Fair PharmaCare

What Is Fair PharmaCare?

 

Fair PharmaCare helps BC families pay for eligible prescription drugs, some medical supplies and devices, and eligible pharmacy services. PharmaCare is income-based; the less a family earns, the more help they get.

What You Get

 

Fair PharmaCare covers

Under the Fair PharmaCare plan, you pay your family’s prescription costs until you meet your deductible. After that, PharmaCare helps you with eligible costs for the rest of the year. If you reach your family maximum, PharmaCare will pay 100% of your eligible costs for the rest of the year. You can get an estimate of your level of coverage under the plan using an online Fair PharmaCare calculator.

Eligibility

 

All BC residents are eligible for Fair PharmaCare coverage if they

  • Have Medical Services Plan (MSP) coverage, and

  • Give PharmaCare permission to check their income with the Canada Revenue Agency (income is from 2 years prior)

Coverage is family-based. A family can be a

  • Single person

  • Married or common-law couple

  • Single person with dependent children

  • Couple with dependent children

Your annual net family income determines the level of coverage you receive. If you have a spouse, or are in a marriage-like relationship, you must include your spouse in your registration. 

Registration

 

You can register online, by phone, or by mailing in a paper form. If you register online or by phone, your coverage will begin immediately. You only need to register once. If you registered previously and no longer have coverage, please contact Heatlh Insurance BC.

To register you need the following for all family members

  • Birth date

  • Personal Health Number

To register you need the following for you and your spouse (if you have one)

  • Social Insurance Number

  • Income from the tax return from two years ago, including:

    • net income (line 236 of the return)

    • any income from a Registered Disability Savings Plan (RDSP) (line 125)

PharmaCare uses income tax data from two years ago to calculate the Fair PharmaCare coverage your family receives. For example, your 2021 coverage will be calculated using your 2019 tax return. PharmaCare automatically renews your coverage as long as your income information from two years prior is available from the Canada Revenue Agency.

After Registering

 

After you register, Health Insurance BC will send you a consent form that you must fill in, sign, and send back within 30 days, so that your income can be verified with the Canada Revenue Agency (CRA)

  • If you do not return your consent form, temporary coverage ends and your family's deductible will be set at $10,000

  • It may take up to 90 days to confirm your income with the CRA

  • Once your income is verified, PharmaCare will send you a confirmation letter within 30 days

 

Q What counts as a 'family'?

A Your 'family' can include you, your children, and/or your spouse. Dependent children on the same MSP contract as you or your spouse will receive Fair PharmaCare coverage as part of your family. Dependent children are:

  • Under the age of 19, or 19-24 attending school or post-secondary education

  • Supported by you and/or your spouse

  • Neither married nor living in a marriage-like relationship

Q If I have joint custody of a child, which family should the child register with?

A The child must be registered on the account of a parent on whose Medical Services Plan (MSP) account the child is registered. MSP and PharmaCare share family structure information, so children must be on the same parent’s account for both MSP and PharmaCare. While children may be on both parents’ MSP accounts, they may be one only one parent’s Fair PharmaCare account.

Q What happens when I turn 19?

A When you turn 19 years old, you must establish your own Medical Services Plan (MSP) account. If you no longer qualify as a dependent for MSP, you can get separate Fair PharmaCare coverage right away or stay as a dependent in your family until the end of the calendar year in which you turn 19.

If you qualify as a dependent for MSP (for example, because you are attending school full-time), you will stay on your parents’ Fair PharmaCare plan.

Q Can adults be registered as a dependent?

A For Fair PharmaCare, a dependent is:

  • A resident who is the legal ward or child of the registrant, and

  • Supported by the registrant, and

  • Neither married nor living and cohabitating in a marriage-like relationship, and

  • Either 18 years or younger or aged 19 to 24 and attending school or university full-time

Dependents must live with the family whose PharmaCare plan they belong to. In cases of joint custody, children must be on only one parent’s Fair PharmaCare account, and they must be on the MSP account for that parent.

Q What if my spouse is not eligible for Fair PharmaCare?

A If your spouse is not eligible for Fair PharmaCare coverage, you still need to report their income when you register, because Fair PharmaCare coverage is based on family net income

Q My spouse and I are no longer together, but we are still on the same Medical Services Plan (MSP) account. How should we register for Fair PharmaCare?

A You have two options:

  • You and your former spouse can establish separate MSP accounts. Then you can contact Health Insurance BC and register for separate Fair PharmaCare accounts.

  • You can register for Fair PharmaCare as a family and report your combined net income

Q What if a federal insurer covers my spouse's prescription drug costs?

A Your spouse's coverage by the federal insurer (for example, the Canadian Forces, Veteran's Affairs Canada or the Non-Insured Health Benefits program) will not change, but you will still need to include their income when you register, because Fair PharmaCare coverage is based on family net income.

Q I am a guardian for a friend/family member. How do I register him/her for Fair PharmaCare?

A As a guardian/power of attorney, you can register a friend/family member by phone or online. When you return the consent form, include a copy of the Power of Attorney that shows you have authority to act on the person's behalf.

Q What is a deductible?

A family’s deductible is the amount they need to spend each year on eligible costs before Fair PharmaCare starts to help with these costs. Once they reach their deductible, PharmaCare pays 70% of costs; or 75% of costs for families with a member born before 1940.

Q What is a family maximum?

A The family maximum is the most a family needs to spend, per year, on eligible drugs, fees, and medical supplies before Fair PharmaCare pays 100% of eligible expenses.You can calculate your family maximum using Fair PharmaCare estimator.

Q Can I cancel my Fair PharmaCare plan registration?

A You can cancel your income-based coverage at any time by withdrawing your consent to check your income

Q How is net income defined?

A Your net income is the income you reported on your tax return from two years ago. If you are registering in 2020, use your net income from 2018. Your net income is the amount reported on Line 236 of your income tax return minus income from a Registered Disability Savings Plan (RDSP) (line 125).

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Editor, Spencer van Vloten: spencer@bcdisability.com

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