Drug Claims

Drug Claims

Drug claims under the Active and 60+ Plans provide reimbursement for eligible prescription medications covered by the plan. Members can easily access benefits using their Benefits Card or through manual submission of claims. The drug coverage integrates with BC Fair PharmaCare to ensure affordability and accessibility.

How to Make a Claim

1. Using the Pay Direct Drug Card

• Present the Pay Direct Drug Card at any participating pharmacy.

• The card allows the pharmacy to bill the plan directly for the covered portion of the prescription cost.

• Members pay only the remaining co-pay or uncovered costs at the point of purchase.

2. Manual Submission

If the pharmacy does not accept the Pay Direct Drug Card, follow these steps:

1. Collect Required Documentation:

   • Obtain an itemized receipt from the pharmacy, including:

     • Name and address of the pharmacy.

     • Prescription number.

     • Date of purchase.

     • Name of the medication and dosage.

     • Total cost and amount paid.

2. Complete the Drug Claim Form:

   • Download the form from www.benefitsoffilm.com or obtain it from the Benefits Office.

   • Fill in all required fields, including your plan number and member details.

3. Submit the Claim:

   • Online:

     • Log in to the My Canada Life at Work portal.

     • Upload scanned copies of your receipts and complete the submission.

   • Mail:

     • Attach the original receipts to the completed Drug Claim Form and send it to Canada Life at the address provided on the form.

Pre-Authorization for Specialty Drugs

1. For certain high-cost or specialty drugs, pre-authorization is required before coverage is approved.

2. Contact Canada Life to initiate the pre-authorization process.

3. Submit documentation from your prescribing physician, including:

   • Diagnosis and treatment plan.

   • Reason for prescribing the specific medication.

   
   

Deadlines

• All drug claims must be submitted within 12 months of the purchase date.

• Late submissions may require an explanation and are subject to approval.

  
  

Reimbursement

1. Pay Direct Drug Card:

   • The plan pays the covered portion directly to the pharmacy, and the member pays any remaining balance.

2. Manual Claims:

   • Reimbursement is processed and deposited directly into your bank account for online claims or via cheque for mail submissions.

     
     

Tips for Filing Drug Claims

1. Use the Pay Direct Drug Card whenever possible for immediate processing.

2. Keep All Receipts:

   • Even if using the card, retain receipts for personal records or potential audit requests.

3. Check Drug Eligibility:

   • Verify coverage under BC PharmaCare or the supplementary drug plan before purchasing.

     
     

Coordination of Benefits

• If you have additional drug coverage (e.g., through a spouse’s plan), first claim through the primary plan and then submit the remaining balance to your supplementary plan.

  
  

Additional Support

• For assistance with the claims process or questions about drug coverage, contact the Benefits Office or Canada Life directly.

• Refer to BC PharmaCare for details on eligible medications under Tier 1.