Member Forms

<a href=Sample Member ID card for My PBC Benefits" width="" />

If your membership card looks like this, please go to the My PBC Benefits resource page:
National Extended Health Care Claim Form [FORM-210 English] Use this form to submit claims for any health expenses covered under the provisions of your benefit plan.

  • National Claim Form (All benefit lines) [FORM-363 English]
  • National Claim Form - Health Spending Account [FORM-376 English]
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    For Veteran Affairs, Canadian Forces and RCMP members

    RCMP Health Services
    Mailstop #1208
    14200 Green Timbers Way
    Surrey, BC
    V3T 6P3

    For Travel Claims and Out-of-Country/Province claims

    For Ministry of Social Development & Poverty Reduction or Health Kids Clients

    Miscellaneous forms

    Additional Blood Glucose Test Strips

    Please have your Endocrinologist or Diabetes Specialist complete this form to request an additional 100 blood glucose test strips, if circumstances warrant a periodic increase in blood glucose testing beyond your annual limit.

    Glucose Monitoring Systems

    If this request is for the Dexcom G6/G7 Continuous Glucose Monitor or the FreeStyle Libre 2 Flash Glucose Monitoring System (Libre 2), please have your Prescriber or Diabetes Specialist complete the BC PharmaCare Special Authority form and apply directly to BC PharmaCare on your behalf.

    For members residing outside of BC, please have your Prescriber or Diabetes Specialist complete the Dexcom G6/G7/FreeStyle Libre 2 (Libre 2) request form.

    *Electronic claims service is available to all Individual Plan customers and to group plan members whose plan sponsors/employers have opted to provide this service as part of their benefits plan
    .