In BCCA EBT Updates

Pharmacogenetic Testing

Effective March 1, 2021, GSC will add Pharmacogenetic testing through GenXys as standard medical services benefit under Diagnostic Services/Laboratory Tests.

Pharmacogenetics (PGx) is a form of “personalized medicine” and is one of several genetic testing available for medical purposes. The test determines whether a person has certain genetic mutations that are known to influence their response to a drug in a certain way. The goal is to predict who will benefit from a medication, who will not respond at all, and who will experience negative side effects. Based on results, doctors can choose medications (or doses) that are better suited for that person. The test will be subject to prior authorization only to be reimbursed when specific criteria are met, and is currently for mental health issues only (specifically depression and anxiety). All other pharmacogenetic tests will continue to be excluded.

The health care provider must first complete and sign the authorization form and lab requisition form. The authorization form is sent to GSC for approval. GenXys will submit claims to GSC directly checking a person is eligible first before issuing the kit. The test is limited to one per lifetime.

The cost of this testing is $499 plus tax per lifetime. The new PGx product is not subject to any copays, deductibles, or maximums with the exception of an overall health maximum.

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Virtual Orthodontics 

Effective March 1, 2021, Greenshield Canada (GSC) is launching Virtual/Tele Orthodontics through a designated partner, SmileDirectClub. This will be available through all dental plans that currently include orthodontic coverage at a reduced cost compared to in-person treatment.

Patients receive Orthodontic treatment from home without seeing a dentist or orthodontist, removing geographic barriers. Using an online assessment process, GSC’s designated partner SmileDirectClub will ensure a patient qualifies. Only cases where mild to moderate correction is required will qualify.

The minimum age is 12 and all adult teeth must be in. Those under 18 require a guardian’s signature. Impression kits are completed by the patient, a treatment plan is created and approved by a dentist or Orthodontist, and clear aligners are mailed to the patient for use over the upcoming 6-12 months.

GSC preferred pricing of just under $2,500 is paid as a one-time fee. All current co-pays, deductibles, age parameter rules, and maximums apply. Claims are submitted directly to GSC by SmileDirectClub, plan members only pay the remaining out-of-pocket costs.

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