British Columbia provincial health plan fact sheet

Your British Columbia Medical Services Plan provides:

Prescription drugs

  • Coverage through the Fair PharmaCare Program, for eligible drugs prescribed by a physician, certain ostomy supplies, insulin, syringes, needles and test strips for diabetics
  • Effective Jan. 1, 2015, Fair PharmaCare limits annual quantity for blood glucose test strips based on the diabetes treatment the patient is receiving 
Treatment category Annual quantity limit
Managing diabetes with insulin 3,000
Managing diabetes with anti-diabetes medications with a high risk of causing hypoglycemia 400
Managing diabetes with anti-diabetes medications with a low risk of causing hypoglycemia 200
Managing diabetes through diet/lifestyle 200
 
  • Coverage for drugs listed on the BC drug formulary after a deductible has been satisfied. The deductible is based on adjusted family income. 
  • Refer to the charts provided for deductible amounts for eligible residents age 18 to 64 and for eligible residents age 65 and older.
  • For eligible residents born after 1939:
Net annual family income
Family deductible Amount covered when deductible is reached Family maximum Amount covered when maximum is reached
Less than $13,750 No deductible 70% No maximum 100%
$13,750.01 to $30,000 No deductible 70% 0.5% to 2.5% of net family income 100%
Over $30,000 2% to 3% of net family income 70% 2% to 4% of net family income 100%
  • For eligible residents born in 1939 or earlier:
Net annual family income
Family deductible Amount covered when deductible is reached Family maximum Amount covered when maximum is reached
Less than $14,000 No deductible 75% No maximum 100%
$14,000 to $33,000 No deductible 75% 1% of net family income 100%
Over $33,000 1% to 2% of net family income 75% 2% to 3% of net family income 100%
  • Effective Oct. 1, 2017, B.C. PharmaCare introduced a new benefit program to provide coverage for First Nations Health Authority members previously covered by Health Canada’s NIHB program.  All B.C. residents eligible for NIHB are automatically enrolled in the B.C. PharmaCare First Nations Health Benefits Plan (FNBC), which 
    • Covers 100 per cent of eligible ingredient costs and dispense fees for covered drugs 
    • Isn’t income tested and will not apply deductibles or family maximums  
    • Is first payer, private plan is second payer

Ambulance

Dental benefits

  • No coverage for most dental procedures
  • Coverage for dental procedures only when hospitalization is required 
  • Limited coverage for residents ages 20 and younger requiring correction of severe congenital facial abnormalities

Vision care

  • No coverage for glasses or contact lenses
  • No coverage of routine eye exams for residents 19 to 64 years old 
  • Coverage of routine eye exams for residents ages 18 and younger, and 65 and older
  • Coverage for all eye exams that are medically required for all age groups
  • Cataract patients will receive foldable intraocular lenses

Hospital

  • Coverage for standard ward rooms only

Paramedicals

  • Coverage for chiropractic, physiotherapy, naturopathy, massage therapy and non-surgical podiatry to B.C. residents who qualify for MSP premium assistance. These individuals are covered for up to a combined annual total (each calendar year) of 10 visits and a maximum of $23 per visit.
  • Surgical podiatry is covered for all B.C. residents 

Hearing aids

  • No coverage

Nursing benefits and home care

  • Limited coverage for home nursing

Medical supplies

  • PharmaCare covers insulin pumps for eligible individuals with Type 1 diabetes or other forms of diabetes requiring insulin.
    • Insulin PumpsPharmaCare will cover 100% of the cost of the OmniPod Management system without a deductible or copay requirement. Alternatively, they will provide coverage (subject to the deductible and family maximum) for a MiniMed system where the OmniPod is not clinically suitable for a patient. All other insulin pumps are ineligible.
    • Insulin Pump Supplies: All insulin pump supplies are eligible through PharmaCare, except for caps, batteries and other non-essential supplies
  • PharmaCare covers prostheses for eligible residents of any age and orthoses for children or youth age 18 or younger when the prosthetic or orthotic device is needed to attain or maintain basic mobility
  • Orthotic devices for age 18 or younger
  • Some coverage for mastectomy, prostheses and ostomy supplies

Accidental death and dismemberment

  • No coverage.

Out of country

  • Coverage for medically required emergency situations rendered by a licensed physician only
  • In-patient coverage of up to $75 per day for adults and children, and $41 per day for newborns. Physicians and diagnostic services are covered at B.C. rates. 
  • No coverage for out-patient services. 

These highlights from the British Columbia Medical Services Plan are for general reference only and are subject to change, corrections and updates. Other government programs may also be available. For more information on the latest coverage details, contact:

Health Insurance BC
P.O. Box 9035 Stn Prov. Govt.
Victoria, BC V8W 9E3

Lower Mainland: 604-683-7151
Elsewhere in B.C.: 1-800-663-7100 (toll-free)

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Updated: August 2019