How to Submit an Extended Health Benefits Claim: Step-by-Step

An extended health benefits claim covers costs that your plan pays on top of provincial medicare. The eligible categories and limits come from your plan certificate, not from provincial coverage. The main categories are prescription drugs, dental, vision, paramedical services, and medical equipment, but each plan defines its own scope. Before filing anything, check which categories your certificate covers and under what conditions.

What counts as an extended health benefits claim?

Plans group eligible costs into claim types, and the names vary by insurer. Manitoba Blue Cross, for example, lists ambulance, dental, vision, and prescription drugs as separate claim types, alongside extended health products and services, health spending account, and hospital claims (Manitoba Blue Cross, 2020). Pacific Blue Cross handles drugs, physiotherapy, massage, chiropractic, psychology, vision, and similar services under its extended health benefits (Pacific Blue Cross).

Three points define the scope of any claim:

• Plan certificate: Your certificate lists which services and products are covered. A service can be insured by medicare and still be excluded from your plan, or the reverse.
• Provincial medicare: Medicare coverage does not determine extended health eligibility. Use the plan’s own definitions.
• Category limits: Some categories carry extra conditions. Under the UBC Sun Life plan, the thresholds below apply before purchase or treatment.

Confirm these conditions with your plan before you commit to a large expense, because a claim that skips a required step may not be paid.

How do you submit a claim online or through the app?

The three insurers in the source data accept online claims, but the claim types available online differ by insurer. Manitoba Blue Cross members can submit most claim types, including ambulance, dental, extended health products and services, health spending account, hospital, prescription drugs and vision, through the mybluecross website or mobile app. Sun Life (UBC plan) members can claim online through mysunlife.ca or the app. Pacific Blue Cross accepts online claims through the Member Profile, for drugs, physiotherapy, massage, chiropractic, psychology, vision and similar services, but only if the plan sponsor has enabled this option.

Submission workflow

The steps below describe the general sequence. Menu labels vary by insurer, so check the names on your own portal.

1. Sign in to the website or app with your member account.
2. Select the claim type that matches the expense. Choose the category the insurer lists for that service, not the category you think is closest.
3. Enter each expense as a separate line, using the date and amount shown on the original receipt.
4. Submit the claim and save the confirmation screen or reference number.
5. Check the claim status in the portal. The status shows whether the claim is still being processed or has been paid.

Travel claims and other channels

Pacific Blue Cross requires expenses outside the online list to go in by mail or in person using the claim form. Manitoba Blue Cross uses a signed paper claim form for paper submissions.

Sun Life audit rules

Sun Life audits one in eight online claims and all online claims over $700. Because an audit can lead to a request for receipts, keep all original receipts even though you do not send them with an online claim.

Can your provider bill the insurer directly?

Some plans let the provider send the claim to the insurer, so the member does not have to file it. The University of British Columbia’s Sun Life plan lists pay-direct at the pharmacy or with a provider as one of its three ways to claim, alongside online submission and mail (University of British Columbia Human Resources, 2024). The source does not describe how pharmacy claims differ from provider-submitted claims, so the table below also covers situations where the member still has to act.

When two plans cover the same expense, coordination of benefits applies. Claim from your own plan first, then send the remaining balance to the second plan with the EOB. For dependent children, the parent whose birthday falls earlier in the calendar year is the first payer (Pacific Blue Cross).

Physiotherapy and massage receipts must show the treatment length in minutes. Since January 1, 2017, Pacific Blue Cross pays claims without this detail as a 20-minute physiotherapy session or a 30-minute massage session.

How do you submit a paper claim?

A paper claim is a package of three parts: the plan’s signed claim form, the receipts and supporting documents for each expense, and a mailed envelope sent to the plan’s claims department. Plans differ in what they require, but the core steps are the same. For Manitoba Blue Cross, paper claims need the signed claim form plus copies of receipts and supporting documents (Manitoba Blue Cross, 2020). Pacific Blue Cross handles expenses that can’t be filed online by mail or in person, using its claim form (Pacific Blue Cross).

Assemble the package in this order before mailing:

1. Complete the claim form in full. Fill in the member and patient details, then the expense details for each item.
2. Sign the form. A claim form without a signature is not a complete submission.
3. Attach each receipt and supporting document to the matching expense line. Follow the instructions printed on the plan’s claim form for how to package your documents.
4. Make a copy of the full package before sending it.

