Adjudication and payment of Extended Health and Dental claims is outsourced to Pacific Blue Cross (PBC) and HBT oversees the governance and administration of the overall claim process to ensure fairness and consistency.
More specifically, the role of HBT in Extended Health and Dental Benefit Plans is to:
- Negotiate the terms and conditions of the contract with PBC
- Provide PBC with all related Benefit Plan information for the purpose of adjudicating and paying claims
- Set rates for Extended Health and Dental Benefits
- Provide funds for claims payment
- Provide dispute resolution of escalated issues
- Measure and track overall performance of PBC
- Report on claims statistics for all member employers
The role of PBC in Extended Health and Dental Benefit Plans is to:
- Enrol beneficiaries
- Answer questions from beneficiaries
- Assess claims to determine if claimant qualifies to receive Benefits
- Determine the amount of Benefits payable, based on the Benefits contract
- Pay claims as per Benefits contract
- Collect premiums from employers
- Escalate issues to HBT
Online Service: Member Profile
Member Profile is an online service from PBC that offers members convenient and secure access to Benefits and claim information. Member Profile provides:
- Secure 24/7 access to Benefit and Claims information, including Claim history
- A summary of Extended Heath coverage and/or Dental coverage
- Claim forms and ID cards
- Direct deposit and online claims statements