Claims
Related FAQs
How quickly will my health or dental claim(s) be paid?
Though it can vary from one insurance company to the next, you can generally expect to receive payment within approximately 5-6 business days.
Submitting your claims online helps to ensure that all required information is obtained and that your claims are received and processed faster.
Alternatively, you can submit claims manually using a paper form. Naturally, paper forms are more error-prone and can result in longer processing times. For this reason, using online claims is advisable.
Submitting your claims online helps to ensure that all required information is obtained and that your claims are received and processed faster.
Alternatively, you can submit claims manually using a paper form. Naturally, paper forms are more error-prone and can result in longer processing times. For this reason, using online claims is advisable.
How do I submit health insurance claims online?
Each insurance company will have its own secure client portal you can use for submitting your claims electronically.
Instructions for getting registered for online claims will be included with your policy documents. You will need your Plan and ID numbers in order to register for online claims successfully.
If you aren't yet registered for online claims, please use the following links:
Manulife Plans:
http://manulife.ca/secureserve
Sun Life Plans:
http://mysunlife.ca/
Canada Life Plans:
https://my.canadalife.com/
If you need assistance, please email support@aeva.ca.
Instructions for getting registered for online claims will be included with your policy documents. You will need your Plan and ID numbers in order to register for online claims successfully.
If you aren't yet registered for online claims, please use the following links:
Manulife Plans:
http://manulife.ca/secureserve
Sun Life Plans:
http://mysunlife.ca/
Canada Life Plans:
https://my.canadalife.com/
If you need assistance, please email support@aeva.ca.
How will I know when my health insurance claim has been approved?
Claims are paid in one of two ways:
Insurance companies offer online access to their plans, allowing you to view your claim history, claim status, and add your banking information for direct deposit of claims.
If your claim is approved, you will receive a direct deposit to your bank account. Alternatively, if you have not provided direct deposit instructions, a cheque will be issued and mailed to your physical address.
If your claim submission is complete and accurate, you will generally receive your claim reimbursement within 5-6 business days.
- Direct deposit
- Cheque
Insurance companies offer online access to their plans, allowing you to view your claim history, claim status, and add your banking information for direct deposit of claims.
If your claim is approved, you will receive a direct deposit to your bank account. Alternatively, if you have not provided direct deposit instructions, a cheque will be issued and mailed to your physical address.
If your claim submission is complete and accurate, you will generally receive your claim reimbursement within 5-6 business days.
What information can I find online from my health insurance company?
Though each health insurance company will vary in terms of what they offer for online services, generally you can expect the following items to be accessible online:
Insurance providers such as Alberta Blue Cross, Canada Life, Manulife, and Sun Life typically offer these details online to help you manage your health insurance policy effectively.
- Status of any claims you have submitted
- Your claims history for the last 12+ months
- Benefit details for your health insurance plan including dollar maximums
Insurance providers such as Alberta Blue Cross, Canada Life, Manulife, and Sun Life typically offer these details online to help you manage your health insurance policy effectively.
What are some common reasons why a health insurance claim wouldn't be paid?
The most common reasons for delayed payment of health insurance claims or claims not being paid include:
Improper documentation/lack of receipts: Submitting claims without copies of the original receipts will likely result in claim rejection.
Costs submitted after 12 months: Claims must be submitted within 12 months of the date you paid for the expenses you're claiming.
Costs that aren't medically necessary: Generally, health claims must be deemed medically necessary under the terms of your plan. Preventative dental services aren’t usually medically necessary; however, they may be allowable if your plan covers them.
Excluded conditions: Some plans (Medically Underwritten) require insured persons to qualify medically, which involves the completion of a medical questionnaire. Consequently, specific health conditions may be excluded from these plans. When a medical condition is excluded, it means there is no coverage for any treatments—including medications—related to the excluded condition. If a treatment normally used for an excluded condition is being used to treat an unrelated condition, your health provider must provide a written explanation. Include this explanation when you submit your claim.
Improper documentation/lack of receipts: Submitting claims without copies of the original receipts will likely result in claim rejection.
Costs submitted after 12 months: Claims must be submitted within 12 months of the date you paid for the expenses you're claiming.
