Your dental plan covers you, your spouse/partner, and dependent children (under 21, or under 25 if a full-time student). Coverage is based on the BC Dental Fee Guide. Claims are usually submitted directly to PBC by your dentist — you only pay the difference, if any.
| Service | Frequency / Limit | Coverage |
|---|---|---|
| Complete oral exam | 1 per 36 months | 90% |
| Recall exam (dentist or hygienist) | Combined limit: 2 per calendar year | 90% |
| Specific / emergency exam | Combined limit: 2 per calendar year | 90% |
| Scaling (cleaning) | No stated unit limit | 90% |
| Polishing | 2 per calendar year | 90% |
| Fluoride treatment | 2 per calendar year | 90% |
| Bitewing & periapical x-rays | Per calendar year · dental fee guide max | 90% |
| Panoramic x-ray | 1 per 24 months | 90% |
| Complete series x-rays | 1 per 36 months | 90% |
| Silver (amalgam) fillings | 1 per tooth per 24 months | 90% |
| White (composite) fillings | 1 per tooth per 24 months · molar paid at silver rate | 90% |
| Prefabricated metal restorations | 1 per tooth per 24 months | 90% |
| Root canals (all types) | 1 per tooth per 60 months | 90% |
| Extractions (simple & complex) | 1 per tooth per lifetime · combined limit | 90% |
| Dental surgery & anaesthesia | Anaesthesia only on same day as oral/periodontal surgery | 90% |
| Periodontal (gum) treatment | Root planing, osseous surgery — 1 per sextant per 5 yrs | 90% |
| Night guards (bruxing appliances) | 2 per 60 months · lost/stolen not covered | 90% |
| Space maintainers | 1 per quadrant per calendar year | 90% |
Major restorative services are reimbursed at 70% of the BC Dental Fee Guide. There is no single annual dollar maximum — limits are per tooth per period as shown. Pre-authorization is strongly recommended.
| Service | Frequency / Limit | Coverage |
|---|---|---|
| Crowns (porcelain, gold, veneer) | 1 per tooth per 60 months · combined limit with bridges/inlays/veneers | 70% |
| Bridge pontics, abutments & retainers | 1 per tooth per 60 months · combined limit | 70% |
| Bridge implants | 1 per tooth per 60 months · combined limit | 70% |
| Inlays & onlays | 1 per tooth per 60 months · combined limit | 70% |
| Veneers | 1 per tooth per 60 months · combined limit | 70% |
| Complete dentures (upper & lower) | 1 per person per 60 months · lost/stolen not covered | 70% |
| Partial dentures | 1 per person per 60 months | 70% |
| Service | Limit | Coverage |
|---|---|---|
| Denture repairs & additions | GP or denturist | 90% |
| Denture adjustments | 4 per calendar year combined | 90% |
| Denture rebases & relines | 1 per person per 24 months · upper and lower tracked separately | 90% |
| Tissue conditioning | 2 per person per 60 months · 2 per arch per 5-year overall cap | 90% |
| Bridge recementation & repairs | 2 per tooth per day from first eligible claim | 90% |
| Bridge removal | 2 per tooth per day from first eligible claim | 90% |
Orthodontic coverage (braces, retainers, appliances) is reimbursed at 75% up to a $5,000 lifetime maximum per person. A pre-determination must be submitted to PBC before treatment begins. TMJ dysfunction and lost/stolen appliances are not covered.
Extended health coverage supplements the BC Medical Services Plan. Your plan covers you, your spouse/partner, and dependent children (under 21, or under 25 if a full-time student).
All paramedical limits are per person per calendar year. Practitioners must be registered in BC. If visits exceed what PBC considers reasonable, a doctor's note may be requested.
| Practitioner | Annual Maximum | Notes |
|---|---|---|
| Physiotherapist | $1,000/person/year | In-person and online · 80/100% structure |
| Registered Massage Therapist | $1,000/person/year | In-person only · 80/100% structure |
| Chiropractor | $1,000/person/year | Includes chiro x-rays · $131 initial / $77 subsequent visit · 80/100% |
| Acupuncturist | $1,000/person/year | In-person only · $135 initial / $115 subsequent · 80/100% |
| Naturopath | $1,000/person/year | Treatments and testing · $257 initial / $189 subsequent · 80/100%X-rays, appliances, and remedies dispensed by naturopath are not covered |
| Podiatrist | $800/person/year | In-person only · $180 initial / $105 subsequent · 80/100%Podiatry x-rays are not covered |
| Speech Therapist | $800/person/year | In-person and online · $200 initial / $175 subsequent · 80/100% |
All counselling providers below share a combined $1,500 per person per calendar year limit. Subject to the 80/100% reimbursement structure and $50 family deductible. Eligible amounts are based on a 60-minute visit — your actual reimbursement depends on visit length.
| Provider Type | Eligible Amount | Notes |
|---|---|---|
| Registered Psychologist | $300/visit | In-person or online |
| Counsellor / Psychotherapist | $170/visit | In-person or online · Must be registered with BCACC, CPCA, CCPA, ACCT, CRPO, or equivalentGroup counselling is not eligible |
| Clinical Social Worker | $170/visit | In-person or online |
| Online Cognitive Behavioural Therapy (CBT) | Covered | Must use a PBC-eligible vendor · Shares $1,500 combined limitVisit pac.bluecross.ca to find eligible CBT vendors |
Vision benefits are subject to the standard extended health $50 annual family deductible and the 80/100% reimbursement structure (same as paramedical). All eyewear types share a single combined dollar maximum.
