
benefits programs. Share the
details with your family so you can
make the most of your benefits
program.
In the event of any conflict
between the contents of this
guide and the actual plans and
contracts or regulations, the
provisions outlined in those
documents apply.
On average, your benefits add over 20 per cent to your overall compensation.
Know your benefits. Know your options.

With choice comes responsibility. You must enrol in the Flexible Benefits Program to take an active role in
choosing your benefits. Take the time to learn about your options and to decide how to best apply them to your
personal situation. You will have the opportunity to update your options every year during an
Open Enrolment period and after an eligible life event.
Program overview
In recognition of the diversity that exists in todays workplace, the Flexible Benefits Program
helps you tailor a benefits package that meets the specific needs of you and your family.
So rather than all employees having the same benefits coverage, eligible employees get to decide how to spend the money that
the BC Public Service allocates to them for benefits coverage. You decide what suits you best.
The plans
A number of health and life insurance benefit plans make up
the Flexible Benefits Program. They fall into the categories of
core and optional plans. The difference between the two is that
the employer provides funding towards coverage under each
of the four core benefit plans. You fund your participation in
the optional benefit programs.
Optional benefits:
Optional family funeral benefit

Employee optional life insurance
Spouse optional life insurance
Child optional life insurance
Employee optional accidental death and dismemberment
insurance
Spouse optional accidental death and dismemberment

insurance
Dental plan
Employee basic life insurance (mandatory)
You can adjust your coverage over

time by making changes to your
options during the annual Open
Enrolment period. See page 10 for
information.
Core benefits:
Medical Services Plan of B.C.
Important
Child optional accidental death and dismemberment

insurance
Program overview
Your choices
Your costs and flex credits
Only one core plan, Employee Basic Life Insurance, is

mandatory, which means you must maintain a minimum level
of coverage you cannot waive coverage. You can, however,
waive coverage in any or all of the remaining plans. Its your
choice.
Funding dollars are called flex credits and each flex credit
equals $1. Flex credits are before-tax dollars and allocated to
employees as follows:
All core and optional plans offer multiple levels of coverage

ranging from basic to more comprehensive coverage. Each
level of coverage is called an option and has a cost (or price)
associated with it. In a given plan, the higher the option, the
greater the coverage and the more it costs. See Your choices at
a glance, starting on page 16.
1. You receive $200 general flex credits that you can spend
however you choose (e.g. higher dental coverage).
2. You receive flex credits towards the cost of your Medical
Services Plan, extended health, dental and employee basic
life insurance.
Important
Use the calculator tool on MyHR
to determine the total number of
flex credits you receive, the cost of
your benefits and the maximum
number of flex credits you may
allocate to your Health Spending
Account.
3. You receive the number of flex credits required to pay for

a middle option (called fully funded) in each of those four
core benefit plans regardless of your family status (employee
only; employee plus one; employee plus two or more).
If you choose that fully funded option, the cost is $0.
If you choose an option that is below that fully funded
option, you will have additional flex credits to use elsewhere.
If you choose an option that is above that fully funded
option, you will pay for the coverage using unallocated flex
credits or by paying monthly premiums based on your family
status.
Employees
Spouse
The Flexible Benefits Program is offered to regular excluded

employees and eligible excluded auxiliary employees in the
following categories:
Your legal or common-law spouse (same or opposite sex) who

is living with you is eligible for coverage. By enrolling your
common-law spouse in your benefits plans, you are declaring
that person as your common-law spouse. A separate form is
not required.
Orders in Council: Categories A, B and C.

Managers in the three bands of Applied, Business and
Strategic Leadership.
Schedule A, legal counsel, executive administrative assistants
and senior executive assistants.
Salaried physicians.
Deputy ministers, associate deputy ministers and assistant
deputy ministers.
Provincial Court Judges and Masters of the Supreme Court.
Judicial Justices.
Officers of the Legislature.
You must enrol to be eligible for coverage.
Dependents
You can extend your benefits to your spouse and to children
who meet eligibility requirements. You must enrol your
dependents to receive coverage.
Definitions
A glossary with terms that may be
unfamiliar to you is available on
page 52.
If your spouse is also enrolled in a benefits program, you may

be able to submit your extended health and dental receipts
to both plans and get up to 100 per cent of your eligible
expenses reimbursed, which may impact your enrolment
choices. See page 46 for information.
If you separate from your spouse, s/he is no longer eligible
for coverage under your benefits plan. Any terms and
conditions under separation and divorce agreements are the
responsibility of the employee, not the employer. Once a
common-law spouse has been enrolled in your benefits plan,
a different common-law spouse and any eligible dependents
may be enrolled in the plan 12 months after you have
cancelled coverage for the previous common-law spouse and
applicable dependents. You are responsible for cancelling your
spouses coverage when s/he is no longer eligible for coverage.
Dependent Children
Your children (natural, adopted, step children or legal
wards) are eligible for coverage if they are unmarried/not
in a common-law relationship, mainly supported by you,
dependents for income tax purposes, and who are any of the
following:
Under the age of 19.
Under the age of 25 and in full-time attendance at a
school, university or vocational institution which provides a
recognized diploma, certificate or degree.

Mentally or physically disabled and past the maximum
ages stated above, provided they became disabled before
reaching the maximum ages and that the disability has
been continuous. The child, upon reaching the maximum
age, must still be incapable of self-sustaining employment
and must be completely dependent on you for support and
maintenance.
Residing with your former spouse who is not eligible for
health and dental coverage.
children who are no longer eligible for coverage (e.g. If they

decide not to attend school after you have certified their status
as a student).
Coverage for a dependent child with full-time student status
will automatically end at age 25 unless the child has disability
status.
Important
To maintain benefits and ensure
uninterrupted coverage, when
your dependent child reaches 19
you must certify his or her status
as a full-time student and recertify that status each year.
Note: A grandchild is not an eligible dependent unless

adopted by or a legal ward of the employee or the employees
spouse.
Certification of dependent children over 19

Coverage for a dependent child will automatically end at
the end of the month in which s/he reaches age 19 unless
you certify that the child is in full-time attendance at a
school, university or vocational institution which provides a
recognized diploma, certificate or degree. You must certify that
dependent childs status as a student and re-certify that status
each year to maintain coverage.
To certify or register your dependent child as a student, submit
the forms for updating coverage on page 8.
Recertification notices for each benefits plan will be sent to
you by the benefits carrier (i.e. Pacific Blue Cross for extended
health and dental plans and Health Insurance BC for your
Medical Services Plan).
It is your responsibility to ensure that the requested
certification forms for each benefits plan are submitted.
You are responsible for cancelling coverage for dependent

Benefit
Regular Employee
Auxiliary Employee
Medical Services
Plan, extended
health and dental
plans
You can enrol immediately.

You must enrol within 30 days of becoming eligible or you will receive
the default options (see page 9).
Coverage begins the first day of the month following enrolment.
You can enrol after meeting eligibility requirements.

You must enrol within 30 days of becoming eligible or you will be
assigned to the default options (see page 9).
Coverage begins the first day of the month following enrolment.
Basic employee life

insurance
Coverage begins immediately.

You must enrol within 30 days of becoming eligible or you will receive
the default option (see page 9).
Its strongly recommended that you designate a beneficiary for your life
insurance.
Coverage begins upon meeting eligibility requirements.

You must enrol within 30 days of becoming eligible or you will be
assigned to the default option (see page 9).
Its strongly recommended that you designate a beneficiary for your
life insurance.
Optional family
funeral benefit

You must enrol or you will receive the default option, which is to
waive coverage. Coverage is effective for all dependents listed on the
enrolment form.
If selected, coverage begins the first of the month following enrolment.
Eligible to enrol after meeting eligibility requirements.

You must enrol within 30 days of becoming eligible or you will
receive the default option, which is to waive coverage. Coverage is
effective for all dependents listed on the enrolment form.
If selected, coverage begins the first of the month following
enrolment.
Optional life &

optional accidental
death and
dismemberment
(AD&D) insurance

You must enrol or you will receive the default option, which is to waive
coverage. You must list which dependents you wish to cover under
each insurance plan.
If selected, coverage begins the first of the month following enrolment
except where evidence of insurability and approval is required.
Coverage will begin once approval is granted by the carrier.
You can enrol after meeting eligibility requirements.

You must enrol within 30 days of becoming eligible or you will
receive the default option, which is to waive coverage. You must list
which dependents you wish to cover under each insurance plan.
If selected, coverage begins the first of the month following
enrolment except where evidence of insurability and approval is
required. Coverage will begin once approval is granted by the carrier.
Coverage for eligible dependents

Coverage is effective on the date on which your coverage is effective, or on the first of the month following the date the
enrolment form is received and processed by the Benefits Service Centre, whichever is later, except where evidence of insurability
and approval is required. Then, coverage will begin once approval is granted by the carrier. Note: Coverage for a newborn child
is effective from the date of birth provided you enrol him/her within 60 days. Otherwise, coverage for your newborn will be
effective on the date of application.
How to enrol
How to enrol for the first time
How to Update Your Dependents
1. Do your homework so you can tailor your benefits to meet

your needs:
To add or cancel dependents, complete and submit these

forms:
Read this document carefully.
Medical Services Plan (MSP) Group Change Request
Review your medical and dental expenses over the

past year.
Flexible Benefits Enrolment/Change Form
Review your spouses coverage, if applicable.
Use the calculator tool on MyHR to review.
2. Complete these forms:
Medical Services Plan (MSP) Application for

Group Enrolment
Flexible Benefits Enrolment/Change Form
Group Life Beneficiary Designation (You are

automatically enrolled in employee basic life
insurance, but you may want to designate a
beneficiary.)
Note: The Benefits Service Centre requires the
originals of any group life insurance forms.
PharmaCare Registration
Note: Do not submit this form to MyHR.
3. Submit forms by faxing, emailing or mailing to MyHR within

30 days of eligibility:
Fax: 604-320-4031
Email: Attach to an AskMyHR Online Service

Request
Mail: Benefits Service Centre, Block E, 2261 Keating

Cross Road, Saanichton, B.C. V8M 2A5
For information about updating your benefits due to an

eligible life event, see page 11.
Note: If you are mailing your change forms, allow plenty of
time for them to reach the Benefits Service Centre within 60
calendar days from the date of the eligible life event.
Choosing life insurance coverage

Maintaining employee basic life insurance coverage is a
condition of employment and cannot be waived. The minimum
coverage required is $25,000, and there are two other options
available. The rules around when you need to provide
evidence of insurability (good health) are outlined below.
Dont miss out

Your benefits enrolment forms
must be received by MyHR no later
than 30 calendar days from your
date of hire (or date of eligibility).
If you miss the deadline, you
will receive the default benefits
package outlined on page 9.
Employee Life Insurance

Beneficiary
Remember you may update
your employee life insurance
beneficiary at any time.
When you first enrol, you can choose any option of basic
employee life insurance without having to provide evidence of
good health.
You can also elect up to $50,000 of optional life insurance
coverage for yourself and/or your spouse without having to
provide evidence of insurability. If you elect more than $50,000
of optional life insurance for yourself and/or your spouse in
your initial enrolment, you will be required to provide evidence
of good health.
Evidence of good health is not required for child optional
life insurance, Optional Accidental Death & Dismemberment
Insurance or the Family Funeral Benefit.
If required, complete an evidence of insurability form and mail
it to the address noted on the form.
How to enrol
Remember to list your dependents and select them

for the benefit on the enrolment form
If you do not enrol on time, youll receive a default

package of benefits
In order to have dependents covered under Medical Services

Plan, extended health and dental, you must ensure that your
dependents are listed on the enrolment form and that you
select the dependents you wish to cover under each benefit
plan (Medical Services Plan, extended health and dental). So,
take the time to ensure that your dependent information is
correct and that you have selected the right dependents for
coverage in each plan.
Dont miss out on the opportunity to tailor your benefits

package. Take the time to review your benefits and actively
enrol. The following default package may not meet your needs
and you will not be able to change your benefits until the
annual Open Enrolment period unless you have an eligible life
event.
Be sure to designate beneficiaries for your employee

basic and optional life insurance
Complete and sign a beneficiary designation form. If you do
not designate your beneficiary by submitting the signed form,
benefits will be paid to your estate. Beneficiary designations
are not effective until the completed and signed original form
has been received by MyHR.
Benefit
Default
General flex credits
You will receive the $200 in

general flex credits
Waive
Extended health
Option 3 coverage for yourself

only
Dental
Option 4 coverage for yourself

only
Option 3 (3 x annual salary,

$80,000 minimum)
Waive
Unallocated flex credits
Paid out as taxable cash
Note: If you are transferring into the Flexible Benefits Program

from the Bargaining Unit Benefits Program, you will be enrolled
in the benefit plans (and plan options) that most closely match
the coverage you had while participating in the Bargaining
Unit Benefits Program. Eligible dependents covered under the
Bargaining Unit Benefits Program will also be covered under
the Flexible Benefits Program.
Open Enrolment
Each fall, during Open Enrolment, you are able to change benefits coverage for you and your
dependents for the next benefit plan year, which starts on January 1.
The only exception to this is if you selected the top option for
extended health (Option 5) and/or dental (Option 6). You are
locked into these options for two plan years.
It is recommended that you review your recent claims
experience and look at the changes to the plans (See Whats
new in 2015 to the right), and then either confirm your current
choice or select a better option for you and your family
through Employee Self Service.
If you dont make choices during Open Enrolment, your
benefits will remain the same as the previous year, and you
waive the opportunity to have a Health Spending Account.
You will not be able to change your benefits until the next
Open Enrolment period or eligible life event.
What if Im away during Open Enrolment?
If you are away during Open Enrolment, and wish to make
changes to your options, contact MyHR before you leave.
You can access Employee Self Service from home, or you can
request enrolment forms to be sent to you. Simply complete
the forms and mail them to MyHR.
Whats new for 2015?

