Frequently asked questions

Patients are notified by letter if a request for coverage has been approved or denied. You can also phone Pharmacare to inquire if you have been approved.

If your vision benefit is every 24 months, this means that your vision benefit won't be available for 24 months from the previous date of purchase. It is possible your glasses were purchased within the 24 month period, even though they were in two separate calendar years.

Frequency and eligibility varies by plan. Visit Coverage in mybluecross® and view your vision eligibility to find out when you are eligible for your next eyeglass or lens purchase, or contact us.

Appointments are monitored and controlled to prevent scheduling back-to-back appointments with individuals from the same organization. You do not have to notify your employer to access our services. Employee Assistance will not disclose client or clinical information to anyone at any time without your written consent. Exceptions to confidentiality are those required by law.

Money cannot be withdrawn from your account. Direct deposit only allows Manitoba Blue Cross to deposit claim payments into your account.

If both plans are with Manitoba Blue Cross and we have the most up-to-date information on file, you can submit one claim and it will automatically be considered under both plans. Contact us if you need to update your coordination information.

Verify charges to your plan by contacting the hospital you were admitted to. You should only be charged if you have requested and signed for such accommodation. You should never be charged for hospital ward accommodations (three or more beds in a room), ICU (Intensive Care Unit) beds, CCU (Critical Care Unit) beds, or outpatient beds for day surgery. Additionally, if your doctor requests that you have a private or semi-private room for medical reasons, neither you nor Manitoba Blue Cross should be billed for the room charges.

* Manitoba Blue Cross will not cover the cost of the room for panelled patients or for hospitalization due to cosmetic reasons.

This information can be found on the Manitoba Government website.

No, Health Spending Account credits cannot be assigned to pay a provider. According to Canada Revenue Agency guidelines, credits can only be used to reimburse expenses which have been paid.

If your drug is approved by Pharmacare, you will be notified in writing.

Prior to filling your prescription, upload your Pharmacare EDS approval letter. Manitoba Blue Cross will then update your file and process all applicable claims for the drug specified, according to the dates indicated in the letter.

Important: If you prefer to mail your Pharmacare EDS approval letter, you must include your certificate number.

No. Case records are kept confidential and handled in compliance with all applicable federal and provincial laws. No information regarding your appointment can be released to anyone, including your spouse, without your consent.

At Manitoba Blue Cross, we respect your privacy and take protecting it seriously. Your personal information is held in strict confidence. We do not sell or share your information with anyone else.

Sensitive information (such as login credentials or bank account information) is stored within secure databases, using the latest in data protection systems. Manitoba Blue Cross uses a secure sockets layer (SSL) to protect your sensitive information, in addition to other physical, technological and organizational safeguards.

If a person is a member of more than one plan, the adjudication priority is as follows:The employer plan where the member is an active full-time employeeThe employer plan where the member is an active part-time employeeThe employer plan where the member is a retireeThe individual plan that a member has purchased on their ownThe plan where the person is covered as a dependent

Recognized hostels in Manitoba include:

• Lennox Bell Lodge (associated with the Health Sciences Centre)
• Misericordia General Hospital Lodge (associated with Misericordia General Hospital)
• Grace Hospital Complex Site (associated with Grace Hospital)
• Ronald McDonald House A Port in the Storm (associated with St Boniface Hospital)

Visit How to submit a travel claim for information on making a travel claim.

In accordance with The Income Tax Act, unused credits are forfeited. To maximize credit use, members should request reimbursement during the benefit year, ideally at time of expense.

• Generic drugs contain the same active medicinal ingredients and quality as their brand-name counterparts. In Canada, generic drugs are strictly regulated and must meet certain clinical standards in order to be substituted by the pharmacist.
• To be approved, generic drugs must include the same active ingredient, provide the same strength per dosage, and be administered the same way (oral, topical, or injection). The non-medicinal ingredients of a generic brand are the only component that can differ.
• Generic products normally cost less and can therefore reduce the costs of your health plan. To keep your plan costs down, ask your doctor or pharmacist to prescribe the generic drug whenever possible.

Yes. Contact the Employee Assistance Centre at 1.800.590.5553 (toll-free) or 204.775.0586 (TTY) to find out how we can help. We have a network of providers across 23 rural and northern Manitoba communities.

Our terms and conditions are in place to protect the validity of the Online Claims Submission system. If you have questions or concerns about any of the terms listed, contact us.

