Custom Orthopedic shoe claiming checklist - Complete this checklist and submit with your claim if you are claiming for orthopedic shoes.Accident or Injury Reimbursement Agreement (WorkSafe) - Health, dental or disability claim for a WORKPLACE accident or injury.Accident or Injury Reimbursement Agreement (ICBC) - Health, dental or disability claim for a VEHICULAR accident or injury prior to November 9, 2018.

Accident or Injury Reimbursement Agreement - Complete this form if your health, dental or disability claim is the result of an accident or injury not related to a workplace or automobile incident.

Make sure to answer yes to the question “Apply unpaid balance to HSA plan?”

Health Spending Accounts - Use the standard health claim form to submit claims under your HSA plan (if applicable) for expenses that are recognized as medical expenses under Canada Revenue Agency (CRA) Income Tax guidelines.

Claims for Orthodontic treatments may also be submitted online through Member Profile.

Dental Claim Form - Use this form to submit claims for dental expenses if your dentist is not able to submit your claim directly to Pacific Blue Cross.

Note: Claims for vision care and paramedical treatments may also be submitted online through Member Profile.

Health Claim Form - Use this form to submit claims for any health expenses covered under the provisions of your benefit plan.

For plan members with benefits through their workplace

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