Frequently Asked Questions: Health, Travel & Life

How do I submit a claim? Icon/UI/plus-circle

Using your group or personal member portal or mobile app is the most convenient way to submit claims. Learn more here.

For Travel Claims, please refer to the Travel Assistance & Claims section here.

Who is considered a dependent? Icon/UI/plus-circle

For Personal members: An applicant’s spouse, unmarried child up to 18 years of age (or up to age 25 if a full-time student at an accredited educational institution) or any disabled child unable to leave the care of the policyholder.

For Group plan members: An applicant’s spouse, unmarried child up to 21 years of age (or up to age 26 if a full-time student at an accredited educational institution) or any disabled child unable to leave the care of the policyholder.

How do I know which plan or options are right for me? Icon/UI/plus-circle

Our dedicated team can help you understand and choose the coverage you need, no matter what stage of life you’re in.

Get in touch here.

Will coverage under my Conversion Plan be identical to my Employer Benefits Plan? Icon/UI/plus-circle

Coverage may differ. Certain exclusions and limitations may apply, or benefits offered as part of your Employer Plan may not be available in a Conversion Plan.

I’m leaving my employer; how do I convert my benefits? Icon/UI/plus-circle

Simply apply within 60 days of leaving an Employer Benefits Plan and we’ll transition your Health, Prescription Drugs, Dental and Travel benefits into a new Conversion Plan with no interruption in coverage. If you wait until after 60 days you will be required to complete a medical questionnaire.

What payment options are available? Icon/UI/plus-circle

You may choose pre-authorized monthly debit from a bank account or pay annually using your credit card.

When does my Personal Health Plan coverage take effect? Icon/UI/plus-circle

For Blue Choice® plans: Your coverage begins on the first day of the month following the approval of your application and the receipt of your payment.

For Conversion plans: Apply within 60 days of leaving an Employer Benefits Plan and experience no interruption in coverage.

What is an exception drug status letter? Icon/UI/plus-circle

Certain drugs are approved for coverage under the Exception Drug Status (EDS) Program, upon review and recommendation of the Saskatchewan Formulary Committee. If an EDS drug is approved as a benefit, the drug is added to the SK Formulary Drug Plan for the approved individual.

Do I have disability coverage under my group plan and if so, what are the details and how do I apply? Icon/UI/plus-circle

You can contact our Customer Service Centre at 1-800-667-6853 to confirm if your group plan holds active coverage for Disability benefits. If you have further questions on coverage or how to apply, please contact your plan administrator for further details.

I have more than one health plan. Who do I submit my claims to first? Icon/UI/plus-circle

When you are covered under more than one health plan, you can enjoy the benefits of both. Submit your claim under one plan, and then submit the remainder of that claim (for example, the remaining 20% of a claim that is covered up to 80%) to the other plan. Learn more here.

Can I have my claims deposited directly into my bank account? Icon/UI/plus-circle

Yes! Sign up for direct deposit using your group or personal member portal or mobile app.

What can I expect following my claims assessment? Icon/UI/plus-circle

If you have signed up for direct deposit, eligible reimbursement will be direct deposited into your bank account and the funds should appear in your bank account within 1-3 business days from time of processing.

If you haven’t signed up for direct deposit, you’ll receive a cheque in the mail. To get your money back faster, sign up for direct deposit.

Why has my claim been reduced or denied? Icon/UI/plus-circle

Claims adjudication (i.e. whether a benefit is paid, declined, or limits applied) is based on the provisions in your Personal Health Plan Policy. These can include co-insurance amounts, dollar maximums, frequency limits, fee schedules, exclusions, and/or usual, reasonable, and customary limitations.

How long will it take to process my claim? Icon/UI/plus-circle

Pharmacies and Dentists can direct bill Saskatchewan Blue Cross in real-time using an electronic submission method.

For all other claims, your wait time will depend on the type of claim, how it was submitted, and our current claims volume. Our standard turnaround time is 3-5 business days from time of receipt. For the simplest process and quickest turnaround time, we encourage you to register for the group or personal member portal or mobile app.

I have Saskatchewan Health coverage. How would a Saskatchewan Blue Cross health insurance plan offer further coverage? Icon/UI/plus-circle

The Blue Choice and Conversion health plans provide coverage for health benefits above the provincial plan, such as hospital accommodations, emergency ambulance services, health practitioners like massage therapy, and many more! Please contact our office at 1-800-667-6853 and an agent would be happy to discuss further details.

Can I add my spouse and children to my policy? Icon/UI/plus-circle

For Personal members: You can apply to add your child and/or spouse to your policy by completing the Personal Health Plans Application here.

For Group plan members: Please contact your plan administrator to inquire about adding your spouse and dependents.

Learn more about managing your plan here.

How can I find out how much balance I have left for a specific benefit? Icon/UI/plus-circle

You can view your balances through your group or personal member portal or mobile app or by calling our Customer Service Centre at 1-800-667-6853.

