Board Communique: July 4, 2024

Your extended health care plan is changing on January 1, 2025

Updated December 12, 2024 with information on reasonable and customary limits.

After a full review of the plan’s retirement health coverage, as well as a close analysis of member feedback, we are taking action to ensure your health coverage better reflects member’s needs. These changes will improve coverage for vision care, hearing care and paramedical services, such as physiotherapy and counselling. The changes will also help keep your extended health care plan sustainable for plan members, both now and in the future. Below is a summary of the changes – read on for more detailed information.

Vision Care: Coverage for vision care, including eye exams, will increase to $400 every two calendar years for both adults and children—up from $300 every two calendar years for adults and every calendar year for children. You do not have to pay a deductible for vision care claims.
Hearing Care: Coverage for hearing care will increase to $2,000 every five calendar years—up from $1,400 every four calendar years. You do not have to pay a deductible for hearing care claims.
Paramedical Services: Coverage for paramedical services, including counsellors and social workers, will increase to $1,500 every year for all practitioners combined—up from $1,000 every year.
Prescription Drugs: Prescription drugs will be covered at 80 per cent up to $2,000 of expenses paid, combined with all other health expenses. After that, prescription drugs will be covered at 100 per cent up to an annual maximum of $20,000 per claimant. When a member’s prescription drug expenses reach $20,000 in a calendar year, prescription drugs will not be covered by the plan for the remainder of that year.
Costco Prescriptions: We are removing the preferred arrangement on prescriptions with Costco.
Reasonable and customary limits: Changes are being made to some reasonable and customary limits (the maximum amount reimbursed for each claim for a service or item) for certain practitioners and medical equipment. For details on these limits, sign in to your GreenShield+ account or call 1-888-711-1119.

Detailed information and examples

Vision care and hearing care balances

The vision care period will renew every two calendar years, and the hearing care period will renew every five calendar years. When these periods renew, you will see the full available balance. These periods are based on when your first claim was approved. Here are examples of what that might look like:

Vision care example: On July 1, 2024, a plan member had their first $300 vision care claim approved, after which their total available balance of coverage was $0 for the rest of the year. The period for vision care will renew every two calendar years. On January 1, 2025, they will have an additional $100 available to claim, which they can apply to future claims. On January 1, 2026, their vision care period will renew, and they will have an available balance of coverage of $400.

Hearing care example: On March 1, 2022, a plan member had their first $1,400 hearing care claim approved, after which their total available balance of coverage was $0 until January 1, 2025. The period for hearing care renews every five calendar years. On January 1, 2025, they will have an additional $600 available to claim, which they can apply to future claims. On January 1, 2027, their hearing care period will renew, and they will have an available balance of coverage of $2,000.

Remaining balances for coverage

Can I apply the extra available coverage to previous claims made within the period?

No. Claims incurred before January 1, 2025, cannot be reassessed.

Where can I see my available balance of coverage?

If you have signed up for a GreenShield online account, you can check your available balances for vision care and paramedical services under Check coverage. If you have not signed up for a GreenShield online account, you can contact the GreenShield call centre at 1-888-711-1119 or email customer.service@greenshield.ca.

Hearing coverage balances are not available to view in your online account. To check your available balance for hearing care coverage, speak to a GreenShield representative at 1-888-711-1119, or email customer.service@greenshield.ca.

Prescription drugs

Why is there a $20,000 annual maximum on prescription drugs?

We understand that healthcare costs can be a significant concern, and that the cost of prescription drugs is increasing. This means a higher likelihood of members reaching their lifetime maximum. In reviewing changes to the program, we carefully considered ways to help members preserve their lifetime maximum and to better support members who need high-cost drugs.

The $20,000 annual drug maximum will help slow accumulation toward your $200,000 lifetime maximum. This is important because if you reach that lifetime maximum, you will no longer be covered (your dependants will continue to be covered and your premium rates will be adjusted to pay only for that dependant coverage). The $20,000 annual maximum helps you maintain your coverage for longer, and coverage for high-cost specialty drugs can be coordinated through provincial drug programs, financial support from the drug manufacturer or a spousal plan.

Here's an example of a situation where the $20,000 annual maximum allows for a more gradual build towards the $200,000 lifetime maximum:

A plan member is prescribed a cancer drug that costs $50,000 per year. Before January 1, 2025, without the annual maximum, the plan member pays the annual deductible of $200 out of pocket and reaches their lifetime maximum after four years. With the introduction of a $20,000 annual maximum, this member has options that will slow the accumulation toward their lifetime maximum and increase the duration of their coverage. They could pay the remaining cost of $30,000 per year through financial support from the drug manufacturer, after which their lifetime maximum would be reached in ten years, or they could apply to the BC Cancer agency for the full funding, keeping their lifetime maximum intact.

What if I have reached the $20,000 annual maximum?

Support is available to you. If you are currently claiming a drug for which the plan is paying over $20,000 per year, GreenShield will contact you directly in late 2024 and provide information on where you can inquire about coverage support.

After the plan changes take effect on January 1, 2025, GreenShield will notify you by mail if you are approaching $20,000 in drug claims for the calendar year. Upon reaching the $20,000 annual maximum, you will receive a second letter from GreenShield confirming that you have reached your annual maximum.

What the board considered when making these changes

We engaged directly with plan members and considered feedback, best practices for plan administration, data on how coverage is used, advice from benefits professionals and financial analysis. As part of its review, we invited members to participate in a survey in fall 2023; 1,093 members participated. A summary of the survey findings was published on the plan website in March 2024.

Retirement health coverage remains optional and is member funded. We periodically review the program to ensure that coverage aligns with members’ needs. We strive to ensure changes are fair for current and future generations. Thank you to everyone who participated in the survey.

Learn more

When you are working, extended health care coverage is provided by your employer. However, when you retire that coverage ends. You can apply for optional coverage when you apply for your pension.

We encourage you to learn more about your options for retirement health coverage by visiting the Retirement Health Coverage section of the website. If you are still working, you can register for the Approaching Retirement webinar in the Learning Resources section of the website.

You can also contact the GreenShield Customer Contact Centre for specific questions relating to these changes or any questions about health care coverage. You can speak to a GreenShield representative at 1-888-711-1119, or email customer.service@greenshield.ca