Who is eligible?
To be eligible, all plan members must have provincial health coverage.
If you have been hired as a permanent employee to work at least 40% of a regular work week, you are entitled to coverage for you, your spouse and dependents.
If you have been hired for a term (temporary) position for a period of no less than 12 months, to work at least 40% of a regular work week, you are entitled to coverage for you, your spouse and dependents.
Your spouse is defined as someone to whom you are married legally or common law (defined as having lived with your partner for 12 months or more; the 12 month cohabitation period is waived in the event a child is born of such relationship). This includes a spouse of the same sex.
Your dependent child is defined as an employee’s or spouse’s child who:
A child who is incapable of employment due to a mental or physical condition that occurred before reaching the maximum age will continue to be covered if approved by the insurance company.
Note: Dependents between ages 21 and 26 have the same coverage and restrictions as adults and not the same as dependents under age 21.
If you meet the eligibility requirements you MUST participate in this benefit unless you have other group or association plan coverage.
When will my coverage begin?
NSH and IWK employees: Health Coverage starts the first of the pay period following the date of eligibility. If you are eligible on the first of the pay period, your coverage will start immediately.
All other employees: Health Coverage starts on first of the month following the date you are eligible. If you are eligible on the first of the month, your coverage will start immediately.
If your employer offers this benefit you must enrol unless you have other group or association plan coverage. You must provide proof of coverage elsewhere or you will be enrolled with single coverage.
When will my coverage end?
NSH and IWK employees: Coverage ceases when you are no longer eligible, or the end of the pay period that your employment ends, or retirement, whichever comes first. Note: Prescription Drug Coverage for you and your spouse ceases at age 70.
All other employees: Coverage ceases when you are no longer eligible, or the end of the month that your employment ends, or retirement, whichever comes first. Note: Prescription Drug Cover for you and your spouse ceases at age 70.
Refer to “Continuation of Coverage” for Retiree Coverage
What is covered?
Prescription Drugs
The plan covers drugs that require a written prescription, have a drug identification number and are on the Medavie Blue Cross Managed Formulary (this list is subject to change without notice). Prescription Drug Coverage for you and your spouse ceases at age 70. An electronic drug look-up tool is available on the Medavie Blue Cross site or mobile app www.medaviebc.ca/app
For each prescription fill, you pay the dispensing fee up to $492 per family per calendar year, for the lowest priced alternative (typically a generic) drug covered under the managed drug formulary. Please show your Benefits Card to your pharmacist. If you do not have a card, please contact your employer or Group Benefits Solutions at 1-866-886-7246.
Prescription drugs are the biggest cost for your group plan. We manage the drug costs using the following strategies to support the plan members prescription drug needs and the sustainability of the plan.
Defined drug list: The formulary is made up of a list of clinically-effective and affordable prescription drugs that are used to treat most medical conditions. For drugs that are not covered by your plan, a suitable alternative can usually be found within the formulary that offer similar, equally-effective medical results and is available at a lower cost.
Prior Authorization: Certain Eligible Drugs require prior or ongoing authorization by Medavie Blue Cross to qualify for reimbursement. The criteria to be met for Prior Authorization is established by Medavie Blue Cross and may include requiring the Participant to participate in a Patient Support Program. The first time you present a prescription for an Eligible Drug on the Prior Authorization list your pharmacist will indicate the need for Prior Authorization. You and your physician must complete a Prior Authorization Prescription Drug Form and submit to Medavie Blue Cross. You will receive confirmation in writing regarding the decision and if approved, this confirmation will include the effective date and duration of your approval.
Mandatory Drug Substitution (Lowest Cost Alternative): Your plan will pay up to the cost of the lowest-cost alternative, typically the generic drug, even if a brand name medication is dispensed. This means the Medavie Blue Cross Substitution Provision applies and an Interchangeable Drug has been prescribed, Medavie Blue Cross will reimburse to the lowest ingredient cost Interchangeable Drug. In the case of biologic drugs, Medavie Blue Cross reserves the right to reimburse to a less expensive biosimilar drug. Participants may request a higher cost Interchangeable Drug; however, they will be responsible for paying the difference in cost between the Interchangeable Drugs. For Participants with an adverse reaction to the Interchangeable Drug dispensed, Medavie Blue Cross will consider reimbursement to another Interchangeable Drug on a case by case basis only through the Prior Authorization process.