Costs and credits for Medical Services Plan have

changed to reflect the increase in Medical Services
Plan premiums effective January 1, 2015. There is no
additional cost to you.
The annual premium for the Family Funeral Benefit
has increased from $25.20 annually to $25.80 annually
effective January 1, 2015.
Dont miss out!

Open Enrolment is your annual
chance to update your coverage
for the next calendar year.
Plan members will receive email
reminders about Open Enrolment.
Important
Use the calculator tool on MyHR
to determine the total number of
flex credits you receive, the cost of
your benefits and the maximum
number of flex credits you may
allocate to your Health Spending
Account.
10
Eligible life event

During the year, you may change your benefit options after you experience an eligible life
event.
Eligible life events allow you to make changes to your benefit
options within 60 days of the event. They include:
Marriage or entering a common-law relationship.
Divorce, separation or end of a common-law relationship.
Birth or adoption of a child.
Loss of a childs status as a dependent (marriage, age limit,
school status, etc.).
Your spouse gains or loses a benefit coverage.
Death of a spouse or child.
To update your dependents see page 8.
Increasing life insurance coverage

There are some limitations on increasing life insurance.
You or your spouse will be asked to complete an
evidence of insurability form (a medical questionnaire)
if you:
increase your employee basic or optional life
insurance from the previous year; or
Effective dates of coverage

Changes will be effective on the appropriate date based on
the timing of Open Enrolment, an eligible life event or the
approval of evidence of good health for life insurance.
Important
If you dont notify MyHR within 60
days of a life event, you can add (or
subtract) your dependents from
your coverage but you cannot
update your choices (i.e. select
different plan options).
Changes made during Open Enrolment will be effective at

the start of the subsequent plan year (January 1).
Changes made as a result of an eligible life event will be
effective on the date of the event. If a life event is reported
more than 60 days after the event, changes to your options
will not be permitted at that time.
Exceptions, back-dating and retroactive adjustments will
not be made. Be sure to review your coverage and make
changes during the Open Enrolment period or as soon as
possible after the eligible life event to ensure that MyHR
receives your benefits change forms no later than 60 days
from the date of the event.
Note: If you are mailing your change forms, allow plenty of
time for them to reach MyHR within 60 calendar days from the
date of the eligible life event.
increase your spouse optional life insurance.

The insurance company must review your information
and approve your request before increased coverage
can take effect.
11
Work status changes
The BC Public Service recognizes that each of us, throughout our career in the BC Public Service, may experience
various work events (e.g. becoming a new employee, travelling out of the country, leaving the public service,
etc.) that will change the type of coverage we receive. The following is a list of common work status changes and
the effects on benefits coverage. If you have any questions, contact MyHR.
What happens if:

I transfer from a regular to an
auxiliary position?
Your benefits coverage ends at the end of the month of your date of transfer and you must re-qualify for benefits. Any balances remaining
in your Health Spending Account or taxable cash are forfeited.
I am on a temporary
assignment to an excluded
position from my base
position which is a bargaining
unit position?
You are eligible for flexible benefits effective the first of the month following your temporary assignment to the excluded position. Your
temporary assignment must be 21 days or longer to apply. When you return to your bargaining unit position, you return to the bargaining
unit benefits plan. Your Health Spending Account or taxable cash terminates at the end of the month. Any balances remaining are forfeited.
I transfer to a bargaining unit

position?
When you transfer to your bargaining unit position, you are covered under the bargaining unit benefits plan. Your flexible benefits coverage
terminates at the end of the month of your transfer. Your Health Spending Account or taxable cash terminates at the end of the month. Any
balances remaining are forfeited.
Your extended health and dental claims history (e.g. payment towards your deductible, eligibility periods for things like vision care) will
remain with you throughout your employment. You should always confirm your eligibility for reimbursement prior to purchasing.
Note: Your extended health and dental claims history (e.g. payment towards your deductible, eligibility periods for things like vision care)
will remain with you throughout your employment. As such, you should always confirm your eligibility for reimbursement of a product or
service prior to purchasing it.
Note: The Family Funeral Benefit under the Flexible Benefits Program is the same coverage as Optional Spouse and Dependent Life
Insurance Plan under the bargaining unit benefit program (with the exception that there is an evidence of insurability requirement under
the bargaining unit plan). You can transfer to the bargaining unit plan evidence free by completing the election form and submitting it to
MyHR within 90 days of your date of transfer into the bargaining unit. If you miss this deadline, you will be required to submit evidence of
insurability along with the election form, and coverage will be subject to approval by the insurance carrier.
12
Work status changes
I transfer from a bargaining

unit position to an excluded
position and do not enrol in
the Flexible Benefits Program?
When you transfer into an excluded position, you have 30 days to enrol in the Flexible Benefits Program. We recommend that you complete
your enrolment forms. Its your opportunity to choose the best options available to you and any eligible dependents.
If you do not enrol, you will be enrolled (by default) in the corresponding benefit plans you had under the Bargaining Unit Benefits Program
with the options that most closely match your coverage under the bargaining unit plan. Any dependents covered under the bargaining
unit plans will also be covered under the Flexible Benefits Program. Any unused flex credits will be paid out in monthly instalments as
taxable cash. You will have to wait until the next Open Enrolment period (or until you experience an eligible life event) to make any changes.
Your extended health and dental claims history (e.g. payment towards your deductible, eligibility periods for things like vision care) will
remain with you throughout your employment. As such, you should always confirm your eligibility for reimbursement prior to purchasing.
I am away during Open

Enrolment period?
If you will be on a short-term leave with pay or on vacation during the Open Enrolment period, you must contact MyHR before you leave
if you wish to make changes to your benefit plan options and/or to allocate flex credits to a Health Spending Account. You can access
Employee Self Service from home, or you can find the change forms on MyHR.
I am on Short Term Illness and

Injury Plan (STIIP)?
You are eligible to continue in the flexible benefit options you have at the time you commence STIIP. You can participate in Open Enrolment
and make changes if you have an eligible life event.
I am approved for Long Term

Disability (LTD)?
Benefits in place prior to being approved for LTD will remain in place during the LTD period, and $200 flex credits (dollars) will be allocated
to your Health Spending Account.
I commence a rehabilitation
trial?
If you return to work on a rehabilitation trial after being on LTD, your LTD claim continues to be active and there are no changes to your
benefits coverage.
I return to work from Long

Term Disability?
If you return to work during the same plan year (calendar year), you are reinstated in the options you selected within the Flexible Benefits
Program and are eligible to make changes at the next Open Enrolment or eligible life event windows. If you return to work in a different
plan year (calendar year), you will have the opportunity to make new selections in the Flexible Benefits Program at that time.
I am on a leave with pay?
During these leaves, you may participate in Open Enrolment and make changes after eligible life events. Contact MyHR for information.
13
Work status changes
I am on a leave without pay?
You cannot make changes to your options while you are on a leave without pay. You may continue in the benefit plan options that you
have at the time you commence your leave by paying the benefit premiums, otherwise coverage will terminate until you return to work.
If you return to work during the same plan year (calendar year), you will be reinstated in the options you selected within the Flexible
Benefits Program and would be eligible to make changes at the next Open Enrolment or eligible life event windows. If you return to work in
a different plan year (calendar year), you will be able to make your new selections in the Flexible Benefit Program at that time. If you choose
not to continue your employee or spouse optional life insurance during your leave, and your leave extends beyond 90 days, you will be
required to provide evidence of insurability if you wish to reinstate these benefits.
I am on a Maternity/Parental/
Pre-placement Adoption
Leave?
You may participate in Open Enrolment during your leave. Benefits in place prior to your leave will remain in place during this leave.
The birth of a child is an eligible life event. As such, you have 60 days from the birth of your child to update your benefits coverage (except
for changes related to the optional Health Spending Account, which can only be made during Open Enrolment). After 60 days, you can still
add your child to your coverage, but you cannot change your options.
If you choose, you may waive Medical Services Plan and/or extended health and dental plan coverage during your leave. Employees often
consider this if they have coverage under their spouses plan or if they want to minimize repayment of benefits if they are unsure about
returning to work after their leave.
Maintenance of employee life insurance and long term disability coverage is mandatory during your leave. If you do not satisfy the return to
work requirements after your leave, you will be required to pay for these and any other benefit premiums paid on your behalf during your
leave. For more information, visit MyHR.
I travel out of province?
Your coverage depends on a number of factors, including whether you are on government business, on vacation or on a leave of absence.
Contact MyHR at 1-877-277-0772.
Note: The Medical Services Plan strongly advises B.C. residents to purchase additional health insurance when traveling out-of-province to
cover the cost of services not included in the plan. Detailed information is available on MyHR.
My employment terminates
and Im rehired within 90 days
to an excluded position that is
eligible for flexible benefits?
When your flexible benefits are reinstated, you will receive the same coverage you had prior to termination. You cannot make changes until
the next Open Enrolment period or eligible life event windows.
14
Work status changes
I am actively working and I

reach the age of 65?
Coverage for Medical Services Plan, extended health and dental does not change when you turn 65. However, you are no longer eligible for
employee basic life insurance or for any of the optional life insurance or optional accidental death and dismemberment insurance products.
To learn more about converting to individual benefits plans, see page 49. Note that Long Term Disability also ends at age 65.
I retire from the BC Public

Service?
Your coverage ends at the end of the month in which you retire.
I resign from the BC Public

Service?
Your extended health and dental coverage terminates on your last day of work. All other flexible benefits terminate on the last day of the
month of your date of termination. Any balances remaining in your Health Spending Account or taxable cash are forfeited.
I die?
Employee coverage
Flexible benefits coverage will terminate at the end of the month in which the death occurs.
Retirement benefits are administered through the BC Public Service Pension Plan. The benefits coverage available under the Public Service
Pension Plan is different from this program. Review retirement benefits criteria at the BC Pension Corporation website.
Medical Services Plan coverage for dependents

Dependent coverage will terminate at the end of the month in which the death occurs. Cancellation of the dependent coverage will
generate an individual account for any covered dependents. Dependents are advised to contact the Medical Services Plan at 1-800-6637100 to confirm coverage and contact information so there is no lapse in coverage.
Extended health, dental plan and Health Spending Account coverage for dependents
Extended health, dental plan and HSA terminates at the end of the month following the month in which the employee dies (e.g. extended
health, dental plan and HSA terminates on April 30 when the employees death occurs in March). Under the conversion policy, dependents
can purchase individual extended health and dental plan coverage, evidence free and with no waiting period, within 60 days of the end of
the month in which the group coverage ends. Of course, family members are free to purchase coverage from any health insurance carrier
they choose.
Optional life and optional AD&D coverage for dependents
Coverage ends at the end of the month in which the death occurs. Covered dependents have the opportunity to apply for individual
coverage. See Converting to individual benefits on page 49 for further information.
15
Choices at a glance
Important
Everyone is unique and has different needs for benefits. There are plenty of
choices in the Flexible Benefits Program to enable you to create a benefits
package to meet your needs. For each benefit, you will either select the option
that best meets your needs or you will waive that coverage. The exception is
with employee life insurance you must maintain a minimum ($25,000) level of
coverage.
The following tables summarize the coverage in each option of each benefit plan, starting with the Medical
Services Plan of B.C.
For your convenience, weve included annual net pricing information with each table. See sidebar for full details.
Note that the fully funded option is shaded in blue in each benefit plan.
MEDICAL SERVICES PLAN

