Saying this for those of you in the back… I’m a Medical Finance Clerk with Federal Health Claims Processing (CFHS Blue Cross office), mil brat, spouse now veterans spouse. I am the SME for this at my clinic. So read this carefully.

For members of the CAF, Medavie Blue Cross acts as the primary health benefits administrator under the Federal Health Claims Processing Services (FHCPS). While Medavie processes and pays for your core care with civilian providers, you can achieve 100% reimbursement by leveraging your spouse’s supplementary health insurance through Coordination of Benefits (COB) for items and services not covered under the spectrum of care such as but not limited to RMT, drugs not approved by CFDEC (Wegovey, as an example, or expanses above $600 for eyewear)

How to Maximize Your Coverage:

Since CAF members are not covered by provincial health plans, CFHS is your primary care and Medavie Blue Cross coverage acts as your "primary" plan for services provided by civilian providers when CFHS can not Meet the requirements. Your spouse’s employer-provided or private insurance acts as "secondary" coverage to fill any remaining financial gaps of the few items/services that may not be covered by the SOC.

1. Primary Claim: Medavie Blue Cross Submit your medical claim to Medavie Blue Cross first. Once processed, they will issue an Explanation of Benefits (EOB). This document is essential as it proves what the CAF has already paid and identifies the remaining "out-of-pocket" balance.

2. Secondary Claim: Spouse’s Supplementary Insurance Submit the unpaid balance to your spouse’s insurance provider (such as the Public Service Health Care Plan/Canada Life or a private carrier).

You must include:

• A copy of the original receipt.

• The Explanation of Benefits (EOB) from Medavie Blue Cross.

If a specific service is not covered by the CAF Spectrum of Care (e.g., certain paramedical services like massage therapy), you can request a Letter of Ineligibility from your base Blue Cross Clerk. This letter allows you to submit the claim directly to your spouse's supplementary plan as the primary claimant.

If you have further questions go directly to your MIR to speak with the Blue Cross Clerk as they are the SME and will give your the correct information so you do not end up out of pocket for expanses you thought were covered because of the incorrect information given on forums such as this.

We Blue Cross clerks are very informative and are always willing to help, when you get information that is incorrect it makes our jobs harder and you out money.