How do I confirm if a provider is eligible? Icon/UI/plus-circle

For Personal members: Our Personal Health Plans include coverage for diagnosis or treatment by the following health practitioners:

  • chiropractor
  • chiropodist/podiatrist
  • physiotherapist/athletic therapist
  • registered massage therapist
  • psychologist/counsellor/social worker
  • naturopath
  • acupuncturist
  • speech-language pathologist

When a profession is regulated in a specific province/territory, we will confirm that the health practitioner is listed in good standing with the regulatory body that governs that profession. However, not all healthcare professions are regulated in every province/territory in Canada. As a result, some healthcare professions have developed associations which have varying membership requirements. Such associations are evaluated against established criteria to determine if their members will be approved providers with Saskatchewan Blue Cross.

We recommend you contact our Customer Service team to ensure expenses for services or supplies from a specific health practitioner are eligible for coverage before the expenses are incurred.

For Group plan members: Please refer to your group member portal, mobile app or employee benefits booklet for details on what your plan covers.

How can I confirm if an expense is eligible? Icon/UI/plus-circle

For Personal members: Your personal member portal and mobile app give you a centralized platform to view your coverage benefits. After opening the app or logging in to the member portal, just hit the ‘My Coverage’ button and you'll be able to browse your Core Health benefits and Custom options. You can also find information in your Personal Health Plan policy booklet. If you’re unable to find the information you’re looking for, contact our Customer Service team at 1-888-667-6853.

For Group plan members: Your group member portal and mobile app are the best place to check for the most up-to-date information about your coverage benefits. After opening the app or logging in to your member portal, just hit the ‘Check My Coverage’ button and you'll be able to browse your available benefits. You can also refer to your employee benefits booklet. If you’re unable to find the information you’re looking for, contact our Customer Service team at 1-888-667-6853.

How can I find out what benefits are offered with my plan? Icon/UI/plus-circle

You can use your group or personal member portal or app to get 24/7 access to view your benefit plan details, along with many other self-serve features.

How can I find out if a specific procedure is covered under my dental insurance? Icon/UI/plus-circle

You can submit an estimate into our office in the same manner you would submit your claims (through your Group or Personal Member portal or app, online directly through our website, in person or by mail).

What is the Special Support Program? Icon/UI/plus-circle

The Special Support Program (SSP) is designed to help those whose drug costs are high in relation to their income. This program is available to residents of Saskatchewan that hold valid Saskatchewan Health. Based on family income and the drugs that are used in a year, Saskatchewan Health determines the level of coverage they will provide. This program is family-based and everyone is eligible to apply for this coverage.

Can I make a payment every 4 or 6 months? Icon/UI/plus-circle

Personal Health Plans are annual plans; as such, payment must be made either annually by cheque or credit card, or monthly by automatic withdrawal.

Do your rates increase each year? By how much? Icon/UI/plus-circle

As a not-for-profit organization, we take great care in ensuring that our Personal Health Plans continue to be among the most affordable and sustainable in Saskatchewan. The rates you pay go towards claims, service and administration costs – not profit margins.

Annually, Personal Health Plans undergo a rate review to adjust for factors including general inflation, the cost of health care and paramedical services for all Saskatchewan members on our Personal Plans, and enhancements to the benefits and service options offered to you.

Personal Health Plan pricing is also aligned to 10-year age increments, providing greater stability in your plan pricing over time. Rate adjustments occur when you enter a new age group, and can be a contributing factor in your renewal rate. Our rates are determined by the following age brackets: Under 35 | 35-44 | 55-64 | 65-74 | 75-84 | 85+

I’ve applied for coverage and received an offer. If I don’t accept it now, can I re-apply for coverage in the future? Icon/UI/plus-circle

Yes, however you will need to complete a new application for coverage at that time. Coverage for Blue Choice® Health Plans is evaluated and offered based on your medical history, which means we cannot guarantee that you would receive the same offer when you re-apply.

I have a small business, but my business doesn’t meet the minimum number of employees for any of the Saskatchewan Blue Cross workplace benefits plans. What are my options? Icon/UI/plus-circle

Saskatchewan Blue Cross Personal Health Plans are a great fit for entrepreneurs with fewer than 3 employees. By offering a health plan for yourself and your employees, you can ensure that your employees' healthcare needs are taken care of without impacting your operations.

As a sole proprietor, a Personal Health Plan serves as a tax deductible expense on your personal tax return. Deductibility is limited to $1,500 for each self-employed person.

If you’d like to offer Personal Health Plan coverage for yourself and your employees, each person should apply for their own Personal Health Plan. You as the business owner can decide how much coverage you’d like to offer, or how much of the plan premium you’ll reimburse for your employees. For more information, please contact us.

I am retiring and looking for a health insurance plan. What plan should I be looking for? Icon/UI/plus-circle

You’ve reached the retirement milestone, congratulations! Our Conversion Plan is designed to support you through this important and exciting transition. Simply apply within 60 days of your group benefits ending and the Conversion Plan will offer no interruption in coverage, no waiting periods, and no medical review.

The Conversion plan is designed to coordinate with many provincial and federal programs - including the Seniors Drug Program, which results in a decrease in your premium starting at age 65.

Are you ready to design a Personal Health Plan that fits your needs and lifestyle? Apply today!