Medical Services Plan coverage
Annual price (all family sizes)
Waive
Option 1
(fully funded)
No coverage
Coverage
$117 CR
$0
If the cost of the option you

choose is less than the fully funded
option, you will have left-over flex
credits. The annual price, in green,
will show a dollar amount credit
(e.g. $117 CR).
choose is $0, this is the fully
funded option. It is shaded in blue
for ease of reference.
choose is greater than the fully
funded option you will have to
partially pay for that option. The
annual price, in red, will show a
dollar amount cost (e.g. $108).
16
Choices at a glance
EXTENDED HEALTH PLAN
Waive
Option 1
Option 2
Option 3
(fully funded)
Option 4
Option 5
(two year lock-in)
Annual deductible
No coverage
$80
$200
$80
$0
$0
Reimbursement (for most expenses

including prescription drugs)
No coverage
20%
80%1
80%1
80%1
100%
Vision
No coverage
$250/2 years
None
$250/2 years
$500/2 years
$500/2 years
Paramedical services (acupuncture,

chiropractor, massage therapy,
naturopathic physician, physiotherapy,
podiatry)
No coverage
$300/year/person
combined
(all services)
$800/year/person
combined
(all providers)
$200/year/person ($500/ family)/service

except:
$500/year/person/
service
$500/year/person/
service
Hearing aids (Adult: 4 years/

Child: 2 years)
No coverage
$700 per ear
$700 per ear
$1,500 per ear
$1,500 per ear
$1,500 per ear
$300 CR
$198 CR
$135 CR
$0
$108
$309
Employee + 1 dependent
$216
$417
Employee + 2 or more dependents
$324
$525
Option 4
(fully funded)
Option 5
Option 6
(two year lock-in)
massage therapy ($750/person/year)

physiotherapy (no annual maximum)
Annual price
Employee only
DENTAL PLAN
Waive
Option 1
Option 2
Option 3
Basic services
recall exams every 6 months for
dependent children and every 9 for
adults, unless otherwise stated.
No coverage
20%
80%
100%
Recall for adults:
6 months
100%
100%
100%
Recall for adults:
6 months
Major services
No coverage
50%
65%
No coverage
65%
75%
85%
Orthodontic services
(Note: LTM = lifetime maximum)
No coverage
50% with LTM

of $2,000
No coverage
No coverage
55% with LTM

of $3,500
No coverage
55% with LTM

of $5,000
$300 CR
$195 CR
$96 CR
$75 CR
$0
$42
$213
Employee + 1 dependent
$84
$426
Employee + 2 or more dependents
$120
$633
Annual price
Employee only
Reimbursement at 80% for the first $1,000, then at 100% for the balance of the year.
Cost to you
Left-over flex credits
17
Choices at a glance
EMPLOYEE BASIC LIFE INSURANCE
Option 1
Option 2 (fully funded)
Option 3
Coverage
$25,000
$80,000
3x annual salary (minimum $80,000)
Annual price (Employees portion)
$112 CR
$0
(0.00612 x annual salary) - $163*
OPTIONAL LIFE INSURANCE
Waive
Employee
You must choose Option 3 of employee
basic life insurance to apply for this coverage.
Spouse
No coverage
No coverage
Child
No coverage
Option 1
Units of $25,000 to
$1 million maximum
Units of $25,000 to
$500,000 maximum
$11.28 per unit of $5,000
to a maximum of $20,000
Note: A minimum amount of life

insurance is required. Evidence of
insurability is not required on first
enrolment, but it is required for
future increases.
ANNUAL RATE FOR EACH UNIT ($25,000) OF COVERAGE

FOR OPTIONAL LIFE INSURANCE (NS=NON-SMOKER; S=SMOKER)
Under 35
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
Female (NS)
$9
$12
$18
$30
$48
$78
$105
Gender\Age (yrs)
Female (S)
$12
$18
$30
$54
$87
$132
$183
Male (NS)
$15
$15
$21
$45
$84
$138
$183
Male (S)
$30
$33
$54
$99
$168
$285
$381
Note: During initial enrolment, you and your spouse are eligible for up to $50,000 of optional life
insurance evidence free. Evidence of insurability is required for all future increases.
OPTIONAL
ACCIDENTAL
DEATH AND
DISMEMBERMENT
INSURANCE
Employee
Spouse
Waive
Option 1
Rates for Option 1
OPTIONAL FAMILY FUNERAL

BENEFIT
Waive
No coverage
No coverage
Units of $25,000 to
$500,000 maximum
$9.60 per unit of $25,000
No coverage
Units of $25,000 to
$500,000 maximum
$9.60 per unit of $25,000
No coverage
Units of $10,000 to
$250,000
$3.30 per unit of $10,000

(single rate covers all
listed children)
Child
Annual price
$0
HEALTH SPENDING ACCOUNT (HSA)
Waive
No HSA
Option 1
$10,000 spouse
$5,000 per child
$25.80
Option 1
Elect HSA and allocate
a minimum of $100 flex
credits to it.
Note: You may only allocate funds to an HSA during initial enrolment and Open Enrolment.
Cost to you
Left-over flex credits
18
The Medical Services Plan of B.C. insures medically-required services provided by physicians
and supplementary health care practitioners to all eligible British Columbians.
All British Columbia residents must be covered under the
Your Medical Services Plan options
Medical Services Plan.
After you enrol for coverage under the Flexible Benefits

Program, your employer will pay 100 per cent of your Medical
Services Plan premiums, which are valued at more than $800
per year (more if you have a family). For information about how
to enrol, see page 8.
Eligibility
To be eligible for coverage, employees and their dependents
must:
Be residents of British Columbia.
Be Canadian citizens, permanent residents or temporary
document holders.
Employees must also meet the eligibility requirements for
regular and auxiliary employees.
If you and/or your dependents recently moved to B.C., the
Medical Services Plan requires a waiting period of the
remainder of the month in which your residence in B.C. is
established, plus two months.
First Nations and Inuit Residents

Status Native and Inuit residents usually enrol through Health
Canadas First Nations and Inuit Health Branch. For further
information about Medical Services Plan coverage for status
Native and Inuit peoples, visit Ministry of Health website.
Waive
If you waive coverage under the Flexible Benefits Program:
You must have coverage elsewhere or a self-administered
account will automatically be set up for you and you will be
billed directly by Health Insurance BC.
You will receive flex credits that you can use elsewhere.
Note: All employees, regardless of family status, will receive
the same number of flex credits upon waiving a benefit plan.
Option 1
Important
You are responsible for any
premiums you incur for any period
during which you were eligible
but were not enrolled in the group
plan.
The Medical Services Plan insures
services like your doctors visits,
lab services and diagnostic
procedures, like X-rays. For more
detailed information on Medical
Services Plan benefits, visit the
Ministry of Health website.
You can select coverage for:

Employee only
Employee plus one dependent
Employee plus two or more dependents
Note: You must list any dependents you wish to cover.
Option 1 is fully funded so your annual price is $0.
Things to consider
If you and your spouse both have access to this benefit, only
one person needs to enrol for coverage for the whole family.
Because this is a taxable benefit, it is important to ensure you
are only enrolled once to avoid paying unnecessary taxes.
There may be a tax advantage for the lower income earner
to provide coverage, but individual circumstances will vary.
19
The extended health plan is designed to partially reimburse you for a specific group of
medical expenses which are not covered by the Medical Services Plan or the PharmaCare
program.
Overview
CARESnet
Pacific Blue Cross administers your extended health plan on

behalf of your employer. Detailed descriptions of expenses
eligible for reimbursement under this plan are provided in the
table beginning on the following page.
CARESnet is the Pacific Blue Cross self-service website for

your extended health and dental plans. Log in to:
There is a lifetime maximum of $250,000 per covered person.

This lifetime maximum may be reinstated after paying for
any one serious illness on the basis of satisfactory evidence
provided by the employee to the carrier of complete recovery
and return to good health.
Submit eClaims.
Submit/update direct deposit banking information.
Important
It is your responsibility to verify
that an item or service is covered
prior to purchase. Contact Pacific
Blue Cross if the item is not listed
in this guide.
It is recommended that you get
an expense pre-approved if the
cost is over $1,000.
View your coverage at a glance.

Track your eligibility and limits.
Print replacement ID cards.
Reimbursement
Your rate of reimbursement depends on the option you select.
20
What is covered by your extended health plan?

The following is a list of expenses eligible for reimbursement under the extended health plan when incurred as a result of a
necessary treatment of an illness or injury and, where applicable, when ordered by a physician and/or surgeon. Check CARESnet
for detailed information. The value of your entitlement will be impacted by the option you select because there are differences in
annual deductibles and reimbursement percentages.
Feature
Accidental injury to teeth
Entitlement
Dental treatment by a dentist or denturist for the repair or replacement of natural teeth or prosthetics, which is required and performed
and completed within 52 weeks after an accidental injury that occurred while covered under this plan. No reimbursement will be made for
temporary, duplicate or incomplete procedures, or for correcting unsuccessful procedures. Expenses are limited to the applicable fee guide
or schedule.
Accidental means the injury was caused by a direct external blow to the mouth or face resulting in immediate damage to the natural teeth
or prosthetics and not by an object intentionally or unintentionally being placed in the mouth.
Acupuncture
Acupuncture treatments performed by a medical doctor or an acupuncturist registered with the College of Traditional Chinese Practitioners
and Acupuncturists of British Columbia. See the Paramedical services section of this table for information about reasonable and customary
limits.
Braces, prosthetics and

supports
Effective March 1, 2013, to be eligible for reimbursement, you must include a practitioners note for all prosthetics, braces and supports to
confirm the medical need for the device. Accepted practitioners include licensed chiropractors, physiotherapists and physicians.
These devices typically contain hard plastic or metal - common examples include wrist braces (for carpal tunnel syndrome from repetitive
stress), knee braces with a metal support structure and prosthetic limbs.
Breast prosthetics
See the Mastectomy forms and bras section of this table for information.
Chiropractor
Chiropractic treatments performed by a chiropractor registered with the College of Chiropractors of British Columbia. See the Paramedical
services section of this table for information about reasonable and customary limits.
Note: X-rays taken by a chiropractor are not eligible for reimbursement.
Contraceptives
Prescribed oral or injectable contraceptives. See the Drugs and medicines section of this table for information.
21
Counsellors, registered clinical
Service fees of a registered clinical psychologist or counsellor payable to a maximum of $500 per family per calendar year. The practitioner
must be registered in the province where the service is rendered.
To determine if a psychologist is registered for claiming purposes, contact the College of Psychologists of B.C. at 604-736-6164
(toll free 1 800 665-0979).
To determine if a counsellor is registered for claiming purposes, contact the BC Association of Clinical Counsellors at 250-595-4448 (toll free
1 800 909-6303).
Visit the Health & Well-Being section of MyHR for information about the free short-term counselling services available to you.
Drugs and medicines
Covered drugs and medicines purchased from a licensed pharmacy, which are dispensed by a pharmacist, physician or dentist subject to
PharmaCares policies including reference-based pricing and lowest cost alternative.
Drugs and medicines include:

Injectables provided by a medical practitioner and drugs used by a medical practitioner when providing services under circumstances
whereby the drug is not otherwise provided.
Insulin preparations, testing supplies, needles and syringes for diabetes.
Vitamin B12 for the treatment of pernicious anaemia.
Allergy serums when administered by a physician.
Other drugs and medicines that require a prescription from a medical provider who is legally authorized to do so, including oral and
injectable contraceptives.
Reimbursements are subject to the deductible and percentage in the option you select. Generally the reimbursement percentage will be
applied to the first $1,000 per person in a calendar year, and then 100 per cent coverage for the balance of that year.
Reimbursement of eligible drugs and medicines will be based on a maximum dispensing fee of $7.60 and a maximum mark-up of 7 per
cent over the manufacturers list price. Use Pacific Blue Cross Pharmacy Compass to find the best price for your medications.
All plan members must sign up for PharmaCare to assist with prescription coverage, limiting the impact on your lifetime maximum.
Note: You will be required to apply for PharmaCare Special Authority for certain high-cost drugs before you can claim these drugs under the
extended health plan.
Emergency ambulance
services
Emergency transportation by licensed ambulance to the nearest Canadian hospital equipped to provide medical treatment essential to the
patient.
Air transport when time is critical and the patients physical condition prevents the use of another means of transport. Doctors note may be
required.
Emergency transport from one hospital to another only when the original hospital has inadequate facilities.
Charges for an attendant when medically necessary.
22
Examinations, medical
Medical examinations rendered by a physician, required by a statute or regulation of the provincial and/or federal government for
employment purposes, for you and all of your registered dependents provided such charges are not otherwise covered.
Examinations, vision
Fees for routine eye examinations to a maximum of $75 per 24 months per person between the ages of 19 and 64, when performed by a
physician or optometrist.
Note: Exams for persons under age 19 and over age 64 are covered under the Medical Services Plan. Your practitioner may charge more
than what is payable by the Medical Services Plan for this service. The balance is not covered by your extended health plan.
Hairpieces and wigs
Hairpieces and wigs for chemotherapy and alopecia patients are eligible for reimbursement to a maximum of $500 per 24 months.
Hearing aids and repairs
Reimbursements per ear per 48 months for adults and 24 months for children. This benefit is not subject to an annual deductible.
Note: Batteries, recharging devices or other such accessories are not covered.
Hospital charges
Additional charges for semi-private or private accommodation over and above the amount paid by provincial health care for a normal daily
public ward while you are confined in a hospital under active treatment. This does not include telephone or TV rental or other amenities.
Massage therapy
Massage treatments performed by a massage practitioner registered with the College of Massage Therapists of British Columbia. See the
Paramedical services section of this table for information about reasonable and customary limits.
Note: X-rays taken by, and drugs, medicines or supplies recommended and prescribed by a massage therapist are not covered.
Mastectomy forms and bras
Mastectomy forms and bras are eligible for reimbursement to a maximum of $1,000 per calendar year.
23
Medical aids and supplies
A variety of medical aids and supplies as follows:

For diabetes:
Testing supplies, needles and syringes; or
Insulin injector; or
Insulin infusion pumps if other methods are not suitable.
Note: If you switch from using testing supplies to an insulin injector, testing supplies are not covered for the next 60 month
consecutive period.
Light boxes including light visors used for the treatment of seasonal affective disorder.
Oxygen, blood and blood plasma.
Ostomy and ileostomy supplies.
Aerochambers.
Elastic support stockings.
Walkers, canes and cane tips, crutches, splints, collars and trusses (elastic or foam supports are not covered).
Rigid support braces and permanent prostheses (artificial eyes, limbs and larynxes).
Note: Myoelectrical limbs are not covered but the plan will pay an amount equal to the cost of a standard prostheses.
Stump socks to a maximum of $200 per calendar year.
Standard durable equipment as follows:

The cost of renting, where more economical, or the purchase cost of durable equipment for therapeutic treatment including:
Manual wheelchairs, scooters, manual type hospital beds and necessary accessories.
Note: If the patient is incapable of operating a manual wheelchair, an electric wheelchair will be covered; otherwise, the plan
will pay the equivalent of a manual wheelchair.
Cardiac screeners and blood glucose monitors.
Growth guidance systems.
Breathing machines and appliances including respirators, compressors, suction pumps, oxygen cylinders, masks and regulators.
Continuous positive airway pressure machine when prescribed for sleep apnea.
Infant apnea monitor.
Note: Pre-authorization is recommended for items costing over $1,000 and is required for items over $5,000.
24
Naturopathic physician
Naturopathic services performed by a naturopathic physician licensed by College of Naturopathic Physicians of British Columbia. See the
Note: X-rays taken by, and drugs, medicines or supplies recommended and prescribed by a naturopathic physician are not covered.
Needleless injectors
When prescribed by a physician:

needleless injectors are payable up to $500/60 months;
diabetic needles are payable up to $500/60 months.
Note: You cannot claim both.
Orthotics and orthopedic

shoes
When prescribed by a physician or podiatrist for the proper management of congenital or post-traumatic foot problems, custom-fit
orthotics or orthopedic shoes, including repairs, orthotic devices and modifications to stock item footwear. Payable to a maximum of $400
per person per calendar year.
Note: Arch supports/inserts are not covered.
Note: Prior to obtaining services for these items, visit Pacific Blue Cross for important information about claiming for orthotics and
orthopedic shoes.
Out-of-province emergencies
Reasonable charges for a physicians services due to an emergency are eligible for reimbursement, less any amount paid or payable by the
Medical Services Plan, subject to the lifetime maximum of the plan. See page 28 for information about coverage while traveling.
Paramedical services
Services provided by licensed paramedical practitioners. For the purposes of this plan, paramedical services are a defined group of
services and professions that supplement and support medical work but do not require a fully qualified physician. These services include:
acupuncture, chiropractor, massage therapy, naturopathic physician, physiotherapy, and podiatry.
Acupuncture
Chiropractor
Massage therapy
Naturopathic physician
Physiotherapy
Podiatry
Physiotherapist
Paramedical services are subject to reasonable and customary limits. That is, for a given paramedical service (e.g. massage therapy),
paramedical services claims may continue to be considered for up to and including the 24th visit per calendar year, per person. After the
24th visit, you will be required to provide a note from the attending medical doctor that indicates the nature of illness and the prognosis for
future claims to be considered. For more information on reasonable and customary limits, visit the Pacific Blue Cross website.
Professional services performed by a physiotherapist registered with the College of Physical Therapists of British Columbia. See the
25
Podiatrist
Professional services performed by a podiatrist registered with the British Columbia Association of Podiatrists. See the Paramedical services
section of this table for information about reasonable and customary limits.
Note: X-rays taken or other special fees charged by a podiatrist are not covered.
Private duty nurse
Fees for a registered nurse for special duty nursing in acute cases while you are registered as a bed patient in a public general hospital.
Referral by a physician is required.
The special duty nurse providing the service must not be related by blood or marriage (legal or common-law) to the covered person and
must not be an employee of the hospital in which the special nursing services are performed.
Prostate-Serum Antigen test
Once per calendar year.
Psychologists, registered
clinical
Service fees of a registered clinical psychologist or counsellor to a maximum of $500 per family per calendar year. The practitioner must be
registered in the province where the service is rendered.
To determine if a psychologist is registered for claiming purposes, contact the College of Psychologists of BC at 604-736-6164
(toll free 1 800 665-0979).
To determine if a counsellor is registered for claiming purposes, contact the BC Association of Clinical Counsellors at 250-595-4448 (toll free
1 800 909-6303).
Visit the Health & Well-Being section of MyHR for information about the free short-term counselling services available to you.
Smoking cessation products
Drugs and supplies for prescriptions and non-prescription smoking cessation.

Maximum: $300/year/individual to a lifetime maximum of $1,000
Note: You must register with the Quittin Time program on MyHR prior to purchasing any products. Pacific Blue Cross requires a copy of your
registration confirmation form to process your claims.
Vision care
This benefit is not subject to the deductible. Corrective eyewear prescribed by an optometrist, ophthalmologist or physician and/or laser
eye surgery. Corrective eyewear includes lenses, frames, contact lenses, prescription sunglasses, prescription safety goggles, and vision care
repairs. Charges for non-prescription eyewear are not covered. Eye exams are a separate feature. See the Examinations, vision section of this
table for information.
Note: Any item not specifically listed as being covered under this plan is not an eligible item under this extended health plan.
26
Your extended health plan options

Waive
Option 4
If you waive extended health coverage under the Flexible

Benefits Program you will receive flex credits that you can use
elsewhere. Note: All employees, regardless of family status, will
receive the same number of flex credits upon waiving a benefit
plan.
Option 4 has no deductible and provides more comprehensive

coverage for vision and some paramedical services.
Option 1
Option 1 is a low-cost option which provides a low level
of coverage for most services. This option has a deductible.
This option may work well if you are able to coordinate your
benefits with your spouses plan, depending on terms of his/
her plan. Note that if you are coordinating benefits with
your spouse and you select this option, your reimbursements
under this option (e.g. when you go to the pharmacy) will be
the lower portion (i.e. 20 per cent), with the more significant
portion being reimbursed through your spouses plan after
you have submitted a claim to that plan. Its important to be
aware of this so there are no surprises when you are paying for
products and services.
Option 2
Option 2 is also a low-cost option. Option 2 has a higher
deductible and no vision coverage but provides a higher
reimbursement than Option 1 for most services.
Option 5
Dont miss out

Extended health plan coverage is
not automatic. You must enrol and
list any eligible dependents.
Option 5 has no deductible, has a higher reimbursement rate

for the first $1,000 of coverage and includes the higher vision
coverage found in Option 4.
Note: This option has a two-year lock-in, so if you choose it, you
must remain under this option for two plan years.
Things to consider
Given your claims history and any anticipated future medical
expenses, which option offers the best value? Reviewing
your past claims information can help you with anticipating
future expenses.
If you are covering dependents, which dependents will you
cover? Given their claims history, which option offers the
best value for you?
If you are able to coordinate benefits with a spouse, which
option offers the best value to you?
Option 3
Option 3 provides a medium level of coverage in all identified
areas and is the fully funded option. This option has a
deductible.
27
Out-of-province coverage
Business Travel
Medi-Assist travel emergency numbers
If you are covered under this extended health plan and you
travel out-of-province or out-of-country on business for the
BC Public Service, you are covered for medical emergencies
including those resulting from pre-existing conditions to
a lifetime maximum of $3 million. Review Section C.9 and
Section C. 11 of the core Policy and Procedures Manual for
important information about travel medical insurance and a
link to the Foreign Travel Guide.
The extended health plan includes a worldwide medical

assistance provision called Medi-Assist that provides
communication services from anywhere in the world 24 hours
a day seven days a week.
Personal Travel
Should you or an eligible dependent have a medical
emergency while traveling out-of-province or out-of-country,
the extended health plan will pay eligible medical expenses in
excess of the payment made by the Medical Services Plan of
B.C.
Because extended health benefits are subject to a lifetime
maximum of $250,000 per person and emergency expenses
can exceed this amount consider purchasing medical travel
insurance during periods of personal travel.
Trained personnel who speak various languages will help you

locate medical care, arrange emergency and routine medical
transportation, assist travel companions, contact relatives,
employers and personal physicians, and assist in facilitating
claims payment. See the Medi-Assist brochure for more
information.
Medi-Assist provides advice and coordinates services at no
additional charge. However, it is not a means of paying for
any of the services that you may require. The actual cost for
any service(s) received is your responsibility. Some of these
expenses may be claimed through Medical Services Plan
of B.C., travel insurance purchased by you or your extended
health plan.
Medical Travel Insurance

Travel insurance plans can vary significantly. Some insurance
carriers require that you first exhaust the lifetime maximum
under your extended health plan before they will reimburse
you. It is recommended that you purchase travel insurance
from a carrier that reimburses first, such as Pacific Blue Cross,
which also offers a discount to plan members.
Note: When purchasing travel insurance, make sure you
understand the fine print. Most individual policies, including
those offered by Pacific Blue Cross, exclude coverage for preexisting conditions.
28
Dental plan
The dental plan is designed to assist you with the cost of your dental care and reimburses
most basic and major dentistry and orthodontic services.
Overview
Pacific Blue Cross administers your dental plan on behalf of
your employer. Dental coverage is available for services in B.C.
and for emergency dental services while traveling anywhere
outside of B.C. The plan will cover eligible expenses up to
the amount it would have covered had the services been
performed in B.C.
Dental services fall into three categories or plans:

