Can members prescribed the antiviral medication Paxlovid (nirmatrelvir and ritonavir) submit claims for these drugs?
Currently, governments are controlling the purchasing & distribution of these drug and there is no expectation for private plan coverage.
We will be closely monitoring the issue and any eventual need for potential private purchase of these medications in the future.
You can find out more about these emerging treatments here.
Are COVID-19 tests covered by benefits plans?
COVID-19 tests, including travel-specific tests, are not covered by benefits plans.
For members with a Health Spending Account (HSA), a prescription from a medical practitioner is required for any COVID-19 tests to be eligible for reimbursement.
Expenses maybe eligible under your Personal Wellness Account if the benefit categories Safety and Security Items, Other Medical, General Lifestyle, Miscellaneous or Leisure Travel is included in coverage.
Can members still submit health and dental claims?
Of course! However, in light of the pandemic and potential impact to mail delivery, we encourage plan members to submit claims online via our website or mobile app. Click to learn more about how easy it is to submit claims online.
Can members be reimbursed for claims from health practitioners who offer their services virtually?
Yes. We have conducted a review of the scopes of practice for covered health practitioners to facilitate access to, and continuity of, needed care by virtual means. Currently we will accept receipts for virtual appointments from the health practitioners listed below. Members should consult their own provider(s) to determine if their specific care can be provided remotely. The list below is subject to change as we continue to assess scopes of practice. As always, providers must be registered with Medavie Blue Cross and all claims are adjudicated based on the member’s plan design and our reasonable and customary limits.
Guidelines around the types of services allowed, as well as specific protocols in providing virtual therapy, vary by the governing body of each provider type listed above. Again, members should speak with their health care provider to confirm what specific services they can deliver online and rely on them to follow the appropriate protocols.
Have you closed your Quick Pay locations?
Yes. As a precaution we have temporarily closed our Quick Pay locations across Atlantic Canada. We do not have a re-open date for our other locations currently, however, drop boxes for member claims are available at our Moncton, NB, Dartmouth, NS and St. John's locations.
Our location in Halifax has reopened as Medavie Benefits+, a new all-inclusive health benefits and wellness centre with agents available to recommend a plan or help members optimize use of an existing plan and smart kiosks to assist with digital adoption and self-service through our mobile app. Full social distancing protocols are in place.
Are charges for Personal Protective Equipment (PPE) charged by dental care professionals eligible for reimbursement under a dental plan?
Some dental care professionals have begun charging for PPE usage during the pandemic. Plan members are strongly encouraged to discuss any extra charges that may be requested by their provider, prior to their visit.
COVID-19 related surcharges for PPE are NOT eligible benefits under existing dental plans. Dental claims will continue to be paid in accordance with the benefit provisions outlined in the group insurance contract, which does not include reimbursement for these items. Any additional surcharges for added time requirements (i.e. pre-screening, donning and removing PPE and any down time for sanitizing, etc.) are also NOT eligible expenses.
Upon request, plans of any size can add coverage for these surcharges under ‘Basic Care’, subject to the plan’s rules.
Please contact your Medavie Blue Cross representative should you wish to add this coverage to your dental plan and/or to determine the impact on your dental premium.
What about PPE surcharges from other types of health care professionals?
PPE surcharges from eligible, non-dental health care professionals are managed within the reasonable and customary limits that are set per practitioner per visit, based on a monitoring of claims activity.
If a health care professional adds the cost of these items to their invoice, our system controls ensure the total reimbursement for the service will not exceed this limit.
Are PPE expenses eligible under HSA?
Yes. PPE surcharges from both health and dental care professionals are considered eligible under Health Spending Account (HSA) or Personal Spending Account (PSA) plans.
Are COVID-19 tests from private providers covered?
COVID-19 tests are available through government agencies, so they are not covered by benefits plans. A prescription from a medical practitioner is required for any COVID-19 tests to be eligible for reimbursement through a Health Spending Account (HSA).
Will benefit maximums/coverage be extended for people: a) who had health or dental appointments delayed or cancelled and their policy year ended (i.e. annual maximums were reset); or b) whose coverage is no longer in effect (i.e. over-age dependants)?
We will continue to administer our group benefits plan according to the terms of each contract, which means claims incurred during the current policy year and/or before someone’s coverage has come to an end will be paid according to the plan rules and benefit maximums for that policy year.
Have the terms of a Health Spending Account (HSA) and/or Personal Spending Account (PSA) changed?
HSA and PSA terms remain the same and these plans will continue to be managed in accordance with the contractual provisions. Members can check their benefit and grace periods in their benefits booklet and learn more about the many expenses they can claim against their HSA and/or PSA balances by checking their booklet or our online Help Centre.
Our HSA admin system is designed to protect plans against actions typically not permitted by the Canada Revenue Agency. Temporarily extending the period for unused HSA credits can be entertained but system testing is required for quality assurance purposes. An allocation equal to the balance of expiring credits can more easily be added to the credit allocation for the next policy year.
Does group life insurance cover a death resulting from COVID-19?
Yes. If a covered plan member or eligible dependant were to die as a result of contracting COVID-19 then the life insurance claim would be payable, assuming all other terms of the group life policy are satisfied.