To ensure that claims are paid promptly, it is important that the claim form be fully completed, signed and dated and that the original receipts are attached to the claim form before submitting it to the claims provider. The plan member should keep copies of all receipts as the originals will not be returned. All claims incurred must be submitted for reimbursement no later then 15 months from the date of service except Out-of-Country Claims (other than those for Global Medical Assistance expenses) should be submitted to Canada Life as soon as possible after the expense is incurred.
Making Out-of-Country Claims (other than those for Global Medical Assistance expenses) – it is very important that you send your claims to the Canada Life Out-of-Country Claims Department immediately as your Provincial Medical Plan has very strict time limits.
Out-of-Country Claims Form
Extended Health Care
Ambulance – When a member is required to submit a claim for ambulance expenses a manual claim must be submitted. The original bill must be attached to the completed claim form however; the ambulance bill does not have to be paid prior to submitting the claim. Once the claim has been received and approved, the insurance carrier will send a reimbursement cheque directly to the member which in turn the member must pay the ambulance expenses. This will avoid paying out of pocket for the expense.
Medical, Paramedical and Vision Care – Original receipts are required for all claims. These receipts must be attached to a completed claim form, signed, dated and sent to the claims provider for processing.
Extended Health Care Claim Forms
The assure card is used for prescription drugs and is accepted at most drug stores across Canada. The card allows the member to pay only their portion of the drug cost directly to the pharmacist. This eliminates the need to pay the full cost of the prescription up front and then submit a claim to the claims provider for processing and reimbursement. Each member will be provided with a drug card once we receive their completed Employee Enrollment Form. If the member has single coverage, they will receive one card. If they have family coverage, they will receive two cards. For claims to be adjudicated accurately at the pharmacy, member information, including all eligible dependent information must be provided accurately and promptly to the benefits office.
Following are some examples of why a drug card may not work:
- Pharmacists must key in the date of birth manually, so they may be typing it incorrectly;
- A date of birth has been reported to the benefits office incorrectly;
- The employee is set-up with co-ordination of benefits and the drug should be filed under the spouse’s plan first; The dependent turned 21 years of age and the benefits office has not been provided with the proper information to indicate that the dependent is an over-aged student;
- The drug is not an eligible expense as it is not covered under the Manitoba Health Care Formulary.
If any of your employees experience a problem using their drug card, they should contact Canada Life at 1-800-957-9777 or the benefits office at 204-953-2101.
Electronic claims submission – Most dental offices have access to electronic claims submission direct to the insurance provider. If the member assigns the benefits to the dentist, the cheque from the insurance provider will be issued to the dentist. If the member does not assign the benefits to the dentist and pays for the service(s) out-of-pocket, the cheque will be issued to the member and these cheques are issued daily by the insurance company.
Paper claims submission – Both the dentist and the member must sign and date the Standard Dental Claim Form prior to submitting it to the insurance provider for processing. Claim forms that are missing any information will be returned to the member and must be re-submitted to the insurance provider once corrected.
Dental Care following an accident – When dental work is required to sound natural teeth following an accident, treatment must start within 60 days of the accident unless delayed by a medical condition.
A sound tooth is any tooth that did not require restorative treatment immediately before the accident. A natural tooth is any tooth that has not been artificially replaced.
Before incurring any large dental expenses, or beginning any orthodontic treatment, ask your dental service provider to complete a treatment plan and submit it to Canada Life. Canada Life will calculate the benefits payable for the proposed treatment, so you will know in advance the approximate portion of the cost you will have to pay.
Dental Claim Forms
Short and Long Term Disability
Filing a disability claim – To file a disability claim with Canada Life, all three statements of the disability application must be completed in full:
- the Employee’s Statement,
- the Employer’s Statement and
- the Attending Physician´s Statement.
Copies of the disability forms can be obtained from the benefits office. If all three statements are not completed, the claim cannot be processed. Note that any fees incurred for completion of the Attending Physician´s Statement is the responsibility of the member. Once the insurance carrier has made a decision to approve, decline or pend the claim for further medical information, a letter is sent to the member.
Frequency of claim payments – Cheques are issued monthly for Long Term Disability and are payable on the last day of the month and cheques are issued weekly for short term disability. The payment is either sent directly to the member, or if they have provided the insurance carrier with a void cheque, the payments are deposited directly into their bank account. An Explanation of Benefits is sent to the benefits office for confirmation of the dollar amount paid.