Plan A - Basic preventative and restorative services.
Plan B - Major services.
It is your responsibility to verify

that an item or service is covered
prior to purchase. Contact Pacific
Blue Cross if the item is not listed
in this guide.
Plan C - Orthodontic services.
It is your responsibility to contact Pacific Blue Cross (see

page 51 for contact info) to verify that certain procedures are
covered before the treatment is performed.
Detailed information about each of these plans follows. Your

available options cover each plan differently. See page 32 for
details about your options.
For information about how to enrol, see page 8.
Reimbursement
For information about how to make a claim, see page 45.
Your rate of reimbursement depends on the option you select.
CARESnet
Note: Dentists set their own rates for service, but

reimbursement of dental fees under this group plan is subject
to the dental fee guide and to plan limits.
CARESnet is the Pacific Blue Cross self-service website for your

extended health and dental plans. Log in to:
Important
You are responsible for any fees that exceed plan limits.
Submit eClaims.
Submit/update direct deposit banking information.
View your coverage at a glance.
Track your eligibility and limits.
Print replacement ID cards.
29
Dental plan

Plan A Basic preventative and
restorative services
Basic dentistry comprises services that are routinely available in
the office of a general practising dentist and are necessary to
restore teeth to natural or normal function.
Gingivectomy/gingivoplasty, pit and fissure sealants,

preventative restorative resins.
Fixed space maintainers intended to maintain space and
regain lost space but not to obtain more space.
Restorative services
Standard oral exams.
Fillings amalgam fillings and composite (white) fillings on

all teeth. Note: Specialty fillings and crowns such as synthetic
porcelain plastic, composite resin, stainless steel and gold
may result in additional cost to be paid by the employee or
dependent.
Specific oral exams.
Stainless steel crowns on primary and permanent teeth.
X-rays, including panoramic X-rays.
Inlays and onlays.
Note:
Note:
A specific oral exam will be reimbursed once for any

specific area and only if a standard oral exam has not been
reimbursed within the previous 60 days.
Only one inlay, onlay or other major restorative service

involving the same tooth will be covered in a five-year
period.
Diagnostic services
Recall or new patient exams are conducted to determine or
diagnose the dental treatment required, including:
A complete oral exam will be reimbursed only once every

three years, provided that the plan has not reimbursed for
any examination during the preceding nine months.
Preventative services
Procedures that prevent oral disease, including:
Cleaning and polishing teeth.
Topical fluoride.
Treatment of disease of the soft tissue (gum) and bones
surrounding and supporting the teeth, including occlusal
adjustment, recontouring of teeth, root planning, gingival
curettage and scaling, but excluding grafts.
Important
Check-up schedule
For dependent children under 19
years of age, general recall services
(oral exam, polishing, scaling and
fluoride) are covered once every
six calendar months.
For adults and students covered
under the dental plan, age 19 and
older, these services are covered
once every nine calendar months.
Surgical services
Extractions and other surgical procedures necessary for the

treatment of diseases of the soft tissue (gum) and bones
surrounding and supporting teeth, but not tissue grafts.
Replacements and repairs
Repair of fixed appliances and the rebase or reline of

removable appliances (may be done by a dentist or by a
licensed dental mechanic). Relines will only be covered once
per 24-month period.
With crowns, restoration for wear, acid erosion, vertical
dimension and/or restoring occlusion are not covered.
Check with Pacific Blue Cross before proceeding.
30
Dental plan
Replacement and repairs
Temporary procedures (e.g. while awaiting repair of an

appliance) are not covered.
Removal, repairs and recementation of fixed appliances.
Plan B Major services
Plan C Orthodontic services
Major services applies to services required for reconstruction

of teeth and for the replacement of missing teeth (e.g. crowns,
bridges and dentures), where basic restorative methods
cannot be used satisfactorily. To determine how much of the
cost will be paid by the plan, and the extent of your financial
liability, you should submit a treatment plan to Pacific Blue
Cross for approval before treatment begins.
This plan is designed to cover orthodontic services provided

to maintain, restore or establish a functional alignment of the
upper and lower teeth. The plan will reimburse orthodontic
services performed after the date coverage begins.
Restorative services
A treatment plan (completed by the dentist) before

treatment starts.
Crowns and related services.

Note: Specialty crowns and fillings such as synthetic
porcelain plastic, composite resin, stainless steel and gold
may result in additional cost to be paid by the employee or
dependent.
Photocopies of receipts monthly, as treatment progresses

(do not hold receipts until the treatment is complete).
Veneers.
Buildups.
Fixed prosthetics
Bridgework to artificially replace missing teeth with a fixed

prosthesis.
Removable prosthetics
Pre-approval
To claim orthodontic benefits, Pacific Blue Cross must receive:
Important
Plan limits
A dentist may charge more for
services than the amount set in
the governing schedule of fees or
may offer to provide services more
frequently than provided for in
the fee guide. You are responsible
for any financial liability resulting
from services performed which
are not covered or that exceed the
costs covered by the plan.
Reimbursement
The carrier will pay benefits on a monthly basis. If you pay the
full amount to the dentist in advance of completed treatment,
the carrier will prorate benefit payment over the months of the
treatment period.
No benefit is payable for the replacement of appliances which
are lost or stolen.
Treatment performed solely for splinting is not covered.
Full upper and lower dentures or partial dentures of basic

standard design and material. Full dentures can be provided
by a dentist or a licensed dental mechanic. Partials can
only be provided by a dentist. No benefit is payable for
the replacement of lost, broken or stolen dentures. Broken
dentures can, however, be repaired under Plan A.
31
Dental plan
Your dental plan options

Waive
Option 5
If you waive dental plan coverage under the Flexible Benefits

Program you will receive flex credits that you can use
elsewhere. Note: All employees, regardless of family status, will
receive the same number of flex credits upon waiving a benefit
plan.
Option 5 provides a medium level of dental coverage without

orthodontics. It reimburses Plan A at 100 per cent and Plan B
at 75 per cent. This option does not provide any coverage for
Plan C.
Option 1
Option 1 is a low-cost option with a lower level of dental
coverage. This option may work well if you are able to
coordinate your benefits with your spouses plan, depending
on terms of his/her plan. This option reimburses Plan A at 20
per cent, Plan B at 50 per cent and Plan C at 50 per cent (with a
lifetime maximum of $2,000 per person).
Option 2
Option 2 is a low-cost option without orthodontics. That is, it
reimburses Plan A at 80 per cent and Plan B at 65 per cent, but
does not provide any coverage for Plan C.
Dental plan coverage is not

automatic. You must enrol and list
any eligible dependents.
Option 6
This option provides a higher level of coverage, including
orthodontics. It reimburses Plan A at 100 per cent, Plan B at
85 per cent and Plan C at 55 per cent (with lifetime maximum
$5,000 per person).
Note: This option has a two-year lock-in, so if you choose it, you
must remain under this option for two plan years.
Things to consider
If you are covering dependents, which dependents will you
cover?
Option 3
Which features of the dental plan are most important to

you and your dependents (e.g. basic dental, major service,
orthodontics)?
Option 3 reimburses Plan A at 100 per cent. This option does

not provide any coverage for Plan B or Plan C.
If you are able to coordinate benefits with a spouse, which

option offers the best value to you?
Option 4
Note: Any item not specifically listed as being covered under

this plan is not an eligible item under this extended health
plan.
Option 4 provides a medium level of dental coverage. It

reimburses Plan A at 100 per cent, Plan B at 65 per cent and
Plan C at 55 per cent (with lifetime maximum $3,500 per
person). This is the fully funded option.
Dont miss out
32
Life insurance plans help protect you and your loved ones from the financial burden of a loss.
The Flexible Benefits Program provides a basic level of life insurance plus the opportunity to
buy additional optional life insurance for you and your dependents.
Overview
Great-West Life (Policy 6878GL5) administers your life insurance
plan on behalf of your employer. The plans available through
the Flexible Benefits Program include:
(e.g. if you get married/divorced or if you have children). The

beneficiary designation form is available on MyHR.
Changes in insurance
Optional accidental death and dismemberment insurance

(employee/spouse/child).
All increases and additions of new benefits are subject to

the actively-at-work requirement unless the changes are a
result of earnings changes that take effect during sick leave.
The actively-at-work rule applies to all life insurance plans.
Also, additions to and increases in benefits coverage are
subject to approval by the benefits carrier, which makes the
determination based on the medical evidence (evidence of
insurability) you must supply.
Things to consider
How to make a claim
Do you have a spouse and/or dependents?
For information about how to make a claim, see page 45.
Employee basic life insurance.

Optional life insurance (employee/spouse/child).
Optional family funeral benefit.
Important
Converting to an individual plan
If your employment ends or you
reach age 65, you can apply
to convert to an individual life
insurance plan. See Converting
to Individual Benefits Plans (page
49) for more information and
important application deadlines.
Do you have other life insurance policies?

What are your familys financial needs?
The importance of designating a beneficiary

Life insurance payments are non-taxable when paid to one or
more designated beneficiaries, and only a named beneficiary
can apply for the funeral advance. If paid to an employees
estate, the insurance becomes part of the proceeds of the
estate and may become taxable. For these reasons, it is highly
recommended that you nominate one or more beneficiaries
for your life insurance during your initial enrolment and that
you keep your beneficiary designation information up-to-date
33
When is evidence of good health required

for life insurance coverage?
The rules around when you and your eligible dependents must
provide evidence of good health (evidence of insurability) are
outlined below.

Maintaining employee basic life insurance coverage is a
condition of employment, so you cannot waive coverage.
When you first enrol, you can choose any option without
having to provide evidence of good health (i.e. you will not
have to complete an evidence of insurability form).
In the future, if you choose to increase your basic employee life
insurance, you will have to provide evidence of good health,
and any increases in coverage must be approved by the life
insurance carrier before they can take effect.
In the future, if you wish to increase optional life insurance

coverage for yourself and/or your spouse, you will have to
provide evidence of good health and coverage must be
approved by the life insurance carrier before it can take effect.
Evidence of good health is not required for child optional life
insurance.
Optional accidental death and dismemberment

insurance
Evidence of good health is not required for this type of
insurance.
Family funeral benefit

Evidence of good health is not required for this type of
insurance.
Optional life insurance

You have the opportunity to purchase optional life insurance
for yourself and your family. When you first enrol, you can elect
up to $50,000 of optional life insurance coverage for yourself
and/or your spouse without having to provide evidence
of good health. If you elect more than $50,000 of optional
life insurance for yourself and/or your spouse in your initial
enrolment, you will be required to provide evidence of good
health.
34

Plan options
Employee basic life insurance is mandatory and your coverage

begins as soon as you become eligible for benefits. Coverage is
effective 24 hours a day, 7 days a week.
You cannot waive employee basic life insurance.
The life insurance plan pays a benefit to your designated

beneficiary or to your estate in the event of your death,
whether you die from accidental or natural causes.
This is the minimum level of coverage available. It provides

$25,000 of life insurance coverage.
This policy is a term life insurance policy and has no cash value.
Initial enrolment
During initial enrolment, you can select the highest level of
coverage without providing evidence of insurability. During
subsequent enrolments, if you wish to increase your life
insurance coverage, you will be required to provide evidence
of insurability to the carrier and the carrier must approve your
application before coverage can begin.
Option 1
Option 2
This is the fully funded level of coverage. It provides $80,000 of
life insurance coverage.
Important
Carefully consider the life
insurance options available to
you during initial enrolment,
especially if you (or your spouse)
have medical conditions that may
prevent you from increasing your
life insurance in the future.
Option 3
This is the highest level of coverage under the basic life
insurance plan. It provides coverage of three times annual
earnings, rounded up to the next higher $1,000. The minimum
is $80,000. The amount of your employee basic life insurance
will be adjusted automatically if there is a change in your basic
annual salary rate. Your premium will also change to reflect the
revised amount of insurance.
Note: If you wish to purchase employee optional life insurance,
you must select this option.
35
Other benefits included in the employee

basic life insurance plan
Accidental dismemberment and loss of sight
If you suffer one of the following losses as a result of an
accident, you will receive 100 per cent of the principal sum
(which is the amount of insurance in the option you elect:
$25,000, $80,000 or three times your annual earnings) for:
Loss of both hands or feet; or
Loss of sight of both eyes; or
Loss of one hand and one foot; or
Loss of one hand or one foot and sight of one eye.
If you suffer one of the following losses, you will receive 50 per
cent of the principal sum for:
Loss of one hand or one foot; or
Loss of sight of one eye.
If benefits are paid to you because of an accidental
dismemberment or loss of sight benefit claim, and you die
as a result of that injury, the payment to your beneficiary will
be reduced by the benefit payment you received before your
death.
A claim for accidental dismemberment or loss of sight should
be made in writing to MyHR. Forms and instructions will be
forwarded for you and your physician to complete.
Advance payment for terminally ill employees

