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Insurance Claims

Once you have chosen your health insurance provider and settled on a plan that is right for you, you will want to begin to make the plan work for you. In order to do so, you must be sure you know how to properly file your insurance claims. While the process of filing insurance claims is not difficult, it can seem intimidating or confusing the first time it must be done. The guidelines below will help you to file your insurance claims with ease and guarantee that you will make effective use of your health insurance plan.

Some health care providers submit claims directly to the health insurance company. In this case, the user (you) does not need to submit a form. Be sure to check with your health care provider concerning the party responsible for submitting claims. If the health care provider does not submit the claim for you, you are required to submit your own form for eligible expenses.

To Submit a Claim:

If you are required to submit your own claim, you must do so within twelve months from the date the medical charges were incurred.
To submit your claim, first you must complete a claim form. Your insurance company will provide these forms for you. It is likely that the forms will also be available on the company website. The information required on claim forms differs depending on the health care service provided. All forms will ask for certain basic information including:

Patient contact information
Health care provider contact information
Description of the service provided
Patient health insurance plan information (ex. plan number, type)

Original receipts and all pertinent documentation must be attached to the form. Photocopies and faxes will not be accepted.

Helpful Reminder:

Dental claims are often filed by the dentist, not the patient. But ask your dentist to be sure.

To Submit a Claim for Prescription Drugs:

Receipts must show the name of the drug, drug identification number, date of service, prescription number, drug cost and dispensing fee.

To Submit a Claim for Prosthetic Appliances, Medical Equipment or Hearing Aids:

Attach the original receipt
Include a copy of your provincial health plan contribution statement