Claims

 

Critical Illness Claims

In the event of a claim, your employer should be contacted immediately.

To submit an Employee Critical Illness claim, you must complete the Critical Illness Notification form (#49) which is available from your Benefits Administrator or on our website.

Written notice of the claim must be given to Manulife Financial within thirty (30) days after the date of the diagnosis and completed claim forms (written proof of loss) must be submitted ninety (90) days after the date of diagnosis.

 

Long Term Disability Claims

We strongly recommend that you send your Long Term Disability (LTD) application forms to your Benefits Administrator between four and six weeks before your Long Term Disability benefits are to begin. This will help speed up assessment of your claim and determine if participation in a rehabilitation program will help you.

There is a 150-day waiting (or elimination) period before you can receive LTD benefits. The latest you can submit your application for LTD is one year after this 150-day waiting period begins.

Additional Required Information

As well as the required forms, you'll need to send in the following with your application for Long Term Disability:

  • An up-to-date Job Description (ask your supervisor for a copy).
  • Copies of correspondence from the Workers' Compensation Board (WCB), indicating the status of a claim, if WCB is involved.
  • Copies of correspondence from Canada Pension Plan (CPP), indicating the status of a claim, if CPP is involved.
  • A copy of your Birth Certificate or valid Driver's License.

Additional Optional Information

If you have any of the following information available to you, we recommend that you send it along with your application:

  • Current copies of all medical reports and information about the illness or injury that led to your claim for LTD, such as:
  • Specialists consult reports.
  • Results of investigative diagnostic procedures (such as X-rays, Blood work, Biopsy's, MRI's, CT Scan's, Bone Scan's, EKG reports, etc.).
  • Hospital Admission and Discharge summaries.
  • Operating Room reports.
  • Neuropsychological testing results.
  • Psychological Initial Assessment report and Progress reports.
  • Occupational Therapists Initial Assessment reports and Progress reports.
  • Physiotherapy Initial Assessment reports and Progress reports.
  • Functional Capacity Evaluation results.
  • Copies of clinical notes since the date your health became affected.
  • Current copies of all medical reports and information from the Occupational Health Department about the illness or injury that led to your LTD application. This includes information about any ongoing and/ or attempted modified work or return to work programs.


It is vital that you provide the most current medical information available. Once you've filled in the forms and gathered the above information, give them to your Benefits Administrator. We realize this may seem like a cumbersome process and a lot of paperwork, but it will help ensure your application process is not delayed.

 

Life Insurance Claims

If you die, or if an insured dependent dies, your Benefits Administrator will give you or the beneficiary a copy of the Sun Life Election of Method of Settlement and Statement (this is an employer form and the employee or beneficiary does not complete it) and go over the process to make a claim. Note that in the event of a dependent's death, you are the beneficiary.

Optional and Basic Life Insurance claims (including claims for your spouse and/or dependent children) must be submitted within one year after the death. You or the beneficiary should:

  • Complete the Sun Life Election of Method of Settlement and Statement of Claim Form;
  • Show the cause of death on the form;
  • Provide proof of death, such as an original Funeral Director's Statement of Death; and
  • Return the completed forms to your Benefits Administrator, who will send them to Health Association Nova Scotia.

What other benefits may apply in the event of my death?

If you die before you retire, benefits may be payable under your Pension Plan. Your surviving spouse and dependents may also qualify for benefits under the Canada Pension Plan (CPP). These payments could take the form of a lump-sum benefit, a widow/widower's pension, and orphan's pension. You may contact the Canada Pension Plan at 1-800-277-9914.

If your death is caused by a work-related injury, your survivor may also be eligible for benefits from Nova Scotia Workers' Compensation. You may contact Workers' Compensation at 1-800-870-3331.

Additional benefits may also be payable from our Optional Accidental Death and Dismemberment Insurance Plan. You may contact Group Benefits Solutions at 1-866-886-7246.

 

Optional Accidental Death & Dismemberment Claims

In the event of a claim, you or your beneficiary must notify your Employer.

Written notice of Injury must be given to SSQ Financial Group within 30 days after the date of the accident and written proof of loss must be furnished to them within 90 days after the date of such Loss. Failure to furnish such notice or proof within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such notice or proof and that such notice or proof was furnished as soon as was reasonably possible, but in no event later than one year after the date of the accident.

For the payment of Optional Accidental Death & Dismemberment claims, contact:

SSQ Financial Group
c/o Accident & Sickness Claims Dept.
2001 University Avenue, Suite 1850
Montreal, Quebec
H3A 2L8

1-800-327-7872

Website: www.ssq.ca

 

Dental Claims

Many dentists will bill Manulife directly and send you a bill for any remaining balance. However, in those instances where you do need to submit a claim, your dentist should complete the Standard Dental Claim Form (Form #42).

