​Client FAQ

General Questions​​

Can I continue to use my current provider (e.g., oral health provider or optometrist) if they do not bill PBC directly?

• Yes, that is your choice. However, we encourage clients to call 1-855-550-5454 to make sure that the item or service is covered. If the provider does not bill PBC, clients will have to pay out-of-pocket for the item or service and submit a reimbursement request to PBC. Also, providers may charge more than the rate covered, but PBC only reimburses up to the maximum coverage rate, regardless of what the provider charges.

Why should I keep my private insurance if I am eligible for Health Benefits through the FNHA?

• Some benefits covered under private or employer-sponsored insurance are not covered under Health Benefits (e.g., physiotherapy or chiropractic treatment).  

Does Health Benefits provide out-of-country coverage?

• Health Benefits may cover the cost of supplemental health insurance premiums for approved students or migrant workers. Supplementary health insurance coverage for all other travel outside of Canada (e.g., vacation travel) is not a benefit under Health Benefits. When travelling outside of Canada, it is recommended that you buy travel health insurance in case of an emergency. 

What is the difference between an Exception and an Exclusion?

​If a client has exceptional needs or circumstances, Health Benefits may provide additional coverage for an item or service as an Exception. Exception requests are determined on a case-by-case basis. Exclusions are items and services that are excluded from Health Benefits coverage under all circumstances. Excluded items and services are not available through the exceptions process and cannot be appealed.  ​

Can I appeal a decision and how would I go about it?

• When coverage for an item or service has been denied, the client or their parent/guardian has the right to appeal the decision. Appeals must be forwarded in writing and can be initiated by either the client, their legal guardian, or the client's interpreter. More detailed information can be found on the Appeals page​.
  
  How do I make a complaint about a provider or health organization?
• Clients can email provider@fnha.ca if they would like to make a complaint.​​

Ambulance Bills

Why have I received a bill for ambulance services?

• Health Benefits covers ambulance bills for our clients. To receive coverage, clients must provide BC Ambulance with their status number and PHN to allow BC Ambulance to invoice Health Benefits. Clients with questions about ambulance bills should call Health Benefits at 1-855-550-5454.

I received an ambulance and hospital bill for medical care incurred in the United States and, unfortunately, I did not buy travel insurance for travel outside of Canada. Can Health Benefits assist in paying?

• No, Health Benefits does not cover medical bills incurred outside of Canada. Clients may want to contact the Ministry of Health Out-of-Country Claims Department to discuss any other coverage they may have through MSP.

BC Medical Services Plan (MSP)

I filed my income tax return and the Canada Revenue Agency is indicating that I owe for unpaid MSP premiums. Why?

• If clients receive a bill for unpaid MSP premiums, they likely are not registered with the Health Benefits MSP group. Clients who receive a bill for unpaid MSP premiums should complete an MSP application form and submit it to Health Benefits with the attached bill and supporting documentation. Health Benefits may backdate coverage for eligible clients up to a maximum of five years.

Which services are not covered by MSP?

• Some MSP exclusions include: cosmetic surgery, reversal of sterilization, in-vitro fertilization, artificial insemination, genetic screening and other genetic investigations including DNA probes, acupuncture, hypnotherapy, acupressure, and procedures still in the experimental or developmental phase. Clients should contact MSP for a complete list of what is covered and what is not.​​

What's the difference between a BC Care Card and a BC Services Card?

• On February 15, 2013 the provincial government introduced the BC Services Card. This card replaces the BC Care Card and can be combined with a driver's license. It is a secure government-issued identification that British Columbians can use to prove their identity and access provincially-funded health services. The BC Services Card provides in-person and online access to other government services. A BC Services Card can be issued at an ICBC driver licensing office or you can contact Service BC at 1-800-663-7867 for an alternate approach to get a new card. For more information about the BC Services Card, visit the Ministry of Health website.

Benefits

The provider (e.g., oral health provider, optometrist) is charging me for treatment. Why?

• Health Benefits has a specific fee schedule for each benefit area that outlines what items and services are covered, how much coverage is available, and how often clients can access the benefit. Health care providers may charge above what Health Benefits covers, and clients are responsible for covering these additional costs. 

I have been prescribed a drug and the pharmacist has told me that it is not covered through Health Benefits. Why?

• Health Benefits' drug plan is comprehensive. If you have been prescribed an item that is not covered, the prescriber can request Special Authority from BC PharmaCare for exceptional coverage. Alternatively, you can ask the pharmacist for other treatment options that are covered. Clients with coverage questions can call Health Benefits at 1-855-550-5454.

Is my local pharmacy an approved PharmaCare site?

• Pharmacies in BC and some pharmacies along the BC border are eligible to enroll with PharmaCare. If you would like to know if your pharmacy is enrolled with PharmaCare, please ask your pharmacy directly. If you would like to discuss this further, contact Health Benefits at 1-855-550-5454.​​

Why does my oral health provider have to send in a request before performing some services?

• Predetermination, or prior approval, is common practice for most public and private dental plans. The predetermination process ensures that both the oral health provider and Health Benefits client are informed of the policies and understand what is covered. Clients must meet all of the clinical criteria and guidelines established by Health Benefits, where applicable, for the treatment to be considered for coverage.

Are chiropractic, massage therapy, naturopathy, physical therapy, or podiatry services covered through Health Benefits?

• No, these services (often called “supplementary or paramedical benefits") are not covered by Health Benefits. However, MSP does provide some coverage of supplementary benefits for clients registered with the Health Benefits MSP group. MSP will pay a set amount per visit up to a combined maximum of 10 visits each calendar year. Please note that most health practitioners may charge above what MSP covers, meaning clients will have to pay out-of-pocket for the difference in cost. For more information visit the MSP website. 

Provider FAQ

Pharmacy

Are FNHA clients covered outside of BC?

• BC PharmaCare is a provincial program and it cannot directly pay for eligible prescriptions filled outside the province. We ask that all health care providers remind FNHA clients to plan ahead before they travel by obtaining the maximum days' supply of their medication before they leave the province. FNHA clients who have paid for an eligible prescription filled out-of-province can request reimbursement from PharmaCare by submitting the PharmaCare Out-Of-Province Client Reimbursement Form with the official pharmacy receipts attached. See the Reimbursements page​ for more information.

Are all First Nations in BC covered by PharmaCare?

No, not all First Nations individuals in BC are eligible for PharmaCare Plan W. There are still a small number of people who are clients of the federal NIHB (Non-Insured Health Benefits) program, or who are insured under another benefit plan provided by a First Nations organization pursuant to self-government agreements (e.g., Nisga'a). First Nations individuals residing outside the province who are visiting BC are covered by NIHB and not PharmaCare. Your pharmacy point-of-sale system should adjudicate FNHA clients appropriately based on their PHN. Questions related to Plan W enrollment can be directed to Health Benefits at 1-855-550-5454.