Costs that aren't medically necessary: Generally, health claims must be deemed medically necessary under the terms of your plan. Preventative dental services aren’t usually medically necessary; however, they may be allowable if your plan covers them.
Excluded conditions: Some plans (Medically Underwritten) require insured persons to qualify medically, which involves the completion of a medical questionnaire. Consequently, specific health conditions may be excluded from these plans. When a medical condition is excluded, it means there is no coverage for any treatments—including medications—related to the excluded condition. If a treatment normally used for an excluded condition is being used to treat an unrelated condition, your health provider must provide a written explanation. Include this explanation when you submit your claim.
What is a pre-determination of benefits for dental and when do I need one?
A pre-determination of benefits is an 'estimate' of what your dental insurance plan will cover for a specific dental procedure.
If you are unsure whether a particular dental procedure will be covered, or if a proposed course of treatment is expected to cost more than $500, it is advisable to have your dentist’s office submit a pre-determination of benefits to the insurance company before the procedure. To submit this information, your dentist will need your Plan Number and ID number.
The insurance company will review the submission and reply with a written letter clarifying the amounts (if any) covered by your plan.
This way, you can make an informed decision about how to proceed with your dental treatment.
If you are unsure whether a particular dental procedure will be covered, or if a proposed course of treatment is expected to cost more than $500, it is advisable to have your dentist’s office submit a pre-determination of benefits to the insurance company before the procedure. To submit this information, your dentist will need your Plan Number and ID number.
The insurance company will review the submission and reply with a written letter clarifying the amounts (if any) covered by your plan.
This way, you can make an informed decision about how to proceed with your dental treatment.
How do I make a health or dental insurance claim?
If you need to make a health or dental insurance claim, your health care provider may have already submitted it on your behalf using your Plan and ID numbers.
If your provider has not submitted your claim, you can do it yourself either online or by mail.
To submit your claims online:
- Do so within 12 months of the date you were charged.
- Ensure you've paid more than any deductible in your plan.
- Specify the currency if your claim is for services outside Canada.
- Keep original receipts and applicable supporting documentation for 12 months.
To submit your claim on paper by mail:
- Submit within 12 months of the date you were charged.
- Ensure you've paid more than any deductible in your plan.
- Specify the currency if your claim is for services outside Canada.
- Include original receipts and applicable supporting documentation.
- Make sure you've signed your claim form.
What information needs to be shown on prescription drug receipts?
Prescription drug receipts must be original receipts (not statements) and show:
• Name of drug
• Drug identification number (DIN)
• Date of service
• Prescription number
• Prescription strength and quantity
• Drug cost
• Dispensing fee (if applicable)
All other receipts must be original receipts on the printed letterhead of the person or company providing the service and show:
• Name of patient
• Date(s) of service
• Description of service
• Cost of each service
• Proof of payment
• Name of drug
• Drug identification number (DIN)
• Date of service
• Prescription number
• Prescription strength and quantity
• Drug cost
• Dispensing fee (if applicable)
All other receipts must be original receipts on the printed letterhead of the person or company providing the service and show:
• Name of patient
• Date(s) of service
• Description of service
• Cost of each service
• Proof of payment
How do I make a travel insurance claim?
If your health insurance plan includes travel coverage, you can claim costs for medical emergencies while travelling outside your home province.
Your policy documents will include 24x7x365 toll-free support numbers to call for assistance in the event of a medical emergency. You will need to provide your Plan and ID numbers to confirm coverage and get help with the next steps.
Whenever possible, call these numbers before incurring any medical expenses to ensure you are directed to the best facilities and to maximize the amount covered by the insurance.
Your policy documents will include 24x7x365 toll-free support numbers to call for assistance in the event of a medical emergency. You will need to provide your Plan and ID numbers to confirm coverage and get help with the next steps.
Whenever possible, call these numbers before incurring any medical expenses to ensure you are directed to the best facilities and to maximize the amount covered by the insurance.
What is the time limit for submitting a health or dental claim?
You have 12 months from the date you incurred an expense for a health and dental service to submit your claim for reimbursement.