Transition from HBTF Standard Plan to new Health and Dental Enhanced Plan

Generic drugs

To keep premiums competitive and align with industry best practices, the new plan will change from brand-name drug coverage to voluntary generic drug coverage. Your pharmacist will notify you if there is a lower-cost generic drug alternative to a brand-name drug that has been prescribed to you. 

If you choose to purchase the brand-name drug, you will be reimbursed up to the cost of the generic version. If your doctor indicates no substitutions, the cost of the brand-name drug will be covered.

Enhancements

Due to increasing use, anti-obesity drugs will be added as an eligible drug category. The lifetime maximum for fertility drugs will increase from $2,400 to $5,000.

Fair PharmaCare

Manulife’s standard practice is to reimburse eligible prescription drug claims alongside provincial drug funding that may be available to you. Manulife will require your BC Fair PharmaCare registration confirmation if you are under 65 and reach $800 in claims for drugs listed in the BC Fair PharmaCare formulary or equivalent program, or over the age of 65 and reach $100 of claims. 

Your pharmacist will inform you if these thresholds are met. Register for your provincial drug program and, starting July 1, when your Manulife benefits app becomes available, verify your registration with Manulife to ensure continuous claims coverage.

Special Authority

If you are currently being reimbursed by the HBTF plan for a drug that qualifies for a provincial Special Authority drug program, such as BC’s Expensive Drugs for Rare Disease (EDRD) exceptional funding, please contact insurance@doctorsofbc.ca so we can help ensure continuity of coverage. For new prescriptions for qualifying drugs, proof of Special Authority’s coverage decision notice will be required.

New maximum 

Both your current HBTF plan, insured by Canada Life, and the new Health and Dental plan, insured by Manulife, provide travel emergency medical coverage. 

This benefit covers claims arising from sudden and unforeseen situations such as accidents and emergencies, and typically does not include follow-up or recurrent care. The new plan offers a higher emergency medical travel lifetime benefit maximum of $5 million, up from $3 million.

New eligibility criteria 

Under the HBTF plan, Canada Life defines a medical emergency as a sudden, unexpected injury or illness, or an acute episode of disease that could not have been reasonably anticipated based on the patient’s prior medical condition. This broad description makes it challenging for some enrolees to determine whether their medical condition would be considered “unexpected,” “acute,” or “reasonably anticipated” by the insurer.

Under the new Health and Dental plan, Manulife provides more detailed eligibility guidelines to help members assess whether their pre-existing conditions are covered. Manulife’s travel benefit covers eligible accidents and emergencies. 

The plan is intended to cover medical conditions, whether diagnosed or not at the time of departure, that meet all the following stability criteria in the 90 days before departure: 

• There has not been any new treatment prescribed or recommended, or change(s) to existing treatment. 
• There has not been any change to any existing prescribed drug, or any recommendation or starting of a new prescription drug, not including regular changes in medication that are made as part of an ongoing treatment or a reduction in medication due to an improvement in the medical condition. 
• The medical condition has not become worse. 
• There have not been any new, more frequent, or more severe symptoms. 
• There has been no hospitalization or referral to a specialist. 
• There have not been any tests, investigation, or treatment recommended, but not yet complete, nor any outstanding test results. 
• There is no planned or pending treatment.

Other travel medical eligibility requirements may apply. If you’re travelling outside Canada, review the new Out-of-Canada and Emergency Travel Assistance coverage, and note the new medical emergency contacts before departing.

While the travel coverage aims to cover most situations, you may need supplemental coverage if this plan doesn’t fully meet your needs.

Under the HBTF plan, speech therapy and mental health practitioners have a separate annual limit of $1,000. All other paramedical practitioners are limited to $500 per year, with a combined cap of $1,000. The new plan will eliminate the $500 individual limit, allowing greater total reimbursement for your most frequently visited practitioners.

Mental health practitioners will continue to have a dedicated $1,000 annual limit, while speech therapists and other paramedical practitioners will share the $1,000 combined annual maximum. Reasonable and customary limits continue to apply for each paramedical visit.

Audiologists, kinesiologists, chiropodists, and dieticians will now be covered under the new plan.

Vision care coverage will be included in the new Enhanced plan. This benefit will cover prescription glasses, contact lenses, or laser vision correction procedures, up to $250 every 24 months.

Your claims history will transfer to your new plan. For example, if you claimed $1,500 of your $2,000 annual dental benefit maximum on February 1, your Manulife dental benefits will begin July 1 with a remaining balance of $500. 

The calendar-year balances will reset on January 1, 2027. All prior claims for benefits with lifetime maximums, such as orthodontics and fertility drugs, but excluding travel emergency medical, will also be reflected in your Manulife balances.

The HBTF Standard plan offered a unique unlimited health care maximum. An independent consultant advised introducing a lifetime limit to align with other benefit plans and ensure long-term premium competitiveness. Under the new plan, each enrolee and dependant will have an individual $1 million lifetime health care maximum.

The lifetime maximum will apply to claims for extended health care, including prescription drugs, made on or after January 1, 2026. All prior claims for health benefits with individual lifetime maximums, excluding dental and travel emergency medical claims, will also count towards the overall lifetime health care maximum.

Members, spouses, or dependants who are covered by another provider can waive health and dental benefits. To ensure consistent eligibility guidelines, evidence of insurability will now be required for anyone who waived coverage and later seeks to enrol in the Doctors of BC Health and Dental plan.