| Benefit | Maximum | Notes |
|---|---|---|
| Eyewear — combined limitIncludes: complete prescription glasses, frames, prescription lenses, prescription contact lenses, prescription sunglasses, prescription safety glasses/goggles, and vision care repairs | $650/person | Per 24-month period from date of first eligible claim · All eyewear types share this combined limitNon-prescription sunglasses — not a benefit |
| Eye exam | $145 eligible/visit | 1 visit per person per 24-month period · Subject to $50 deductible and 80/100% structure |
| Benefit | Maximum | Notes |
|---|---|---|
| Private hospital room | $195/day eligible | 80/100% structure · $50 family deductible |
| Semi-private hospital room | $165/day eligible | 80/100% structure · $50 family deductible |
| Local ambulance | $80/service eligible | Licensed ambulance to nearest hospital · 80/100% structure |
| Hearing aids | $3,500/person per 48 months | Combined limit for aids + repairs · $50 family deductible · 80/100% |
| Custom orthotics (one pair) | $500/person/year | Must be custom-made · Doctor's letter required · 80/100% |
| Custom orthopedic shoes | $500/person/year | Separate $500 limit from orthotics · Doctor's letter required · 80/100% |
| Registered nurse (home care) | $20,000/person/year | Doctor's letter required · Not covered in hospital |
| Durable medical equipment | Rental preferred | Wheelchairs, hospital beds, braces, prosthetics, respiratory equipment · Pre-auth required over $5,000 |
| Cochlear implant (speech processor & headset) | $8,000/unit eligible | 80/100% structure |
| Prostheses & braces | Actual cost | Rigid support braces, artificial limbs/eyes, mastectomy forms |
Emergency medical expenses incurred while travelling outside your province of residence or outside Canada are reimbursed at 100%. Important: if your trip exceeds 30 days, contact PBC before you leave — trip duration limits may apply.
| Benefit | Maximum |
|---|---|
| Hospital services & physician/lab/x-ray (out of province) | 100% · no limit |
| Hospital services & physician/lab/x-ray (outside Canada) | 100% · no limit |
| Air ambulance (attendants as required) | 100% |
| Local ambulance during travel emergency | 100% |
| Emergency prescription drugs during travel | 100% |
| Airfare for family transport (all combined) | $5,000/family per calendar year |
| Convalescence accommodation after hospitalization | $75/day · Max 5 days per calendar year |
| Family accommodation & meals | $100/day · Max 7 days per calendar year |
| Vehicle return | $500/emergency |
| Cremation/repatriation outside Canada | $1,500 cremation · $5,000 repatriation per lifetime |
Medi-Assist provides 24/7 travel assistance — medical evacuation, locating care, interpreter services, contacting relatives. Call them immediately in an emergency abroad.
Prescription drug coverage works through two complementary systems: your Pacific Blue Cross extended health plan (for drugs not covered by the province) and BC PharmaCare (the provincial drug plan). Together they provide broad coverage for most prescribed medications. Drug claims share the extended health $50 family deductible and the 80/100% reimbursement structure.
Your Pacific Blue Cross plan includes a pay-direct drug card. Present your PBC ID card at any participating pharmacy — your pharmacist submits the claim directly and you only pay your share at the counter. No forms, no waiting for reimbursement.
The plan covers drugs and medicines that are not covered by BC PharmaCare and require a written prescription, including:
In addition to your PBC plan, BC PharmaCare provides a provincial prescription drug benefit. The deductible is income-based:
| Net Family Income | Annual Deductible | Coverage After Deductible |
|---|---|---|
| Under $15,000 | $0 | 70% of eligible drug costs |
| $15,000 – $30,000 | 2% of net income | 70% of eligible drug costs |
| Over $30,000 | 3% of net income | 70% of eligible drug costs |
Any deductible amounts and the remaining 30% not covered by PharmaCare may be claimed under your Pacific Blue Cross extended health plan, providing layered coverage on most prescription costs.
Tell your dentist
Let your dentist know you have Pacific Blue Cross coverage. Have your PBC ID card ready.
Direct billing
Most dentists submit claims directly to PBC. You only pay the portion not covered — typically nothing for basic services.
Over $500? Get a Treatment Plan
For major work expected to exceed $500, ask your dentist to submit a Treatment Plan first. PBC will confirm coverage before work begins.
Submit deadline
All dental claims must be submitted within 1 year of the service date.
Present your PBC card
Give the pharmacist your Pacific Blue Cross ID card when filling a prescription. They submit the claim automatically.
Pay your share only
You pay only the portion not covered by the plan — no upfront payment and reimbursement wait.
Pay upfront
For most extended health services, you pay the provider directly and keep your original receipt.
Submit online
Log in to your Pacific Blue Cross member account at service.pac.bluecross.ca to submit claims and check status online.
Or mail your claim
Complete a claim form and mail with original receipts to:
Pacific Blue Cross, P.O. Box 7000, Vancouver, BC V6B 4E1
Keep photocopies — originals are not returned.
Submit deadline
All extended health claims must be submitted by December 31 of the year following the year the expense was incurred.
This summary is based on the provincial BC teacher benefit plan structure. For your exact plan details, log in to Pacific Blue Cross or contact the BCTF benefits team at bctf.ca/benefits.