October 14, 2019  
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Submitting Claims

Overview

Prescription drug claims that are purchased at the point-of-sale using the Plan Member’s pay-direct drug card (if applicable to your plan) are submitted directly to the insurance company and the Plan Member is not required to pay out-of-pocket. Any portion of the claim not reimbursed because of plan limitations (e.g., coinsurance amounts, deductibles, etc.) is the responsibility of the claimant.

Your insurer provides a health claim form for prescription drug claims that are not reimbursed using a pay-direct drug card as well as any other type of health claim (e.g., paramedical practitioners, vision care, supplies etc). This form must be completed and signed by the Plan Member. Please advise Plan Members to attach original receipts when submitting a claim (photocopies not accepted). Plan Member should keep a photocopy of all claim documents.

Dental claims are submitted using the Standard Dental Claim Form available on this Web site.

For any extensive course of treatment involving crowns, bridgework, etc., which may exceed $300, we recommend the Plan Member ask his/her dentist to complete a cost estimate before the work is completed. Send the estimate to the insurer’s claim department to determine how the expenses will be reimbursed.

For information regarding long and short-term disability claims as well as life insurance claims, please see the Claims Procedures page.

Health Claims

Prescription Drugs

If your plan includes a “pay-direct drug card” reimbursement will not be necessary in most cases, as transactions will occur at the point of sale (i.e., pharmacy).

If, for any reason, the Plan Member’s pay-direct drug card was not used at the point of sale, or if the Plan Member does not have a pay-direct card, simply have the Plan Member complete the insurer’s drug claim form and attach the original receipt(s). Plan Member may submit claims directly to the insurer.

Other Health Claims (e.g., vision care, health professional services, prostheses, etc.)

Have the Plan Member complete the appropriate claim form and attach the original receipt(s). Plan Member may submit claims directly to the insurer.

Authorization from a physician is required for certain paramedical practitioners - please refer to the master contract for additional details.

Dental Claims

Standard Dental Claim Forms are supplied by Morneau Shepell through this Web site.

Have the dentist complete section 1 of the Standard Dental Claim Form. The Plan Member should complete all other sections.

For any extensive course of treatment involving crowns, bridgework, etc., which may exceed $300, we recommend the Plan Member ask his/her dentist to complete a cost estimate before the work is completed. Send the estimate to the insurer’s claim department to determine how the expenses will be reimbursed.

Disability Claims

Short Term Disability

There are three sections that need to be completed for a Short Term Disability claim:

  • Employee’s Statement
  • Attending Physician’s Statement
  • Employer’s Statement

Once all sections of the forms are completed by the appropriate individuals, send to Morneau Shepell along with a photocopy of the Plan Member's Enrolment Form.

Long Term Disability

There are three sections that need to be completed for a Long Term Disability claim:

  • Employee’s Statement
  • Attending Physician’s Statement
  • Employer’s Statement

Please also provide the following supplemental information:

  • Job Description
  • If short term disability insured through another insurer, forward a copy of the information sent to the STD insurer
  • Birth Certificate if the applicant is over age 60
  • Copy of applicant’s last pay stub
  • Copy of WSIB correspondence (if applicable)

Once all sections of the forms are completed by the appropriate individuals, and you have included the applicable supplemental documents, send to Morneau Shepell along with a photocopy of the Plan Member's Enrolment Form.

Note the following:

  1. Claims must be submitted six to eight weeks before the end of the elimination period (for long term disability) and as soon as possible after the date of disability for short term disability claims. Please refer to your benefit summary for the applicable elimination periods for both long and short term disability benefits.
  2. When a disabled Plan Member returns to work (whether the claim was for short or long term disability), please advise Morneau Shepell as soon as possible.
  3. If the Plan Member is Eligible for Worker's Compensation (WSIB) Benefits, he/she will receive a Worker's Compensation claim form from their employer.

Life and Dependent Life Claims

  1. The plan sponsor and beneficiary must complete the applicable sections of the Life Claim Form
  2. Attach the original death certificate
  3. Once all sections of the form are completed by the appropriate individuals, it should be forwarded to Morneau Shepell along with the Plan Member's original Enrolment Form

Accidental Death Claim

Please contact Morneau Shepell for assistance with an Accidental Death or Accidental Dismemberment claim.

For assistance regarding any aspect of a claim, please contact Morneau Shepell.

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If you have any further questions, please contact us; we'll be glad to help you.


Last updated on:  Tuesday, July 10, 2012  Page: 

This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.

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