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
  • Coverage provided under BC Fair PharmaCare is income based and provides coverage for drugs listed on the BC drug formulary. An annual deductible and family maximum are calculated based on net family income.
  • As of January 1, 2019, BC Fair PharmaCare reduced or eliminated family deductibles and maximums for lower income families.

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  • Effective Jan. 1, 2015, Fair PharmaCare limits annual quantity for blood glucose test strips based on the diabetes treatment the patient is receiving

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  • 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

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  • Effective May 27th, 2019 B.C. PharmaCare launched a Biosimilars Initiative.
  • During the transition period from May 27 - November 25, 2019, PharmaCare will cover both originator and biosimilar versions of the affected drugs to allow patients time to inform themselves and start the switching process with their prescriber.
  • Effective November 26, 2019, PharmaCare will only cover the biosimilar versions of the drugs listed above for the affected indications.

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Ambulance

  • No coverage for ambulance fees, however fees may be subsidized for persons with a valid BC Care Card who are covered by the Medical Services Plan of B.C. (MSP)

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Dental benefits

  • No coverage for most dental procedures such as fillings, caps, crowns, root canals, etc.
  • Coverage provided for dental and oral surgery, when medically required to be performed in hospital
  • Coverage provided for orthodontic services related to severe congenital facial abnormalities.

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Vision care

  • No coverage for glasses or contact lenses
  • Coverage of routine eye exams for residents ages 18 and younger, and 65 and older
  • Coverage provided for medically required eye exams for all age groups

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Hospital

  • Coverage for standard ward rooms only

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Paramedicals

  • Coverage for essential extended medical therapies consisting of acupuncture, chiropractic, massage therapy, naturopathy, podiatry and physical therapy may be provided to specific recipients who are eligible for general health supplements.
    • A medical practitioner or nurse practitioner must confirm an acute need and there must be no other resources available

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Hearing aids

  • Coverage for least expensive, appropriate hearing instruments and associated repairs and supplies are provided to eligible recipients who lack the financial resources.

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Nursing benefits and home care

  • Limited coverage for home nursing

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Medical supplies

  • PharmaCare covers insulin pumps for eligible individuals with Type 1 diabetes or other forms of diabetes requiring insulin who meet the medical criteria and have Special Authority approval for coverage.
    • Insulin Pumps: PharmaCare will cover the OmniPod Management system. 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
  • Coverage may be provided by PharmaCare for limb, breast, ocular, nasal, and ear prostheses needed to attain or maintain basic functionality
  • Coverage may be provided through the PharmaCare Prosthetic and Orthotic program for eligible patients, aged 18 or younger, with the cost of custom orthoses that help attain or maintain basic functionality or prevent further deformity.
  • Coverage may be provided for ostomy supplies

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Accidental death and dismemberment

  • No coverage.

Out of country

  • Coverage for medically required emergency situations rendered by a licensed physician only
  • In-patient coverage is subject to a daily maximum.
  • Physicians and diagnostic services are covered at B.C. rates.
  • No coverage for out-patient services.

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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: January 2020