If you are suffering from a terminal illness with a life expectancy
of 24 months or less, you may be eligible to receive an
advance payment of up to $50,000 or 50 per cent of your
employee basic life insurance, whichever is less. This payment
is non-taxable.
Advance payment claim forms are available from MyHR.
The remaining portion of your basic life insurance will be
paid to your designated beneficiary upon your death. Interest
payments will be charged against the advance payment.
Funeral advance
An advance of $8,000 may be expedited to the named
beneficiary in the event of your death. This does not apply if
the estate or a minor beneficiary has been named. The balance
of the employee basic life insurance benefit is payable by
following claim procedures.
To apply for the funeral advance, your beneficiary should
contact MyHR and provide the following information:
Name of deceased person;
Date of birth of deceased person;
Date of death of deceased person; and
Full name, address and phone number of beneficiary.
36
After confirming the advance is payable, the Benefits Service

Centre will contact Great-West Life and a cheque will be
mailed directly to the beneficiary, usually within a few days of
the request.
Limitations
There are no limitations or restrictions on claims for eligible
employees under age 65 or eligible retired employees under
age 65.
Coverage while on Long Term Disability

If you become disabled while insured and are approved for
Long Term Disability (LTD), your employee basic life insurance
will remain in force and the premiums will be paid by the
employer. Coverage will continue until age 65 or until recovery
from the disability, whichever occurs first.
Coverage for pensioners under age 65

You may be able to elect to continue your group life insurance
as a pensioner on your pension application form. See your
pension application package for further details.
37
Optional life insurance plans

Additional life insurance is available to you if you want to
supplement your employee basic life insurance and/or if you
wish to insure any of your dependents.
Initial enrolment
This optional plan provides employee life insurance in addition

to basic life insurance.
During initial enrolment, you can select up to $50,000 of

employee optional and/or spouse optional life insurance
coverage without providing evidence of insurability. During
subsequent enrolments, if you wish to increase your or
your spouses life insurance coverage, you will be required
to provide evidence of insurability to the carrier and your
applications must be approved before coverage can begin.
Note: You must have selected Option 3 of employee basic life

insurance to select this optional coverage.
Waiver of premium benefit on optional life insurance
Employee optional life insurance
You may select insurance in units of $25,000 up to a maximum

of $1 million. The beneficiary of this coverage is the same as
designated for basic life insurance unless otherwise specified.
Spouse optional life insurance benefit

This optional plan provides life insurance for your spouse. You
may select insurance in units of $25,000 up to a maximum of
$500,000. You are the beneficiary of the life insurance.
Child optional life insurance benefit

This optional plan provides life insurance for any/all dependent
children you choose to cover. Evidence of insurability is not
required, and you may select insurance in units of $5,000 up
to a maximum of $20,000. You are the beneficiary of the life
insurance.
Important
Carefully consider the life
insurance options available to
you during initial enrolment,
especially if you (or your spouse)
have medical conditions that may
prevent you from increasing your
life insurance in future.
If you become disabled while insured, the insurance carrier

will review whether you are eligible for a premium waiver
on the optional life insurance for yourself and your covered
dependents throughout the benefit period, subject to the
Notice of Claim provision. A waiver of premium disability
period is the waiting period plus the benefit period.
Suicide limitation on optional insurance

Optional employee and spouse life insurance benefits are
not paid if the insured person (you or your spouse) commits
suicide within two years after optional life insurance takes
effect or increases. The beneficiary will receive a refund of the
premiums paid for that insurance.
Optional family funeral benefit plan

This optional plan provides spousal life insurance of $10,000
and child life insurance of $5,000 per dependent child. You are
the beneficiary of the life insurance. Evidence of insurability is
not required.
38
Optional accidental death and dismemberment

insurance
Accidental death and dismemberment (AD&D) insurance is
available to you if you want to supplement your employee
basic life insurance coverage and/or if you wish to ensure any
of your dependents.
Three plans are available:
Employee optional AD&D
You may select insurance in units of $25,000 up to a
maximum of $500,000.
Spouse optional AD&D
Child optional AD&D
The following plan features apply to employee, spouse and/or
child AD&D coverage.
Plan features
These optional plans provide coverage if you die as a result
of an accident or suffer a qualifying injury in an accident. This
benefit does not provide coverage due to illness. Coverage is
provided 24 hours a day, 7 days a week. Evidence of insurability
is not required.
The beneficiary of this coverage is:
In the event of employees death: the same as designated
for basic life insurance unless otherwise specified.
In the event of spouses or childs death: the employee.
In the event of eligible injury to employee: the employee.
In the event of eligible injury to spouse or child: the
employee.
Eligible injuries
AD&D insurance will pay a percentage of the insurance to you
if you sustain certain injuries in an accident. Eligible injuries
usually involve dismemberment (loss of a limb, toe or finger) or
permanent loss of use, such as paralysis or vision loss.
39
Benefits
To initiate a claim
The amount of AD&D insurance you purchase is called the principal sum.
For example, if you purchase two units of $25,000 for yourself, your principal sum is $50,000. If you purchase three units of $25,000
for your spouse, your spouses principal sum is $75,000. Depending on the loss you, your spouse or your child suffers as a result of
an accident, a percentage of the applicable principal sum is paid as per the table of losses below:
For loss of:
Amount payable
Life
The principal sum
Both hands
Both feet
For loss of use of:
Amount payable
2 x the principal sum
The principal sum
Both arms and legs

(quadriplegia)
The principal sum
Both legs (paraplegia)
Sight of both eyes
The principal sum
One hand and one foot
The principal sum
One arm and one leg on same

side of body (hemiplegia)
One hand and sight of one eye
The principal sum
One arm and one leg on

different sides of body
The principal sum
One foot and sight of one eye
The principal sum
Both arms
The principal sum
Speech and hearing in both ears The principal sum
Both hands
The principal sum
One arm
of the principal sum
One hand and one leg
The principal sum
One leg
One arm
One hand
One leg
One foot
One hand
Sight of one eye
Speech
Hearing in both ears
Thumb and index finger
Four fingers of one hand
All toes of one foot
1/8 of the principal sum
Contact MyHR at 1-877-2770772 to initiate a life insurance

claim. MyHR will work with the
beneficiary to facilitate the
claiming process.
40
Important definitions regarding losses
Other benefits
Loss by dismemberment means:
If benefits are payable under this plan for a covered accident,

there may be other benefits paid in addition to loss of life,
dismemberment or loss of use benefits. The other benefits are:
For hands and feet, complete severance through or above

the wrist or ankle joints.
For arms and legs, complete severance through or above the
elbow or knee joints.
For thumb and big toe, complete severance of one entire
phalange.
For fingers and other toes, complete severance of two entire
phalanges.
Surgical reattachment
An amount equal to 50 per cent of the dismemberment
benefit is payable if a dismembered part is surgically
reattached regardless if use is regained. The balance of the
dismemberment benefit is paid if the reattachment fails and
the reattached part is removed within one year after the
reattachment is performed.
Loss of sight, speech and hearing means total and
irrecoverable loss beyond correction by surgical or other
means.
Loss of use means total and irrecoverable loss of the ability
to perform every action the arm, leg or hand was able to
perform before the accident occurred, beyond correction
by surgical or other means. Benefits will not be paid for
loss of use of the same arm, leg or hand for which loss by
dismemberment is paid.
Repatriation benefit
If a covered person (you, your spouse or your child) dies as
a result of an accident that occurred at least 150 kilometres
from the covered persons place of residence, the plan will pay
a benefit for preparation of the body and its transportation
to the place of burial or cremation. The maximum payable is
$2,500.
Educational benefit for dependent children

If a covered adult person (you or your spouse) dies as a result
of an accident and a benefit for loss of life is payable, the plan
will pay the tuition fees for enrolling your dependent children
as full-time students at a post-secondary institution. The
maximum payable is the lesser of five per cent of the principal
sum and $5,000.
Family transportation benefit

If a covered person (you, your spouse or child) is hospitalized
more than 150 kilometres from his/her home as a result of a
covered loss, the plan will pay for eligible transportation and
lodging expenses for one family member to join the injured
covered person. The maximum amount payable under this
provision is $2,000.
Occupational benefit for spouses

If a covered adult person (you or your spouse) dies as a result
of an accident, the plan will pay a benefit toward the surviving
spouses expenses for enrolment in an accredited occupational
41
training program. The program must be approved by GreatWest Life. The maximum payable is the lesser of 10 per cent of
the principal sum and $10,000.
AD&D limitations
Educational benefit for employees and spouses
Suicide while sane or insane.
If benefits are paid under this plan for a covered adult person
(you or your spouse) for a loss that requires the insured person
to change occupations, the plan will pay the enrolment fees for
training in a new occupation. The insured person must enrol at
a post-secondary institution within 365 days after the accident.
The maximum payable is $10,000.
Wheelchair benefit
If benefits are paid under this plan for a loss due to injury that
requires a wheelchair, the plan will pay for expenses associated
with:
Alterations to your principal residence to make it wheelchair
accessible and habitable.
Modifications to a motor vehicle used by the injured person
to make it accessible to and drivable by the person.
The entities making the alterations and modifications must be
approved. Benefits will not be paid for:
No benefits will be paid for loss resulting from or associated

with the following:
Intentionally self-inflicted injury while sane or insane.

Viral or bacterial infections, except pyogenic infections
occurring through the injury for which loss is being claimed.
Contact MyHR at 1-877-2770772 to initiate a life insurance

claim. MyHR will work with the
beneficiary to facilitate the
claiming process.
Disease or infirmity.
Medical or surgical treatment except for surgical
reattachment.
Service (including part-time or temporary service) in the
armed forces of any country.
War, insurrection or voluntary participation in a riot.
Air travel except as a passenger in a licensed aircraft flown
by a pilot certified to fly the aircraft. No benefits will be paid
where the aircraft is owned, leased or rented by the Province
of BC or where the person who suffers the loss is acting as a
crew member.
Expenses incurred more than 365 days after the accident.
How to make a claim
Subsequent alterations to your home or vehicle after an

initial claim for these benefits had been made.
To initiate a claim for any of the life insurance products, contact

MyHR. A representative will send claiming information to the
employee or the designated beneficiary and can answer any
questions that he or she may have.
The maximum amount payable for both alterations for the

home and modifications to a motor vehicle combined is
$10,000.
To initiate a claim
42
A Health Spending Account allows you to set aside some of your flex credits to pay for
eligible out-of-pocket expenses that are not covered by your extended health and dental
plans.
How it works
During your initial enrolment and every year during the Open
Enrolment period, you decide whether to establish a Health
Spending Account and indicate how many flex credits to
allocate to it. Then, during the plan year, when you have outof-pocket expenses for eligible items or services, you can claim
them against funds in your account.
The order in which you allocate your flex credits is important
and depends on tax status of the benefits you choose. First,
you use your flex credits for your non-taxable benefits your
extended health and dental plans. Next, you can allocate
your remaining flex credits to a Health Spending Account
(minimum $100).
The remaining flex credits are added to your salary, taxed and
then used to pay for your taxable benefits (Medical Services
Plan coverage and/or employee basic life insurance) and any
optional insurance products you elected.
Rules
Once flex credits are allocated to a Health Spending Account,
you can only access those funds by claiming them for
reimbursement of eligible expenses. You cannot cash in your
account.
Funds in a Health Spending Account must be claimed within
two plan years or you lose them.
If your employment ends, you cannot claim expenses
incurred after your termination date. Any unused funds will

be forfeited.
The claiming deadline for your Health Spending Account is
February 28 following the year in which the expense was
incurred.
You can access funds in your Health Spending Account after
submitting your claim to your extended health or dental
plan and your spouses plan, if applicable.
Unless you have coordinated benefits with your spouse, you
can access your Health Spending Account funds when you
submit your initial claim for reimbursement; just fill out the
applicable Health Spending Account information on the
electronic or paper claim. Check CARESnet for your Health
Spending Account balance.
Important
It is recommended that you
submit claims immediately after
treatment. Late claims will not be
accepted by Pacific Blue Cross. If
you are mailing a paper claim form,
allow plenty of time for it to reach
Pacific Blue Cross by the applicable
deadline.
Claims to your Health Spending
Account must be received by
Pacific Blue Cross no later than
February 28 following the year in
which the expense was incurred.
To be eligible for reimbursement under a Health Spending

Account, the item or service must be recognized as a
medical expense under the Canada Revenue Agency
income tax guidelines.
Key feature
The list of eligible expenses and dependent family members
follows the Canada Revenue Agency income tax guidelines,
which are broader than under your benefit plans, enabling you
to claim more items to your Health Spending Account.
43
Things to consider
Review your previous claims history and try to determine if
you have upcoming expenses (e.g., new glasses). Given this
information, are you likely to have out-of-pocket expenses? Is it
worthwhile to you considering the risk involved and the extra
effort required?
If you conclude that youd like to allocate some flex credits to
a Health Spending Account, what allocation would work best
for you? Remember, you cant cash in your Health Spending
Account, so choose an amount that you know youll be able to
claim.
Your Health Spending Account options

Waive
No flex credits will be allocated to a Health Spending Account.
Any leftover flex credits will be paid out as taxable cash.
Elect a Health Spending Account

Flex credits are allocated to a Health Spending Account in
your name to be used for reimbursement of eligible expenses.
The minimum is $100 dollars; the maximum is the flex credits
left over after paying for your extended health and dental
coverage. Any left-over flex credits that arent allocated to the
account will be paid out as taxable cash.
Dont miss out

Your initial enrolment and the
annual Open Enrolment period are
your only opportunities to elect a
Health Spending Account and/or
allocate flex credits to that account.
How to apply the two-year Use it or Lose it rule

Greg put $200 flex credits into his Health Spending Account in 2015 and $300 flex credits in 2016. In total, Greg has $500 in his HSA.