Send your claim form to Manulife along with your receipts within 18 months. Write your name, policy number and certificate number on the receipts.

Send all claim forms and original receipts to: 
Manulife Financial, Group Health Claims, PO Box 1653, Waterloo ON N2J 4W1

For your convenience, you can also contact the Manulife Customer Service Centre toll-free at 1-855-626-4267 with questions about your dental claims. Please have your benefits card as you will need to provide them your policy and certification number. 

For plan members in Halifax, you may drop-off your claim at the Manulife drop-off box located at the Manulife Security Desk, 2727 Joseph Howe Drive, Halifax, NS.

 

Health Claims

You typically do not have to submit claims for drugs. You will present your pharmacist with your benefit card to pay your "co-pay" amount at the pharmacy. The pharmacy submits for the remainder of the claim.

For some health supplies and services, you will need to submit a claim form along with your original paid-in-full receipts to Manulife.

Claim forms are necessary to be reimbursed for these services:

  • Vision Care (We suggest you bring a Vision Claim Form - Form #51, when you visit your provider). Please note, if your eye doctor is set-up with Provider eClaims, they can submit the eye exam electronically.  Only the eye exam can be submitted electronically. the lenses/frames and contact lenses and other vision benefits require a claim form be completed. See our Benefits Communications page for more information on vision benefit claiming.
  • Clinical Measurements (Form #53)
  • Extended Health Claim (for other medical services/supplies/equipment) (Form #67) Please check out the attached Medical Equipment Guideline for important information on medical equipment claims.

Many paramedical practitioners and providers (chiropractor, massage therapist, physiotherapist) are set up with Provider eClaims.  With this process, providers are able to submit claims directly to Manulife on behalf of plan members.  The plan member only pays the provider what the plan doesn’t cover.

Plan members must be registered on the Manulife Plan Member Secure Website and signed up for direct deposit and electronic claims statements.

Not registered yet?

  • Go to www.manulife.ca/planmember click on “Login/register” (right-side) and you’ll be directed to the site access page
  • On the site access page, click on “register” and provide the required information (If you’re not sure of your plan and certificate numbers, check your group coverage ID card or find the numbers on a previous claims statement)
  • Submit the completed information and follow the directions on the page.

Once you’ve received your personal login information (sent to your home address), you’ll have access to all online information available to your plan.

For those providers not set-up with Provider eClaims:

Mail your Health claim form to Manulife along with your receipts within 18 months. Write your name, policy number and plan member certificate number on the receipts. 

Mail to the address on the claim form.

For online submission, you must be registered on the Manulife Plan Secure Site and set up for direct deposit.  After you login at www.manulife.ca/planmember you select Claims from the the top navigation and then Online claims.  Enter the details of your claim found on your receipt from your provider, along with details on your provider’s name, address and their contact information.

For your convenience, you can also contact the Manulife Customer Service Centre toll-free at 1-855-626-4267 with questions about your health claims. Please have your benefits card as you will need to provide them your policy and certification number. 

For plan members in Halifax, you may drop-off your claim at the Manulife drop-off box located at the Manulife Security Desk, 2727 Joseph Howe Drive, Halifax, NS.

 

Co-ordination of Benefits (CoB)

Canadian insurance companies follow a process called Coordination of Benefits (CoB) when a plan member is covered under more than one health and/or dental plan. CoB ensures you receive the maximum benefit available from your health and dental policies. In fact, two policies can be combined to give you up to 100% reimbursement of eligible claims.

Here's how Coordination of Benefits works when both the employee and their spouse has family coverage:

  • Submit your health and/or dental expenses first to your Health Association benefits program. You can then submit any unpaid portion of your claim to your spouse’s plan.
  • Submit your spouse’s health and/or dental expenses first to your spouse’s benefits program. You can then submit any unpaid portion of your spouse’s claim to your Health Association benefits program.
  • If your dependent children are covered under your and your spouse’s benefit programs, you must submit their health and/or dental expenses first to the benefit program of the parent whose birth date falls earliest in the calendar year (the month, then day). Any remaining balance can then be reimbursed from the other plan. When parents are separated or divorced, the custodial parent claims under his or her plan first, then their spouse’s plan, and then the plan of the parent without custody.
  • When you submit a claim for an unpaid balance from another insurance company, Manulife will need a copy of the receipt and a copy of the statement showing the portion of the claim paid by the other company. Although you have 12 months to claim any remaining balances, your receipts should be submitted as soon as possible.

If you need help determining the order in which your claims should be submitted, call the Manulife Customer Service Centre toll-free at 1-855-626-4267.

For further information, please check out our Benefits Information Coordination of Benefits document available on our Benefits Communication page.