News and Updates


Co-ordination of benefits in My Claims (Part 3)


We want to make co-ordinating your benefits as easy as possible. If your spouse’s insurance company is also with Manulife (or they have benefits with same or another Employee Life and Health Trust (ELHT) where Manulife is also the insurer), co-ordination of benefits is done automatically for you when you submit a claim. (This does not apply if claims are submitted by providers.)

If the other plan is with a different insurance company, their plan information is not needed. For any unpaid amount, you can submit to the other insurance company.

What you need to do

  1. Click on the Log in button on the top right-hand corner.

  2. Select Health and Dental from the drop-down menu.

  3. After you have logged in, click on My Claims.

  4. Click Submit a Claim button and follow the steps to completion.

 
Coordination of Benefits Questions in My Claims
 

Here are tips to answering the above questions “Do you have other coverage?” and “Are you submitting a leftover amount from that plan?”:  

Method of claim submission

Both benefits plans are with the same or another ELHT (both plans insured by Manulife)
(Automatic co-ordination of benefits)

ELHT Benefits Plan is insured by Manulife; the other plan is not insured by Manulife
(Manual co-ordination of benefits)

Online

For these questions, you would click as follows:
Do you have other coverage? Yes
Are you submitting a leftover amount from that plan? No

Because both plans are insured by Manulife, your spouse does not have to do anything to claim the unpaid amount.

*****

If you are submitting a claim as the second payer for the unpaid amount, then you would answer as follows:
Do you have other coverage? Yes
Are you submitting a leftover amount from that plan? Yes

Be sure to get a copy of your spouse’s claim statement, so you can enter the information.

 

For these questions, you would answer as follows:
Do you have other coverage? Yes
Are you submitting a leftover amount from that plan? No

Your spouse will need to:

  • Complete their insurance company claim form, include the OTIP claim statement and send these documents to their insurance company

*****

If you are submitting a claim as the second payer for the unpaid amount, then you would answer as follows:
Do you have other coverage? Yes
Are you submitting a leftover amount from that plan? Yes

Be sure to get a copy of your spouse’s claim statement, so you can enter the information.

Provider submits
(e.g. dentist, pharmacy)

Since the service provider has submitted your claim directly to Manulife, no action is required from you.

*****

Your spouse can submit a claim for any unpaid balance, by logging into My Claims. Your spouse would answer these questions as follows:
Do you have other coverage? Yes
Are you submitting a leftover amount from that plan? Yes
 
Be sure to give a copy of your claim statement to your spouse, so they can enter the unpaid balance amount during online claims submission.

*****

These steps would also apply if the service provider submitted a claim directly for your spouse. You can submit a claim for any unpaid balance, by logging into My Claims and answer these questions the same way as your spouse.

NOTE: If pharmacist is not able to submit to either plans, you may need to submit the unpaid amount online or by paper.

For these questions, you would answer as follows:
Do you have other coverage? Yes
Are you submitting a leftover amount from that plan? No
 
Your spouse will need to:

  • Complete their insurance company claim form, include the OTIP claim statement and send these documents to their insurance company

NOTE: If pharmacist is not able to submit to either plans, you may need to submit the unpaid amount online or by paper.

For paper claims:

The above questions do not apply to you if you send in paper claims.

Complete the Extended Health Benefits Claim form, include receipts and the other insurance company claim statement (if claiming any unpaid amount), and mail to the address on the form.

  

Questions? Please call OTIP Benefits Services at 1-866-783-6847.
 

Related links:

  News and Updates

Submitting your claim 101

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Updating your preferred email address

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What to do if you get in a car accident

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