Greg can claim all the funds at one time or he can submit multiple claims, provided he meets the 2-year rule for the funds.
Greg must claim at least $200 for expenses incurred in plan year 2015 or 2016 or he loses those funds. Any unclaimed funds from 2015 will
be carried forward into 2016 (so funds are available for the 12 months in 2015 and the 12 months in 2016).
Lets say Greg makes a $350 to his HSA for an eligible medical expense incurred in March 2016. The carrier will apply (and exhaust) the
2015 funds to Gregs claim before applying any 2016 funds. Greg will receive the $200 from 2015 and half of the $300 from 2016. Greg
must claim the remaining $150 for expenses incurred in 2016 or 2017 or he forfeits those funds. If the eligible expense is incurred in 2016,
PBC must receive a claim against the remaining funds by February 28, 2017. If the eligible expense is incurred in 2017, PBC must receive a
claim against the remaining funds by February 28, 2018.
44
How to make a claim
When you are ready to make an extended health, drug, dental or life insurance claim, choose
the method that works best for you.
Extended health
To make a claim for reimbursement, you can submit a paper or
electronic claim.
Find the paper claim form on MyHR or CARESnet, and follow
the submission instructions carefully. Make a photocopy of
your expense receipt because the originals cannot be returned
to you.
Submit eClaims on CARESnet for vision care, chiropractic,
physiotherapy, podiatry, psychology, acupuncture, naturopathy
and monthly orthodontic treatments. Keep your original
expense receipts in the event that you are asked to submit
them.
Once a claim is processed, you will receive a direct deposit if
youve provided your banking information to Pacific Blue Cross
through CARESnet. Otherwise, you will receive a cheque in
the mail.
Note: Claims must be received no later than June 30 following
the end of the calendar year in which the expense was
incurred.
Drugs
Did you know prescription drug prices can vary even
between drug stores with the same name? Use Pacific Blue
Cross Pharmacy Compass to find the best price for your
medications.
Most pharmacies will bill Pacific Blue Cross directly when you
present your ID card (and the card for your spouses program,
if you have coordinated benefits), and you will pay only the
portion of the prescription not covered by your benefits

plan(s). If not, you can submit a paper claim.
Use the extended health paper claim form on MyHR or
CARESnet, and follow the submission instructions carefully.
Make a photocopy of the expense receipt because the
originals cannot be returned to you.
All plan members are required to sign up for PharmaCare to
assist with prescription coverage, limiting the impact on your
lifetime maximum. In addition, some high-cost drugs will
require you to apply for PharmaCare special authority before
you can be reimbursed.
Note: Claims must be received no later than June 30 following
the end of the calendar year in which the expense was
incurred.
To make a claim for reimbursement, you can submit a paper
claim form. If you have a Health Spending Account, you can
use the same form to submit eligible expenses.
Dental
Most dental offices will bill Pacific Blue Cross directly when you
present your ID card (and the card for your spouses program,
if you have coordinated benefits), and you will pay only the
portion of the service not covered by your benefits plan(s). If
not, you can submit a paper claim.
Find the paper claim form on MyHR or CARESnet, and follow
the submission instructions carefully. Make a photocopy of the
expense receipt because the originals cannot be returned to
you.
Deadlines
It is recommended that you submit
claims immediately after treatment.
Late claims will not be accepted by
Pacific Blue Cross. If you are mailing
a paper claim form, allow plenty of
time for it to reach Pacific Blue Cross
by the applicable deadline.
Extended health claims, including
drug claims, must be received no
later than June 30 following the end
of the calendar year in which the
expense was incurred.
Dental claims must be received no
later than 12 months following the
date of service.
Health Spending Account claims
must be received no later than
February 28 following the end of the
calendar year in which the expense
was incurred.
45
How to make a claim
Questions?
Note: Claims must be received no later than 12 months
following the date of service.
to both plans at the same time by filing an eClaim through

CARESnet.
Life insurance
If not, you can submit a paper claim form. Similarly, if you have
a Health Spending Account, use a paper claim form to submit
eligible expenses.
To initiate a claim for any of the life insurance products, you,

your supervisor or your designated beneficiary can contact
MyHR. A representative will send claiming information and will
be available to answer questions.
For all claims questions, contact

Pacific Blue Cross. For all other
enquiries, contact MyHR.
Coordinated benefits
If your spouse is also enrolled in a benefits program, you may
be able to submit your extended health and dental receipts
to both plans and get up to 100 per cent of your eligible
expenses reimbursed, which may impact your enrolment
choices.
When you make a claim under coordinated plans, photocopy
your receipt(s) and submit your claim to your plan first.
Once approved, you will receive an explanation of benefits
statement. Now you can submit a claim to your spouses
plan, along with the explanation of benefits statement and
photocopies of your receipt(s).
Spouses will submit to their plans first.
If you have dependent children, the order of submission is
determined by your birthdays. If your birthday is earlier in the
calendar year than that of your spouse, you will submit your
childrens claims to your plan first.
Note: If you and your spouse have coordinated benefits and
you are both covered under Pacific Blue Cross, you can submit
46
Taxation
A key advantage of the Flexible Benefits Program is that it provides benefits in a tax effective
manner.
Flex credits are allocated to you by the employer to pay for
your benefits coverage. How you allocate your flex credits
determines whether they are used tax free or are taxed as
income by Canada Revenue Agency.
Some benefits are non-taxable benefits, meaning you do not
have to pay tax on the cash value of that benefit, whereas
others are taxable benefits.
Your Flexible Benefits Program comprises the following benefit
plans, listed according to their tax treatment:
Non-taxable benefits


Dental plan
Taxable benefits


Optional accidental death &
dismemberment insurance1
Effective 2013 per the Income Tax Act.
How is this more tax effective?

If flex credits were used for your Medical Services Plan or life
insurance, those flex credits would create a taxable benefit. So,
you would generate additional taxes, but you do not create a
taxable benefit by using after-tax income to pay for the taxable
benefits.
What if I have flex credits left over?

You have choices:
You can allocate them to a HSA, where you can use them,
tax free, to pay for eligible medical expenses not otherwise
covered by the group plan.
You can choose to take any unused flex credits as taxable
cash, which will be distributed in equal monthly installments.
These flex credits are treated as regular income for the
purposes of income tax and statutory declarations.
To maximize tax effectiveness, only non-taxable benefits are

paid for using flex credits (i.e. flex credits are applied to the cost
of the option you choose). Taxable benefits, on the other hand,
are paid through payroll deduction.
47

Medical Services Plan of B.C.
Employee life and AD&D insurance
Coverage ends on the last day of the month in which any of

the following occurs:
Coverage ends on the date the policy terminates or the last

day of the month in which any of the following occurs:
Your employment ends.
Your employment ends.
You request that coverage end.
You turn 65.
You take a leave of absence without pay or are laid off for
more than a calendar month (if you do not pay the required
premiums).
You change from regular to auxiliary status or from an

excluded to a bargaining unit position.
The last day of the month in which you change from regular
to auxiliary status.
Extended health and dental plans
You retire under the provisions of the Pension (Public

Service) Act, unless you elect to continue coverage to age 65.
Coverage for eligible dependents
Your last day of employment.
Benefits coverage ends on one of the following:
The day you request that coverage end.
The same date that your insurance terminates.
The last day of the month of a leave of absence without pay

or are laid off for more than a calendar month (if you do not
pay the required premiums).
The date you request coverage end.
The last day of the month in which you retire.
If you end your employment

or if you reach age 65 and are
no longer eligible for group life
insurance, you may convert your
coverage to an individual policy,
limited in both amount and plan,
without a medical examination.
See next section for important
timelines.
After the month in which a premium is not received by you

or by your employer on your behalf.
Coverage ends on one of the following:
The last day of the month in which you change from regular
to auxiliary status or from an excluded to a bargaining unit
position.
Important
The date he/she/they cease to qualify as an eligible

dependent.
In the event of the employees death, extended health,
dental and the Health Spending Account (if applicable)
for dependents is maintained until the end of the month
following the month of the employees death. However,
Medical Services Plan coverage for dependents terminates at
the end of the month of the employees death.
48
Converting to individual benefits plans

The conversion policy enables you to convert to individual
extended health, dental and life insurance plans when your
group coverage ends.
Converting to an individual plan may benefit you if you do
not qualify for other insurance due to an existing medical
condition.
You can apply to convert to some or all of these plans.
Note: You must apply and pay your first premium within 60
days of the end of the month in which your group coverage
ends. This conversion cannot be made retroactive. If you miss
this deadline, you are no longer eligible for conversion.
Individual extended health and dental plans

If you convert to individual extended health and dental plans,
you will not need to provide evidence of good health and
waiting periods for extended health and dental are waived.
To start the conversion process for extended health and dental,
contact Pacific Blue Cross.
coverage combined (maximum $200,000) in force at the time

your group coverage ends. The premium for the individual
policy will depend on your age and on the type of policy you
select. It is not the same rate as paid while covered under the
group plan.
To start the conversion process for life insurance, contact
MyHR.
Important
Converting to an individual plan
may benefit you if you do not
qualify for other insurance due to
an existing medical condition.
Converting your spouses optional life insurance

Provided your spouse is under age 65, you may also convert
his or her optional life insurance to an individual plan at the
same time as you are converting your own coverage. The same
application deadline applies.
If your spouse is older than you when you turns 65, your
spouse is ineligible for conversion to an individual plan.
To start the conversion process for life insurance, contact
MyHR.
Note: Individual plans will be different than the group plan.
Individual life insurance plans

If your employment ends or you reach age 65 you may convert
your coverage to an individual policy, limited in both amount
and plan, without a medical examination. Or, you may take a
medical examination (paid for by the carrier) and choose any
insurance plan offered by the company. If you do not meet
the medical requirements, you still have the opportunity to
convert your coverage to an individual policy, limited in both
amount and plan.
The amount of the individual policy where no medical
examination is taken may be any amount up to the amount of
49
Other benefit programs
The sum of your benefits

Your Flexible Benefits Program is only one of many benefits available to you.
Along with your Public Service Pension Plan, these programs increase the value
of your take-home pay.
Health & Well-being programs include counselling, smoking cessation support, flu shots and a program to
track your personal health goals.
Learning & Education opportunities range from courses offered by the BC Public Service Agency to
scholarships for you and your children and loan forgiveness programs for post-secondary education.
Leave & Time Off options help you achieve work/life balance, whether youre taking a holiday, furthering your
education or taking care of a new member of the family. Options include a Deferred Salary Leave Program,
earned time off, special leave and vacation.
Engagement & Recognition initiatives celebrate your long service and your best work.
Flexible Work Options offering flexibility around when and where you work help you work efficiently from
home or on a schedule thats best for you.
Performance Management resources that support your career growth and optimal performance include
individual and team coaching services and planning tools.
For information about all of your benefits, visit MyHR.
50
Contacts and resources
For questions about extended health and dental claims,

contact:
For all other enquires, contact:
Pacific Blue Cross
MyHR
Mailing address:
PO Box 7000
Vancouver, BC V6B 4E1
Mailing address:
Benefits Service Centre
Block E, 2261 Keating Cross Road
Saanichton BC V8M 2A5
Phone:
1-888-275-4672 (toll free)
604-419-2600
Website:
CARESnet
Tell us what you think

