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Submitting claims

As a member of the McGill Benefit Program, you are responsible for monitoring and submitting your claims. By following a few simple procedures, you will help to ensure that your eligible expenses are reimbursed as quickly and efficiently as possible.

The following is an outline of the steps of each procedure, the forms you will need, and who you can call for additional information.

Health & Dental Claims Submission Deadline

The benefit year is January 1 to December 31. All claims must be received by our insurer within 90 days of the end of the benefit year — that is, by March 31st.

Claims received after this date will not be eligible for consideration.

Claim Forms

You can print claim forms directly from the Human Resources website.

You can also obtain claim forms from the HR Service Center at 688 Sherbrooke St. W., 15th floor, Rm 1520 or by calling 514-398-4747.

Supplemental Health Claims

 

A. Hospital claims
B. Drugs and medical claims
C. Emergency out of province claims


Hospital claims

If the hospital will bill the insurer directly:

  • Advise the admitting clerk that you are covered under plan contract number 85210 with Manulife Financial
  • Give them your McGill identification number
  • The hospital will bill the insurer directly.

If the hospital requires that you pay the bill:

  • Obtain the completed hospitalization claim form from the hospital (keep a copy for your personal records)
  • Forward the completed form directly to Manulife Financial with your policy and ID number or attach the completed form to a Statement of Covered Expenses for Health Care Benefits (Manulife Financial / Maritime Life claim form) and forward both directly to Manulife Financial.

Drugs and other medical services

 Drug claims

  • If you use your deferred drug card to purchase medication, your claim is processed via your pharmacist's computer system. There is no need to submit a paper claim to Manulife Financial. You will automatically receive a reimbursement cheque in the mail.
  • If you do not use your drug card to purchase medication, you may submit a paper claim to Manulife Financial. Follow the same instructions as outlined below "For other claims".

Claims for private duty nursing services

You must submit a Pre-Determination form to Manulife Financial before nursing services can begin; otherwise, your claim could be refused or reimbursed at a lower level. This form can be obtained directly from Manulife Financial.

Orthotics and orthopaedic shoes

In order to be eligible for payment, your orthotics and/or orthopedic shoes must be:

  • Custom made
  • Prescribed by a medical general practitioner or specialist, podiatrist or chiropodist, and
  • Supplied by an orthotist, pedorthist, podiatrist or chiropodist.

For each claim and/or predetermination for orthotics and orthopaedic shoes,you must supply:

A detailed prescription from the prescribing medical practitioner indicating all of the following:

  • A diagnosis of the condition (symptoms alone will not suffice),
  • A list of symptoms and the chief complaint,
  • A description of the physical findings from the clinical examination,
  • A brief narrative description of the gait abnormality with the diagnosis,
  • A detailed receipt from the supplier indicating:
    • The provider's qualifications, and
    • Confirmation that the orthotics or orthopedic shoes have been custom made.

Other medical claims (except Emergency Out of Province Claims)

Obtain a Manulife Financial claim form:

  • Complete the appropriate sections, being sure to include
    • The plan member certificate number (your McGill ID number)
    • The name and date of birth of claimant
    • The total amount submitted
    • Referral or prescription from the treating physician were necessary (consult the Supplemental Health Plan as to whether the service you incurred requires a referral/doctor's prescription)
  • Attach the original receipt(s) and keep a copy for your personal records
  • Sign, date and forward the completed form directly to Manulife Financial. Their address is indicated on the form.

Emergency Out-of-Province claims

Be sure to carry your drug/travel card with you while you are travelling outside your province of residence, especially when travelling to a foreign country.

In case of a medical emergency, contact Allianz Global Assistance immediately at one of the numbers listed on your card. Be sure to quote the ManuAssist Plan ID number (see Emergency Travel Assisitance - Active or Retirees)  as well as your Manulife Plan Contract Number 85210.

  • Keep all receipts
  • Obtain a fully itemized bill for any hospital treatment provided

For expenses of $200 or less

You must file a claim first with your provincial health care plan (eg. RAMQ in Quebec) and then with Manulife for the balance:

  • Attach the original receipt(s) to the appropriate provincial health plan claim form for your province of residence. Keep a copy of all documents to send to Manulife once you receive settlement from the provincial health care plan.
  • Sign, date and forward this form along with the original receipts to your provincial health plan (e.g., RAMQ — Régie de l'assurance-maladie du Québec)
  • Once you receive payment from your provincial health plan, submit any unpaid balance to Manulife. Attach copies of the receipts and the Statement of Expenses indicating amounts considered and paid under your provincial health care plan.

For expenses in excess of $200

Allianz Global Assistance will assume responsibility on your behalf for obtaining reimbursement of eligible medical expenses from your provincial health care plan and from Manulife.

Dental claims

If the total treatment is expected to cost more than $400, you should ask your dentist to submit a treatment plan to Manulife Financial before the treatment begins.

  • Before visiting your dentist, obtain a Manulife Financial dental claim form
  • Some dentists have the ability to submit dental claims electronically to Manulife Financial, in which case no paperwork is required
  • Complete Part 2 of the form before seeing your dentist
  • Have your dentist complete Part 1 of the form
  • You can assign your benefit payment directly to your dentist by signing in the appropriate box on the claim form
  • Otherwise, sign, date and forward the completed form directly to Manulife Financial. The address is provided on the form.

Dental claims as a result of an accident:  submit these under the McGill Supplemental Health Plan using a health claim form.  Include xrays, details of treatment from your dentist and details of the accident.

Coordinating health and dental claims

If both you and your spouse have Health and/or Dental coverage under another employer-sponsored benefit program, you can coordinate your claims. In other words, you can claim payment for health or dental expenses under both plans. This process may allow you to recover some of the costs not covered under the plan — things like deductibles, co-insurance payments, or expenses in excess of the plan limitations or restrictions (but not more than 100% of actual expenses).

To co-ordinate benefits, please follow this process:

If

Then

You incur the expense

You must submit your claims through the McGill plan first. If the McGill plan doesn't cover the full expense, your spouse can submit the unpaid portion through his/her plan.

Your spouse incurs the expense

Your spouse must submit claims through his/her plan first. If that plan doesn't cover the full cost of the service or procedure, you can claim the remaining expense through the McGill plan if you have family coverage.

The expense is for a child

If both you and your spouse have family coverage, claims for children are to be submitted first to the plan of the parent whose birthday falls earlier in the year. If you were born in March, for example, and your spouse was born in July, you would submit claims to the McGill plan first. Again, any uncovered expenses could, in turn, be submitted to your spouse's plan as the secondary payer.


Life Insurance claims

Your beneficiary should contact the HR Service Centre at 514-398-4747 as soon as reasonably possible to obtain the necessary claims forms and information. A representative will be pleased to help your beneficiary complete the claims process.

Accident Insurance claims

You (or your beneficiary if you die in an accident) should contact the HR Service Center at 514 398-4747 to obtain the necessary claims forms and information. Again, a representative will be pleased to help you or your beneficiary complete the claims process.

If you leave the University prior to retirement

You have 90 days from the day you terminate employment to submit any outstanding claims for charges incurred prior to your termination date.