For the UBC Sun Life plan, the mail option requires a signed form. Sun Life also offers pay-direct and online claims as alternatives (University of British Columbia Human Resources, 2024).

Use the mailing address printed on the current claim form or confirmed by your plan.

Which receipts and documents do you need?

Receipt rules depend on the plan and on the submission channel. The same expense can need an original receipt, a photocopy, or no receipt at all, so check the rule for your plan before you submit. Under the UBC Sun Life plan, claims made online through mysunlife.ca or the app do not require receipts to be sent in, but you must keep them. Mailed claims require original receipts. Pacific Blue Cross requires original official receipts for all claims.

Original versus copy rules

Originals are the default for paper and mailed claims. Pacific Blue Cross does not return originals, so keep a copy of every receipt you send, along with the date you mailed it. A photocopy is accepted by Pacific Blue Cross only when it comes with the EOB from the other insurer that already processed the expense. Without that EOB, the photocopy does not meet the rule.

Receipt content

Pacific Blue Cross requires original official receipts. Pacific Blue Cross does not accept cashier receipts or Interac payment receipts as proof of purchase.

Supporting documents

Supporting documents vary by plan. Check the list printed on your plan’s claim form before you send anything, because it states which attachments that plan requires for each expense type. For claims that involve a second insurer, the EOB from the first plan is the document that proves the balance you are claiming.

What are the claim deadlines?

Under the UBC Sun Life plan, each benefit type has its own filing window, and the window starts from a different date. Under the UBC Sun Life plan, each benefit type has its own filing window, and the window starts from a different date. Extended Health claims are measured from the end of the expense year, Dental claims from the expense date, Health Spending Account claims from the end of the expense year, and out-of-province claims from your return home. Check the window for each benefit before you submit, because a claim filed after its deadline can be refused.

Extended Health claims give the most time. An expense incurred on any date in 2025 can be filed until December 31, 2026. Dental claims are tied to the exact date of service, so a dental expense from March 3, 2025 must be filed by March 3, 2026.

Out-of-province and out-of-country claims have a 30-day window. The 30 days run from your return home, not from the date of treatment. If you received care during a trip, count from the day you got back and file within that period. For emergencies, the plan requires you to call Global Excel Management before receiving care. Calling afterward does not replace that step.

Source: University of British Columbia Human Resources, 2024.

How does coordination of benefits work with two plans?

When one person is covered by two extended health plans, one plan is designated as primary and pays first. The secondary plan then settles the eligible costs the primary plan left unpaid. The secondary plan never receives the full claim. It receives the balance, and the primary plan’s Explanation of Benefits (EOB) is what shows that balance. Pacific Blue Cross describes the sequence this way: claim from your own plan first, then send the remaining amount to the second plan with the EOB.

The sequence works in four steps:

1. Submit the expense to the primary plan.
2. Read the EOB, which shows the amount the primary plan paid and the amount it did not cover.
3. Submit the unpaid balance to the secondary plan.
4. Attach the EOB to that second submission.

The EOB is the link between the two plans. Without it, the secondary plan has no record of what the primary plan already paid, so it cannot calculate the remaining balance.

Who is the primary payer for dependent children?

When a dependent child is covered under two parents’ plans, the primary payer is set by birthday. Pacific Blue Cross states that the parent whose birthday falls earlier in the calendar year is the first payer. Only the month and day matter here, so the comparison is made within the same calendar year. The source does not describe how ties or other family situations are handled, so check each plan’s wording for cases this rule does not address.

When do you need pre-approval?

Under the UBC Sun Life plan, some expenses must be approved by Sun Life before you buy or receive the treatment. Cost thresholds and service types trigger the requirement, and the rule covers only the categories below. Other expenses are claimed after payment.

The two mechanisms differ in purpose. The Extended Health claim form covers large purchases of equipment or services, so the amount is confirmed before you commit funds. Predetermination applies to dental work above $500 and to all orthodontic treatment, and it is requested before treatment starts.

Work through these steps before any expense in these categories:

1. Identify whether the expense is equipment or a service above $5,000, dental work above $500, or orthodontics.
2. Get the cost estimate from the provider.
3. Send the required form or predetermination request to Sun Life before buying or starting treatment.
4. Keep the request with your receipts.

The thresholds above come from the UBC Sun Life plan only. Other plans can set different amounts or require different steps, so the certificate wording for your plan sets the exact limits and definitions.

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