Step Therapy: For many conditions, such as high blood pressure, diabetes, gout, high cholesterol and depression, there are a number of equally safe and effective treatment options to choose from. Under Step Therapy, the plan will reimburse the cost of a therapeutic substitution by your pharmacist, making it easier for you to get proven safe and effective treatments in a way that can save money for you and your drug plan. For more information call the Medavie Blue Cross Customer Information Contact Centre toll-free at 1-800-667-4511. Alternatively, you can email your questions to inquiry@medavie.bluecross.ca or visit our website at www.medaviebc.ca
Exclusions and Limitations
Expenses associated with the following categories of drugs or services are not eligible for reimbursement, even when prescribed:
Vision Care
Eye Exams: Eye exams are reimbursed at the Medavie Blue Cross usual, customary and reasonable level. The total maximum eye exam (including retinal imaging) is once every two consecutive calendar years for you and your spouse, and once every consecutive calendar year for participants under age 21.
Lenses, Frames, Contact Lenses and Laser Eye Surgery: The Plan covers a total $300 every two calendar years for prescribed eyeglasses (frames and lenses), contact lenses, laser eye surgery, and intraocular lenses used in cataract surgery (once every calendar year for participants under age 21).
Visual Training: Visual training services are covered as required for the treatment of ocular muscle imbalance, or other medical condition(s) as approved by Medavie Blue Cross, to a lifetime maximum of $200 per person. These services are reimbursed at 100% of the eligible expense, as established and approved in advance by Medavie Blue Cross.
Certain approved providers may offer a pay direct arrangement. In such circumstances, the approved provider will submit the claim to Medavie Blue Cross electronically and you will only pay the provider the portion of the claim that is not covered by this benefit. If pay direct is not available, please refer to the How to Submit a Claim section of this document.
For more information call the Medavie Blue Cross Customer Information Contact Centre toll-free at 1-800-667-4511. Alternatively, you can email your questions to inquiry@medavie.bluecross.ca or visit the website at www.medaviebc.ca
Also, download the Medavie Blue Cross Mobile App by visiting www.medaviebc.ca/app
Paramedical Practitioners
Services are reimbursed at the insurers Usual, Customary and Reasonable level. Any amount over this is not covered.
Paramedical practitioners must be licensed and certified within their respective fields of expertise and validated/registered with Medavie Blue Cross. If your provider is not registered please contact us, Health Association Nova Scotia, and we can give direction to the paramedical practitioner.
The Plan covers up to the maximum $1,500 in each calendar year for the combined services of a:
The Plan covers up to the maximum $1,800 in each calendar year for the combined services of a:
The Plan does not cover charges for any treatment performed in a hospital or covered under your provincial health plan.
There is a calendar year maximum of $35 per practitioner for x-rays.
NOTE:
Usual, Customary and Reasonable: Charges incurred by the Participant that are:
Other Eligible Supplies and Services
What are the health exceptions?
Exclusions and Limitations
No payment will be made (or payment will be reduced) for:
Plan Member Secure Website
The plan member website is a secure, user-friendly website that is available 24 hours a day, 7 days a week. The website provides additional information regarding your coverage and other useful options including:
To register for the plan member website, visit www.medaviebc.ca and log in.
Medavie Blue Cross Mobile App
Plan members can download the Mobile App for iOS and Android devices.
To download the mobile app, visit www.medaviebc.ca/app
My Good Health®
My Good Health is a secure, interactive web portal that provides valuable health information and tools for managing your health. You can create your own health profile and use it to map personal goals using My Good Health resources.
Medavie Blue Cross is proud to help point your way to healthier living. Go to medaviebc.mygoodhealth.ca and simply follow the instructions to register for your free account!
Savings are available to Medavie Blue Cross Members across Canada. To take advantage of these savings, simply present your Medavie Blue Cross identification card to any participating provider and mention the Blue Advantage® program. A complete list of providers and discounts is available at www.blueadvantage.ca.
How do I make a claim?
Pharmacy Submit:
You typically do not have to submit claims for prescription drugs. You need to present your pharmacist with your benefit card to pay your “co-pay” amount at the pharmacy. The pharmacy submits for the remainder of the claim. For prescription drug claims not processed by the pharmacy, you submit directly to Medavie Blue Cross. If you choose not to use your benefit card at the pharmacy and you submit to Medavie Blue Cross a paid-in-full prescription drug receipt, despite the fact pay direct was offered, Medavie Blue Cross will only reimburse the amount that would have been paid to the Approved Provider if the claim had been submitted electronically.
At age 70, your Medavie Blue Cross card cannot be used to pay for Ostomy supplies, Diabetic supplies, or vaccines; you must submit a claim for reimbursement.
Provider eClaims
For Approved Providers who have registered to submit claims to Medavie Blue Cross through electronic claims submission service, e-claim service allows approved health care professionals to instantly submit claims at the time of service. This eliminates the need for you to submit your claim to Medavie Blue Cross and means you only pay the amount not covered under your group benefits plan (if any).