If you have any feedback which
relates specifically to the guide,
provide a comment here on the
@Work benefits discussion forum.
Phone:
1-877-277-0772 (toll free)
250-952-6000 (in Victoria or Vancouver)
Callers from outside B.C.:
Call Enquiry BC at 604-660-2421 and ask to be transferred to
MyHR at 1-877-277-0772.
Website:
MyHR
Email:
Ask MyHR
51
Glossary
Actively-at-work
requirement
To satisfy this requirement, an employee must:

1. Be fully capable of performing his/her regular duties; and
2. Be either:
Actually working at the employers place of business or a place where the employers business requires him to work.
Absent due to vacation, weekends, statutory holidays or shift variances.
Annual earnings
For the purposes of employee basic life insurance, annual earnings are defined as 12 times your current monthly base rate of pay for your current
classification, calculated as bi-weekly salary times 26.0893. Annual earnings are the employees basic annualized salary paid by the employer, including
salary protection, classification adjustments and some temporary market adjustments. Overtime, allowances, bonuses or any other additions to pay are
not included.
Annual price
The final price after flex credits have been deducted from costs.
Auxiliary employee
An employee who is employed for work that is not of a continuous nature. Refer to your Terms and Conditions of Employment for Excluded Employees
for information on eligibility requirements for benefits.
Bargaining unit
employee
The bargaining unit consists of those public service employees who are members of one of the following bargaining units: the British Columbia
Government and Service Employees Union (BCGEU), the Communications, Energy and Paperworkers Union of Canada, (CEP), the Professional
Employees Association (PEA), the British Columbia Nurses Union (BCNU) and the Union of Psychiatric Nurses (UPN).
Beneficiary
The person(s)/registered charity named to receive the insurance benefit if the employee dies while insured. If the employee dies without designating a
beneficiary, payment will be made to the employees estate.
Carrier
The service provider that adjudicates the claims on behalf of the employer:
Note: The employee is the beneficiary for spouse and child optional life insurance.
Pacific Blue Cross is the carrier for extended health and dental.
Great-West Life is the carrier for life insurance products.
Claim
A request to the insurance provider for payment under the benefit plan.
Common-law spouse
A common-law spouse is a person of the same or opposite sex where the employee has signed a declaration or affidavit that they have been living
in a common-law relationship or have been co-habiting for at least 12 months. The period of co-habitation may be less than 12 months where the
employee has claimed the common-law spouses child/children for taxation purposes.
Note: By enrolling your common law spouse in your benefits program, you are declaring that person as your common law spouse. A separate form
(declaration) is not required.
Complete oral exam
Clinical examination and diagnosis of hard and soft tissues, including carious lesions, missing teeth, determination of sulcular depth and location of
periodontal pockets, gingival contours, mobility of teeth, recession, interproximal tooth contact relationships, occlusion of teeth, TMJ, pulp vitality tests,
where necessary and any other pertinent factors.
Conversion policy
A policy that enables members to convert to individual benefits plans (extended health and dental, life insurance) when coverage ends.
52
Glossary
Coordination of
benefits
A provision in a group insurance policy describing which insurer pays a claim first when two policies cover the same claim. This provision applies only
to extended health and dental plans. Under this provision, the total benefit amount that an individual can claim is 100 per cent of the cost of the
eligible expense incurred (i.e. the combined reimbursements across all plans cannot exceed the total cost of the expense).
Deductible
The amount you must pay each year before the plan starts to reimburse eligible medical expenses.
Disability (qualifying)
(optional life insurance
only)
An employee is considered disabled if disease or injury prevents him/her from being gainfully employed.
Gainful employment means work:
That a person is medically able to perform;
For which he/she has at least the minimum qualifications;
That provides income of at least 60 per cent of his/her indexed annual earnings*; and
That exists either in the province or territory where he worked when he became disabled or where he currently lives.
The availability of work will not be considered in assessing disability.
*Indexed annual earnings are pre-disability earnings that have been adjusted to reflect changes in the Consumer Price Index.
Dispensing fee
The fee charged by pharmacies to dispense a medication.
Eligible employee
Employees who may participate in the Flexible Benefits Program. This includes regular excluded employees, whether full- or part-time (unless expressly
excluded) and auxiliary excluded employees upon meeting eligibility criteria (e.g. completion of 1827 hours of work in 33 pay periods). See the Terms
and Conditions for Employment for detailed information on eligibility criteria.
Eligible expenses
Charges for services and/or supplies that have been specifically included in the extended health and dental contract as a benefit. An expense is
incurred on the date the service is provided or the supply is received.
Any payment to a pharmacy or practitioner which represents an amount in excess of the recognized fee schedules is not included in the definition of
an eligible expense.
Eligible life event
A specific event or change that allows you to make changes to your benefit options within 60 days of the event. Eligible life events include events such
as a birth or death of a dependent, a change in marital status or the loss of a spouses benefits coverage.
Employer
BC Public Service or an employer participating in the public service benefits program.
Estate
The whole of ones possessions (assets and liabilities) left by an individual upon his/her death.
Evidence of insurability The documentation of the good health of the employee and/or his/her dependents in order to be approved for some types of coverage. This is also
called evidence of good health.
Explanation of benefits
statement
The statement you receive from health/dental insurance carrier that itemizes how you are being reimbursed for the expenses that you submitted.
53
Glossary
Fee schedule
The Pacific Blue Cross fee schedule for dentists (general practitioners), dental specialists, and denturists that contains eligible dental services, financial
limits, treatment frequencies, and fees in effect on the date the dental service was performed.
The fee schedule generally follows the BC Dental Associations Fee Guide. For more information, contact the Dental Claims and Enquiry line at 1-800873-2583 (toll free) or 1-604-419-2300 (in Vancouver).
Note: Most, but not all, plans will cover costs based on the fee guide. It is not mandatory for dental offices to follow the fees suggested in the fee
guide.
Flex credits
Funding dollars provided by the employer. They are used to buy benefits coverage. Flex credits are before tax dollars.
Full-time attendance
A child is considered a full-time student when he or she meets the attendance requirements specified by the educational institution. If not specified,
full-time attendance means that the child is enrolled for at least 15 hours of instruction per week, per term, and is physically present on campus
OR virtually present on campus by way of regularly scheduled, interactive, course-related activities conducted online. Students must be able to
demonstrate, if requested, that they meet full-time attendance requirements.
Fully funded option
Employer-provided flex credits cover the full cost of benefits coverage for this option.
Health Spending
Account
An individual employee account that provides reimbursement of eligible healthcare expenses not otherwise covered under your group benefits
plan. Plan members may allocate some of their flex credits (before tax dollars) to an HSA, and claim them later, tax free, against eligible out-of-pocket
expenses.
Individual benefit
plans
Benefit plans that an individual purchases for him/herself.
Lowest Cost Alternative Under PharmaCare, drugs deemed the lowest cost alternative are usually (but not always) generic drugs. Generic drugs contain the same active
program
ingredients and are manufactured to the same standards set by Health Canada, and to the same strict regulations established by the Food and Drugs
Act. Only minor ingredients like dyes, coatings or binding agents may vary. The real difference is in price; generic drugs cost 30-50 per cent less, on
average.
Minor
A person who is under 19 years of age.
Net price
The final price after flex credits have been deducted from costs.
Non-taxable benefits
Non-cash benefits, like extended health and dental, provided to employees by their employer. Employees are not required to pay the tax on the cash
value of the benefit.
Open Enrolment
Annual enrolment period where you can update your benefit choices, with changes taking effect on January 1 of the next calendar year.
Paramedical services
A defined group of services and professions that supplement and support medical work but do not require a fully qualified physician. These services
include: acupuncture, naturopathic physician, chiropractor, physiotherapy, massage therapy and podiatry.
54
Glossary
PharmaCare
PharmaCare helps British Columbians with the cost of eligible prescription drugs and designated medical supplies. It is one of the most
comprehensive drug programs in Canada, providing reasonable access to drug therapy through seven drug plans.
Assistance through PharmaCare is based on income. The lower your income, the more help you receive. There is no cost to register and there are no
premiums. More information is available on the Ministry of Health website.
Pre-authorization
Confirmation with Pacific Blue Cross regarding eligible medical/dental expenses and reimbursement percentage.
Premium
The amount paid by the employee or the employer to maintain insurance coverage.
Principal sum
An amount equal to the employees life insurance.
Reasonable and
customary limits
The range of usual fees for comparable medical services in a geographic area. If your health care practitioner charges more than a reasonable and
customary limit, you will be responsible for paying the difference. For more information, visit the Pacific Blue Cross website.
Reference-based
pricing
A process where drugs that are deemed therapeutically equivalent are grouped together, and then the cost of the lowest-priced drug in the group
(typically a generic drug) is used as the reimbursement level for all drugs in the group.
Regular employee
An employee who is employed for work that is of a continuous full-time or continuous part-time nature.
Rehabilitation trial
A trial period of employment for assessment and/or rehabilitation purposes.
Reimbursement
The amount you are paid back for an expense that you incur. Reimbursements can be partial or total.
Specific oral exam
The examination and evaluation of a specific condition in a localized area.
Statutory benefits
Benefits that are fixed, authorized, or established by statute; the employer is required by the law (Employment Standards Legislation) of the province to
provide these benefits to employees.
Taxable benefits
Non-cash benefits, like employee life insurance (employers portion) and Medical Services Plan coverage provided to employees by their employer.
Employees are required to pay the tax on the cash value of the benefit.
Term life insurance
Life insurance protection provided during your term of employment. Term life insurance has no cash value.
55
Note: This document describes the Flexible Benefits Program for eligible
excluded employees in the BC Public Service. While all efforts have been made to make the
document comprehensive, it does not contain all the details in the official documents that
legally govern the operation of each of the benefit plans within the Flexible Benefits Program.
These plans are subject to change from time to time. In the event of any discrepancy or
misunderstanding, benefits will be paid according to the applicable contracts, policies, plan
documents and legislation. The BC Public Service reserves the right to suspend, amend or
terminate any of the benefits, flex credits or price tags at any time.
56

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PLAN YEAR 2015

Flexible Benefits Guide

A GUIDE TO YOUR BENEFITS FOR

Life insurance plans

Employee basic life insurance

Who is eligible for benefits?

Optional life insurance plans

When does coverage begin?

Optional accidental death and

How to update your coverage

Health Spending Account

How to make a claim

Eligible life event

Work status changes

Medical Services Plan

Extended health plan

Health Spending Account

Your extended health plan options

When does coverage end?

What is covered by your extended health plan?

What is covered by your dental plan?

Your dental plan options

Converting to individual benefits plans

Other benefits programs

Contacts and resources

Know your benefits. Know your options.

Optional family funeral benefit

Extended health plan

Spouse optional accidental death and dismemberment

You can adjust your coverage over

Health Spending Account

Medical Services Plan of B.C.

Child optional accidental death and dismemberment

Your costs and flex credits

Only one core plan, Employee Basic Life Insurance, is

All core and optional plans offer multiple levels of coverage

3. You receive the number of flex credits required to pay for

Who is eligible for benefits?

The Flexible Benefits Program is offered to regular excluded

Your legal or common-law spouse (same or opposite sex) who

Orders in Council: Categories A, B and C.

If your spouse is also enrolled in a benefits program, you may

Who is eligible for benefits?

recognized diploma, certificate or degree.

children who are no longer eligible for coverage (e.g. If they

Note: A grandchild is not an eligible dependent unless

Certification of dependent children over 19

When does coverage begin?

When does coverage begin?

You can enrol immediately.

You can enrol after meeting eligibility requirements.

Basic employee life

Coverage begins immediately.

Coverage begins upon meeting eligibility requirements.

You can enrol immediately.

Eligible to enrol after meeting eligibility requirements.

Optional life &

You can enrol immediately.

You can enrol after meeting eligibility requirements.

Coverage for eligible dependents

How to enrol for the first time

How to Update Your Dependents

1. Do your homework so you can tailor your benefits to meet