• Manitoba Blue Cross may verify the accuracy of the claim being submitted by asking you to submit the receipt(s) and, if needed, further supporting documentation. If requested, you agree to send us this information within 30 days of the request.
• Manitoba Blue Cross reserves the right to request that you submit your claim receipt(s) and supporting documentation within 12 months of submitting your claim.
• Manitoba Blue Cross reserves the right to remove your access to Online Claims Submission without notice.
• Manitoba Blue Cross may deny your online claims and terminate your coverage if you provide false, incomplete, or misleading information.
• Manitoba Blue Cross reserves the right to deduct any monies or overpayments that you may owe to Manitoba Blue Cross from your future claim payments.

Yes. We have a selection of personal plans available to meet your needs.

If you are transitioning from another plan with comparable coverage, avoid the three-month dental waiting period by applying within 60 days of loss of coverage. Coverage will be continuous as long as you pay premiums for the first month of coverage loss.

Visit Claims in mybluecross® to view the status of your claims. Claims are processed in the order in which they are received. A Health Spending Account (HSA) claim will need to be first processed under your health or dental plan before it can be submitted to your HSA.

Do not worry as this can sometimes happen. Billing departments are not always located within the medical facility and are often a separate service. As a result, there are times when CanAssistance makes a payment to the medical facility, but this information does not reach the billing department immediately. In the mean time, an automatically-generated reminder bill may be sent to the member. If you receive a bill from a collection agency, contact CanAssistance at 1.866.601.2583 (toll free). CanAssistance will contact the facility and the collection agency and have this rectified. Continue to forward any new bills you receive to CanAssistance, with reference to your existing claim.

To maximize credit use, it is recommended that members submit Health Spending Account (HSA) claims within the same benefit year, ideally at time of expense. Each HSA plan has a grace period following the benefit year which is referred to as the claim limitation period. This grace period varies by group. Visit Coverage in mybluecross® to view your Health Spending Account (HSA) plan information including claim limitation period and benefit year.

* Based on coordination of benefits' guidelines, a member's HSA plan will always pay first, followed by the plan where they are covered as a spouse. To maximize credit use, it is important that members request reimbursement within the same benefit year, prior to allocation of their next year's credits.

If your doctor prescribes a brand-name medication, ask if a generic alternative is available. You can also ask your pharmacist to substitute a generic version when your prescription is filled.

If you have benefits through an employer or group: Contact your plan administrator to determine the effective date of your plan.

If you have purchased benefits through Manitoba Blue Cross or an agent: Your benefits will become effective on the first of the month following the effective date. There is a three-month paid waiting period* for dental.

*If you are transitioning from another plan with comparable coverage, we will waive the dental waiting period provided you apply within 60 days of loss of coverage.

• If your claim is submitted electronically, you will receive an email advising you when a claim has been processed. Visit Claims to view the details of your claims.

To ensure the length of your trip did not exceed coverage restrictions, we require proof of travel dates to confirm your departure and return to your home province.

The following forms of proof are acceptable:

• Receipts of any kind that have dates and addresses
• Hotel receipts that show when you checked in and out
• Credit card statements (with your credit card number blacked out/redacted) that show purchases that occurred while at your destination and then while at home
• An airline itinerary with boarding passes

Paper claims may take up to 15 business days to process. This does not include the time needed by Canada Post to deliver your claim to us, or the time required to process your claim through your health or dental plan if needed.

Provided the HSA claim was received within your group's claim limitation period, it is still considered eligible and will be included in the next payment run. Cheques are mailed every Wednesday and direct deposit payments are transmitted every Monday, Wednesday, and Friday.

To avoid delay, sign up for direct deposit and gain access to HSA Online Request. This service allows you to request reimbursement for outstanding balances previously submitted to your health or dental plan. If you have receipts or unpaid balances with another carrier, be sure to submit an Explanation of Benefits (EOB) from that carrier so we may add these outstanding expenses to your account.

Yes, all prescriptions are subject to a Maximum Days Supply policy of 100 days per Manitoba Pharmacare guidelines. Exceptions will be made when travelling provided the patient has applied for a Term Certificate from Pharmacare.

If you have benefits through an employer or group: Contact your plan administrator to determine cancellation eligibility based on the rules of your plan.

If you purchased benefits through Manitoba Blue Cross or an agent: You may request cancellation at any time; however, re-enrollment would have to be authorized by Manitoba Blue Cross (unless you have cancelled as a result of obtaining comparable coverage through an employer, group or spouse).

To cancel your coverage, notify Manitoba Blue Cross in writing (by email or letter). Upon receipt of notification, your coverage will be cancelled on the last day of the following month.

If the Paid Amount is $0.00, click on your claim to view details. If the claim status is Processed and a Paid Amount is indicated, a payment will be direct deposited within 1-3 business days from the Processed date. Cheque payments are issued weekly.