Member eClaims
You can quickly and easily submit your health, drug and dental claims (as applicable) through MBC secure plan member website. Simply take or scan a digital image of your paid-in-full receipts and submit it through the applicable link on the plan member website.
Mobile App
Filing a claim has never been quicker or easier! Submit your claims through the Medavie Mobile app and have your reimbursement deposited directly to your bank account. Visit www.medaviebc.ca/app for more information or to download the app.
Medavie Benefits (kiosk)
Located in Scotia Square at 1894 Barrington Street
Check with Medavie Blue Cross for service hours.
By Mail
You can also mail your completed claim form to the nearest Medavie Blue Cross office. Medavie Blue Cross, Barrington Tower, Scotia Square, 1894 Barrington St, Halifax, Nova Scotia B3J 2A8
Note:
Time Limit to Submit a Claim: Medavie Blue Cross must receive proof of claim within 18 months of the date the Eligible Expense was incurred.
All purchases and acquisition of services must be made in Canada. The only exception is the online purchase of glasses or contact lenses.
What if my spouse also has coverage?
Canadian insurance companies follow a process called Coordination of Benefits (CoB) when a plan member is covered under more than one health and/or dental plan. CoB ensures you receive the maximum benefit available from your policies. In fact, two policies can be combined to give you up to 100% reimbursement of eligible claims.
When you are covered under your plan and under a spouse’s plan, here’s how Coordination of Benefits works:
If you need help determining the order claims should be submitted, call the Medavie Blue Cross Customer Information Contact Centre toll-free at 1-800-667-4511. Alternatively, you can email your questions to inquiry@medavie.bluecross.ca or visit our website at www.medaviebc.ca
If you are covered by more than one plan, please call Health Association Nova Scotia toll-free at 1-866-886-7246 regarding any changes or updates to your Coordination of Benefits information.
What happens during a leave of absence?
If you take an approved paid leave of absence, you must continue coverage for up to 12 months.
If you take an approved unpaid leave of absence, you may continue for up to 12 months. If you take an approved maternity or parental leave, you may continue for the duration of the leave. If you choose not to continue the benefit during your leave, coverage is reinstated on your return to work.
If you are approved for benefit for your employer sponsored Long Term Disability plan you may continue benefits.
For cost sharing arrangements, please check your collective agreement or contact your employer for more details.
What happens If I lose coverage under another plan?
If you had opted-out of the health plan because you were covered under another plan, you must join the HANS Health plan within 60 days of losing the coverage. To be approved for Family coverage after 60 days you will be required to provide medical evidence of insurability.
What happens to coverage when I turn age 65?
Your coverage does not change. We do recommend you contact Nova Scotia Seniors’ Pharmacare Program when you turn 65 and notify them you have drug coverage under your employers group plan. If eligible, this will assist with a smooth transition to the Seniors’ Pharmacare program when you are no longer covered for prescription drugs under this plan.
What happens to my coverage when I turn age 70.
Your prescription drug coverage ceases. Your premiums may be lower. In advance of losing drug coverage under our plan, you should contact the Nova Scotia Senior’s Pharmacare Program at 902-429-6565 or toll free at 1-800-544-6191 for more information.
What happens to my family coverage if I die before retirement?
In the event of your death before retirement, your eligible spouse and eligible dependent children may continue their coverage for up to 24 months after your death. No premiums are required for this coverage.
What happens to my coverage when I retire?
You may be eligible for retiree benefits. Please check out the Retiree Benefits page of our website. Please contact your Benefits Administrator for more clarification.
Can I convert my coverage?
You may choose to convert your coverage to an individual policy within 31 days of your coverage ending. To convert to a health insurance plan, members can call Medavie Blue Cross toll-free at 1-800-873-2583. You can also visit their corporate website at https://www.medaviebc.ca/en/plans/moving-off-an-employers-plan
Employees of the Health Association Nova Scotia Health Plan (and families of those with family coverage) are covered in case of a medical emergency on a trip outside your province of residence or outside Canada. Travel Coverage ceases at retirement. A medical emergency means it is unexpected and not preplanned.
Checkout the Emergency Travel Coverage page on our website.
Health Association Nova Scotia reserves the right to review the employee benefits program and to modify, amend, discontinue, and/or make exceptions to the program. All information is subject to change. This document provides a information around the key benefits available to you under the Health Association Nova Scotia Single Group Benefits Plan. In the case of a discrepancy, the contracts will prevail.
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© Copyright Health Association Nova Scotia 2023.
© Copyright Health Association Nova Scotia 2023.