Medical Benefits

• Prescription Drugs
• Vision Care
• Medical Supplies & Services
• Hospital 
• Health Spending Benefits
• Dental Benefits
• Co-ordination of Benefits

WHEN DO I MAKE A CLAIM?

Satisfactory written proof of claim must be submitted within the timeframes shown below. Please remember, you must send in your claims in time for them to be paid.

Manulife Financial

• up to 12 months after the date the service or supply was purchased, but not more than 90 days after the date your Medical or Dental coverage terminates.

2) Prescription Drugs:

• immediately upon presentation of your Manulife Financial: Pay Direct Drug Card at all participating pharmacies, or
• if not paid for with the Manulife Financial: Pay Direct Drug Card, claim with original receipts must be submitted to Manulife within 12 months after the date the service or supply was purchased, but not more than 90 days after the date Health Care coverage terminates.

3) Life Insurance and Accidental Death & Dismemberment Insurance:

• up to 6 months after the date of death, under the death provision for Life Insurance,
• up to 12 months after the date the member ceases active work because of Total and Permanent Disability under the Disability Provisions of the Life Insurance,
• up to 6 months after the date of the loss for the Accidental Death and Dismemberment Insurance.

Legal action to recover benefits under this Plan must begin within 2 years (6 years for Life Insurance) from the date of loss.

Manulife shall have the right and opportunity to examine any person whose injury or illness is the basis of claim, when and as often as it may reasonably require during the pendency and payment period, if any, of such claim.

Members have up to twelve (12) months immediately following the end of Year 1 in which to submit receipts for expenses incurred during Year 1 but which were not submitted during Year 1. Any claims for Year 1 expenses not submitted by the end of this twelve (12) month period will not be paid.

Any claims for Year 2 expenses which are to be paid with funds that were carried forward from Year 1, must be submitted for payment within 30 days after the end of Year 2.

Otherwise, members have no more than 90 days after the date coverage terminates for the Medical and Dental Benefits.

Blue Cross Life Insurance Company of Canada

Critical Condition Benefit:
Up to 30 days after the commencement of a critical condition for a disability that may qualify for the critical condition benefit.

HOW DO I MAKE A CLAIM?

Claims to be made through Manulife Financial

1) Prescription Drugs:

• When enrolled in Benefit Levels 02, 03, 04 or 05, you will receive an Manulife Financial: Pay Direct Drug Card which can be used at most pharmacies within Canada by you and your eligible dependents for prescription drugs.
• In order for your dependents to qualify for drug card registration, they must be enrolled through the Health & Welfare Administration Office. If you have not enrolled your dependents, they will not be covered. Annual proof of continued education for children age 21-24 must also be supplied.
• Submit all other prescription drug bills (not purchased through your Manulife Financial: Pay Direct Drug Card) to Manulife together with the completed claim form.

2) Vision Care, Medical Supplies and Services, Hospital, Accidental Dental, Out-of-Province/Country:

• Complete a claim form and securely attach the supporting original receipts (where applicable).

• Expenses incurred out of province / country must be submitted to your provincial medicare plan first and any eligible unpaid balance may then be submitted to Manulife for reimbursement.

• One claim form is required per patient.

• Complete the claim form with appropriate Member signature.

• Your dentist will provide details on the claim form about the services rendered.

• Claims in excess of the maximums of Benefit Level 04 to be paid from the Health Spending Account must be submitted to Manulife. You can indicate on your dental, medical (health care) or vision care claim form if you wish to have any outstanding eligible expenses paid from your Health Spending Benefit.
• On the Medical or Dental claim form, check the box indicating you would like any excluded amount to be taken out of the Health Spending Benefit. Submit with original receipts to Manulife for other expenses not previously submitted.

• If you or your dependents are covered for similar health care benefits under another plan of group insurance, benefits will be co-ordinated. This co-ordination of benefits means that combined benefits under both plans may allow reimbursement of up to 100% of your eligible expenses.

• Claims for dependent children must first be submitted to the plan of the parent who has the earlier month and day of birth in the calendar year.

• Your spouse‘s claims should be submitted to his/her own plan first.

A Plan that doesn’t have a co-ordination of benefits provision must pay a claim before a Plan that does (most, if not all, insurance company plans include a co-ordination provision).

All completed claim forms must be submitted to the Manulife Financial.

Claims to be Made Through the Health & Welfare Administration Office

Life Insurance and Accidental Death & Dismemberment Insurance
Contact your Plan Administrator who will provide information concerning Life Insurance and Accidental Death & Dismemberment Insurance claims and required documentation.

Critical Condition Benefit
Contact your Plan Administrator who will provide information concerning Critical Condition Benefit claims and required documentation.

Contact the Program/Counselor Directly

Member & Family Assistance Program
Contact Family Services directly using the information in this booklet for member and family counseling and for alcohol, drug & addiction  counseling..