Typically, we allow 30 business days to process a travel claim; however, processing time is unique to each travel claim and depends on the complexity of the claim.

This processing time does not include the time needed by Canada Post to deliver your claim to us, nor the time it takes to receive all bills and records from applicable service providers. Please keep this in mind when verifying your claim's status and continue to forward any new bills you receive, with reference to your existing claim.

No, unused credits will not be reimbursed to you. In accordance with The Income Tax Act:

• Health Spending Account credits may only be used to reimburse medical expenses within a specified time period.
• In order to receive reimbursement, you must claim an expense.
• Credits not used within the specified time period are forfeited.

Yes, you may purchase more than the maximum 100-day supply limit if you will be travelling with the intention to return to Manitoba, and have acquired a Term Certificate from Pharmacare.

If your plan has BlueNet, your pharmacy will need a copy of the Term Certificate to process the claim. If you are submitting a paper claim, include a copy of the Term Certificate for processing.

If you have benefits through an employer or group: Contact your plan administrator to determine re-enrollment eligibility based on the rules of your plan.

If you have purchased benefits through Manitoba Blue Cross or an agent: You may be eligible to re-apply. Contact Manitoba Blue Cross or your insurance broker/agent.

Claim information is current as of today; however, recent transactions may still be in process. Claim information does not include claims received by our office but not yet entered, or claims incurred but not yet submitted.

If you provided your certificate or policy number upon admission, the medical facility may forward your invoice directly to CanAssistance, Manitoba Blue Cross's emergency travel assistance provider for processing; however, you will still need to complete the necessary forms. Once CanAssistance receives your claim forms, they will attach them to the invoices received to process the claim.

* Ensure the medical facility knows to send all documents to Manitoba Blue Cross, not their local Blue Cross or Blue Shield.

If your employer terminates your coverage when you start maternity leave, you may submit Health Spending Account (HSA) expenses incurred during the time you were covered, provided they are submitted within the claim limitation period or termination grace period (whichever occurs first).

Visit Coverage in mybluecross® to view your HSA plan information including claim limitation period and benefit year.

Explain what happened to your pharmacist. A pharmacist can override an early prescription refill if your medication is lost, destroyed, or stolen. A note will be made in your file.

Visit Coverage in mybluecross® to view the details of your coverage.

No, a pre-authorization is not required for claim approval; however, without a pre-authorization claim coverage cannot be guaranteed. To avoid unexpected costs associated with a product or service recommended by a provider, ask your provider to send in a detailed description of the service or product with the estimated charges. Manitoba Blue Cross will then provide pre-authorization based on benefit eligibility, frequency limitations and maximums outlined by your plan.

If your employment ends mid-year, you may submit Health Spending Account (HSA) expenses incurred during the time you were covered, provided they are submitted within the claim limitation period or termination grace period (whichever occurs first).

Visit Coverage in mybluecross® to view your Health Spending Account (HSA) plan information including claim limitation period and benefit year.

Ask your pharmacist or contact us to find out if a drug is considered a regular Pharmacare drug. You can also enter the Drug Identification Number (DIN) on the Pharmacare website.

Our Blue Advantage program provides you with discounts on medical, vision, and dental services/products across Canada. These savings are available to all members, regardless of coverage type. Simply present your Manitoba Blue Cross ID card to a participating service provider and mention the Blue Advantage program. We are continually adding new providers to the program. Visit Blue Advantage today to view participating providers.

Visit Documents to view or print a copy of your claim. A duplicate statement can also be issued, for a fee, by contacting us.

Yes. Visit the Update direct deposit in the mybluecross® account dropdown to set up direct deposit using your account number, transit number, and bank number (located on your personal cheque or in your online banking account details). Banking information will be updated within one business day.

Manitoba Pharmacare is a drug benefit program available to all Manitobans. The program covers 100 per cent of eligible drug costs once a deductible is reached. Pharmacare drugs paid for by your Manitoba Blue Cross plan count towards your deductible.

Manitoba Blue Cross produces a statement called an Explanation of Benefits (EOB) for every claim processed. If your claim is only partially paid, your EOB will indicate whether any deductibles, maximums, or co-payments have been applied to the payment of your claim.

Your Health Spending Account (HSA) is administered in accordance with Canada Revenue Agency guidelines which state that an HSA must be the last payer (after government, spousal, and student plans, etc.).

Each year, you are required to pay a portion of your prescription drug costs. This amount is your annual Pharmacare deductible. The province sets your deductible based on your previous two year's income tax returns.

