Manage. Get the Most from Your Benefits

Shop Around

• Dispensing fee costs can range from $5 right up to $25. Higher cost pharmacies may offer free delivery and 24/7 service. If you don’t need those services, why pay for them?

Pay Leftover Expenses with Your HCSA

• You can receive up to 100% reimbursement if you pay leftover expenses with your HCSA. You can view your HCSA balance through the Medavie Blue Cross Mobile App or on their website.

Reimbursement up to Reasonable and Customary Amounts

• Understand reasonable and customary amounts. It’s up to you to pay any charges above reasonable and customary amounts. You can call Medavie Blue Cross to learn what is considered a reasonable and customary expense in your area.
• Ask your practitioner. If your practitioner charges more than the reasonable and customary amount, ask if he/she will decrease the charges to be comparable to the levels covered by the plan.
• Know your options. You can also shop around for less expensive services.

Maximum Annual Coverage Limits (for Certain Services)

• Be aware of annual maximums under the benefits plan. For example, if you need major dental work, you should know that the plan covers each member up to a certain maximum: $500 per person in Core Dental Care; $1,500 per person for basic and major services combined under Enhanced Dental Care, and $2,000 for basic and major services combined under Premium Dental Care. It’s important to know if your bill will be higher so you can be prepared.
• Some maximums are combined. For example, under the Core Health Care option, there is a total maximum for all paramedical services combined of $750 per person, $800 under the Enhanced Health Care option and $1,500 under the Premium Health Care option.
• There are some lifetime limits as well. For example, under Premium Dental Care, there is a lifetime benefit of $2,000 per child for orthodontia.

Get Pre-Authorization First

• Before undergoing any major dental work, it’s important to first receive pre-authorization from Medavie Blue Cross so you will know the amount eligible for reimbursement before the work begins.
• Ask your dentist if he/she follows the Dental Fee Guide for general practitioners applicable to your province of residence. You are responsible for paying any expenses above the limits outlined in the Dental Fee Guide. This is important to consider, since it can directly impact your out-of-pocket expenses.

Check with Medavie Blue Cross

• Before seeing a paramedical practitioner, call Medavie Blue Cross or check their website or app to ensure the paramedical practitioner is an approved provider. This will help you avoid unexpected out-of-pocket expenses.
• What are approved providers? Providers of health care services who are licensed with their provincial licencing body (where applicable) and who are practicing within the scope of their licence. Medavie Blue Cross maintains a list of practitioners who are verified under these criteria.

Submit Claims Online

• Submit claims directly online through the Medavie Blue Cross website—get there directly from the Franchise Benefits Store website.
• While on the Medavie Blue Cross site, you can also register for direct deposit. By providing your banking information, you can receive your reimbursement quickly—sometimes within two days for online claims.
• Remember to submit your eligible health and dental expenses to Medavie Blue Cross for reimbursement.
• For your convenience, for claims that are submitted online through the Medavie Blue Cross website, or through the mobile app, Medavie Blue Cross will send you an email notification regarding the status of your claim.

Check Your HCSA Balance

• Any 2023 plan year unused HCSA balance will expire at the end of the 2024/2025 benefit year. You can check your HCSA balance on the Medavie Blue Cross website and on the mobile app.

Access Medavie Blue Cross—on the Go!

Information at your fingertips!

Download the free Medavie Blue Cross Mobile App from the Apple or Google Play app stores. Once you register and log in, you’ll be able to:

• Update your profile
• Look up benefit details
• Check your benefit usage history
• Check prescription drug coverage
• Submit a claim
• Sign up for direct deposit
• Search for dentists and health professionals in your area, as well as those who offer ePay services—no need for reimbursement
• Access your mobile ID card

The first time you use the app, you’ll need to register by providing your ID number and policy number (found on your Medavie Blue Cross card), as well as create a user name and password. After this initial log in, you will only need to provide your user name and password to use the mobile app.

Use Your ID Card

You can use your personal ID card:

• For any drug and dental claims, as well as for health professionals who offer ePay services
• As your travel card for worldwide medical assistance

You can download, email or print a copy of your ID card from the Medavie Blue Cross website, or access a digital version of your ID card using the mobile app.

Maximize Coverage Through Your Spouse’s Plan.

• Does your spouse have access to an employer benefits plan? If so, maximize your reimbursement by coordinating benefits.
• That means you use both plans to pay for eligible services and supplies. If one plan doesn’t have enough to pay the expense, the other plan may cover the balance.
• If you have coverage under your spouse’s plan, you may want to select lower health and dental coverage options and use your Flex Dollars toward other benefits coverage or your HCSA.