health
benefits

Basic Medical - MSP (BC)

• Benefit
• Definitions
• General Information
• Claims
• General Exclusions
   

Benefit
When you qualify you will be covered with the Medical Services Plan of BC, provided you have completed the required application form. The Medical Services Plan of BC pamphlet provides a detailed outline of the medical coverage under the Government Plan. Your MSP-BC Group Number is: 3131182



 

DEFINITIONS

Deductible means the initial portion of the Eligible expenses, which you must pay before we will reimburse charges for any Eligible expense.

Dentist means a doctor of dentistry who is duly qualified and licensed to practice dentistry in the area where the service is provided. For the purposes of this booklet, Dentist may also mean dental specialist, or denturist.

Duplicate coverage means that you (and your Dependents) are eligible to claim certain benefits under more than one plan. 

Fee guide means the Canadian provincial/territorial dental Fee guide that contains dental services and fees in effect on the date the dental services are performed. For Alberta, the Fee guide means the current Canadian Life and Health Insurance Association fee guide.

Fee schedule means the Plan’s schedule that contains eligible Dental services, financial limits, treatment frequencies, and fees in effect on the date the dental services are performed.

Integration with Government Plans
Extended Health Care benefits are intended to supplement and not overlap benefits under government plans such as the Medical Services Plan and Fair Pharmacare Program of British Columbia. You are required, as a condition of coverage, to take all reasonable steps to qualify and obtain the fullest extent of coverage, benefits, contribution, or reimbursement available under all applicable government plans. We will also make payment only where permitted by provincial legislation or other applicable law.

Effective Date of Coverage and Enrolment
If you are eligible for coverage, you must complete an application card to ensure that your coverage starts on the correct effective date.

You should apply for Dependent coverage (when applicable):

1. on the same date you apply for your own coverage, or
2. if you have a new Dependent.

1. All claims must be submitted to us in English.
2. We pay eligible claims when we receive all the required information within the required time limits. We encourage you to become familiar with the time periods allowed for claiming benefits. Under the Claims sections, we fully describe the claiming deadlines for each benefit. No payment will be made if we receive your claim after the time limits described in this booklet.
3. We may reject your claim if sufficient information is not provided to enable a full assessment of the claim, or if an attempt is made, except through unintentional error, to make an excessive claim, or if a claim is made for a person who is not entitled.
4. The necessary claim forms are available from your Plan Administrator.
5. The exchange rate on foreign currency is payable at the rate quoted by selected financial institutions in Vancouver, British Columbia, for the date on which the expense was paid. Fluctuations in exchange rates are not our responsibility.

Duplicate Coverage
If you and your Spouse have coverage under the Heat & Frost Local Union 118 Health and Wellness Plan, please check with your Plan Administrator to see if Duplicate coverage is allowed for Dental and Extended Health Care benefits. 

If you and your Spouse work for different companies and you are both enrolled for similar benefits, Duplicate coverage is allowed. 

If you are eligible for Duplicate coverage, you and your family should discuss both plans (and what portion of the benefits you pay) to determine whether it is to your advantage to enroll under more than one plan. 

Your Plan Administrator will advise you if you are eligible to waive certain benefits under this group plan.

Coordination of Benefits 
If Duplicate coverage is allowed, we pay claims based on the rules of the Canadian Life and Health Insurance Association guidelines. They are:

1. Dependent children are always covered primarily under the parent who has the earliest birthdate in the year (month and day).
2. In situations of separation or divorce, the following order applies:
   
   1. the plan of the parent with custody of the child
   2. the plan of the Spouse of the parent with custody of the child
   3. the plan of the parent not having custody of the child
   4. the plan of the Spouse of the parent in c) above.
3. Total reimbursement shall never exceed 100% of the Eligible expenses.

1. We will not be liable for any portion of an expense for which you or your Dependent is entitled to reimbursement:
   1. under any other group or individual benefit plan or insurance policy, or
   2. due to the legal liability of any other party.
2. In no event will benefits be payable for expenses resulting directly or indirectly from, or in any manner or degree associated with, any of the following:
   1. intentional self-inflicted injury while sane or insane, war, whether declared or undeclared, or any act of war, or participation in a riot, insurrection, or civil commotion
   2. active duty in the military forces of any nation or international organization, or in any civilian noncombatant unit which serves with such forces in combat
   3. a direct or indirect attempt at, or commission of, an indictable offense under the Criminal Code of Canada or similar law of any other country
   4. any injury, illness, or condition for which care is provided or may be provided or available without cost by public authorities or by a tax-supported agency, including preventive treatment and services available under any Workers’ Compensation Act or similar plan.