When you register under Manitoba Pharmacare, you will receive a letter confirming your deductible. Pharmacare drugs paid for by your Manitoba Blue Cross plan count towards this deductible. Estimate your deductible.

Manitoba Blue Cross does not return receipts. Instead, we produce an Explanation of Benefits (EOB) statement. Your EOB provides information that may be required for tax purposes, as well as any deductibles, maximums or co-payments applied to the payment of your claim. Your EOB can also be used to coordinate coverage if you have coverage under another plan. If you need to keep your original receipt, Manitoba Blue Cross will accept photocopies for claim processing.

In accordance with Canada Revenue Agency guidelines, a Health Spending Account (HSA) must be last payer (after government, spousal, and student plans, etc.). If you have benefits with another carrier, you must submit the claim to that carrier before we can process any remaining balances through your HSA.

Once submitted, please attach the secondary carrier's Explanation of Benefits (EOB) via mybluecross® showing payment or denial of your claim. This will allow us to process any remaining balances through your HSA.

Manitoba Pharmacare is a provincial drug benefit program available to all Manitobans. The program covers 100 per cent of eligible drug costs once a deductible is reached. Pharmacare drugs paid by your Manitoba Blue Cross plan count towards this deductible.

To protect your plan, Manitoba Blue Cross temporarily suspends drug payments once you reach a specific dollar threshold (amount varies by plan). This ensures your plan does not pay for prescription drugs covered by Pharmacare.

Yes. Visit Manage Account in mybluecross® to set up direct deposit using your account number, transit number, and bank number (located on your personal cheques). Banking information will be updated within one business day.

To register for Pharmacare:

1. Ask your pharmacist for an application or find a form online.
2. Select your preferred method of enrollment:
3. ~Option A - One-Time Enrollment*
4. ~Option B - Annual Application

*We recommend the One-Time Enrollment so you do not have to reapply each year. This will ensure uninterrupted processing of eligible drug claims.

Once registered, you will receive a letter confirming your deductible. As Pharmacare will not release information to a third party, you must upload your registration letter. Manitoba Blue Cross will then resume processing all eligible claims.

Important: If you prefer to mail your registration letter, you must include your certificate number. Please note dependents age 18 and older are assigned a separate Manitoba Health registration number and must submit their own Pharmacare registration letter.

Visit Coverage in mybluecross® to view your coverage details.

A dispensing fee is the amount charged to you by the pharmacy for dispensing the drug. Dispensing fees can differ from pharmacy to pharmacy making a big difference in the total cost of the prescription. Claim data indicates that dispensing fees can range from $4 to $20 or more per prescription across different pharmacies. Inquire at your pharmacy to find out what their dispensing fee is. To reduce the dispensing costs on your prescriptions, you can shop around to find the best price.

*You can also reduce dispensing costs by purchasing a three-month supply of a prescription drug at one time rather than paying a dispensing fee each month.

Dependent coverage termination varies based on your plan. Refer to your benefit booklet or contact us for more information.

Online Claims Submission allows only one Drug Identification Number (DIN) to be submitted per prescription. Since a compound is comprised of multiple drugs, you will need to submit a paper claim to Manitoba Blue Cross.

Provided your daughter is below Student Age, she is eligible for coverage until the day of her last exam. It is your responsibility to notify Manitoba Blue Cross when a dependent no longer meets the criteria to remain on your plan.

• If your claim payment cheque has not arrived after allowing for sufficient mailing time, contact us to request a bond form for replacement. We recommend allowing Canada Post three weeks to ensure we do not cancel a cheque that may be in transit.
• To avoid mailing delays, sign up for direct deposit and have claim payments transmitted directly to your bank account.

If a claim is in Audited status, this means it has been selected for review by our online system.Manitoba Blue Cross is committed to protecting your benefits from fraud and abuse. One of the ways we do this is by auditing claims to confirm the accuracy of information provided.Visit Insurance Fraud and Abuse to learn more.

To resolve an Audited claim, use Claim Search to find your claim and submit your receipt(s).

Important: If you prefer to mail your receipt(s), you must include the Reference Number of your audit, which you will find under Claim Details.

If you do not submit receipts for an Audited claim, we will be unable to process that claim or any future online claims.

Queued means your claim is being held for processing. This has happened because you have a claim in Audit status. When a claim is selected for audit, the system places a temporary hold on all subsequent claims. Once Manitoba Blue Cross receives the requested receipt(s) for your Audited claim, all Queued claims will be released for processing.

Visit our Insurance Fraud and Abuse page for detailed information regarding insurance fraud and insurance abuse.