Extended Health Benefits
Extended Health Benefits are designed to provide valuable protection for you and your eligible dependents, in addition to your provincial hospital and medical care plan. Important coverage is provided for things such as prescription drugs, paramedical practitioner services such as chiropractor, massage therapy, and supplies such as splints, wheelchairs etc. For a full list of what is covered, and the level of benefits, please refer to this section of the HEALTH BENEFIT PLAN BOOKLET.
Use the Extended Health Benefits Claim form if you’ve paid for Extended Health expenses (prescription drugs, physiotherapy, chiropractor, vision care, etc.) that are covered under the Plan and you wish to be reimbursed.
Information Needed to Complete the Form
Your personal Member information and the Group Plan number (52565) is needed to complete the form. In addition:
- the name of the insured person(s),
- the relationship to the employee,
- birth date(s),
- service provided,
- service date of each claim,
- information about other benefit or insurance plans that you may be eligible to claim from.
- if you are coordinating claim’s payment with your spouse’s health plan, you should include the primary carrier’s payment statement and copies of receipts.
Please follow the instructions on the form.
Frequently Asked Questions
What do I need to send in with the form?
- You must attach all receipts for reimbursement. Make a copy for yourself before submitting your claim.
- If you are coordinating claim’s payment with your spouse’s health plan, you must include the primary carrier’s payment statement and a photocopy of the original receipts.
What expenses can I be reimbursed for?
My spouse is also a Member of a health benefits plan at work, how do I coordinate my claim with my spouse’s benefits plan?
- If a Member or any eligible Dependents are entitled to receive similar benefits simultaneously under the Health Benefit Plan or any other group insurance plan (including Provincial Plans), to prevent over payment, benefits payable under this Plan would be co-ordinated with the other Plan.For example: A Member’s wife is covered under her employer’s plan with family coverage. The Member, his spouse and their three children are all covered under both Plans. To determine which plan would be primarily responsible for the dependent children: Between the Member and the spouse, whomever’s birthday falls first in the calendar year, their plan is responsible for the initial reimbursement of benefits for the dependent children, then, any amounts that are not paid by that Plan are submitted to the other parent’s plan.In the event that the Member’s birthday is in April and the spouse’s birthday is in January. The spouse’s plan would be primarily responsible for the spouse’s claims and the claims of the children. Any amounts not paid by the spouse’s plan can be submitted to the Member’s Plan for reimbursement. Any amounts for the Member that are not paid by the Member’s Plan can be submitted to the spouse’s plan for reimbursement. Please see the description of Extended Health Benefits for a description of “Coordination of Benefits”.
Other questions on completing the form should be directed to the PLAN ADMINISTRATOR.
Vision Care (part of Extended Health Benefits)
You and your eligible dependents are entitled to receive reimbursement for contact lenses or any one pair of eyeglasses in any 24-consecutive month period. The level of benefit you will be reimbursed as well as a full description of the limitations is outlined in this section of the HEALTH BENEFIT PLAN BOOKLET.