News and Updates


Submitting your claim 101


Submitting your claim can be as easy as this: send in your claim and get your money back. Done.

Depending on the level of complexity, some claims need a little more time and/or information to process correctly. In some cases, even before you spend the money, we recommend that you get an estimate or pre-determination. That way, you know upfront whether your claim will be approved and/or how much will be reimbursed to you.

Claim process

Let’s look at the claim process in more detail and learn some tools and tips that can help you through it.

Step 1: Making a claim

There are three ways for you to make a claim:

Online

Submitted by provider

Mailed in

Cut out the mailing time and postage costs by completing your claim online.

Most pharmacies and dentists’ offices can submit your claim directly to the insurer.

Other service providers may also have this ability. You can show them your benefits card to find out.

Payment may either be sent directly to your provider or to you.

Mail your claim using the forms available.

Based on the type of claim and/or your benefits plan, you may need to attach your doctor’s note, physician’s referral, prescription, diagnosis, invoice and any other supporting documents.

You can do this online or include the documents in the envelope with paper claims.

 

Step 2: Getting reimbursed

Once your claim has been received, it is usually processed within 5-7 business days.

Direct deposit

Cheques

Skip the mailing time and going to the bank by having your money deposited directly into your chequing/savings account.

Allow 1-2 business days for the deposit to be processed.
 
Sign up for direct deposit now! It is convenient, secure and reliable.

Deposit your cheques at the bank or online.
Allow standard mailing times.


As per your benefits booklet, reasonable and customary limitations, maximums, coinsurance, and deductibles will affect the amount that is paid back to you.

Related: How do I find my benefits booklet?

Did you know?

If you have more than one family benefits plan, co-ordination of benefits can help you. When you link your plans together, you and your spouse/children (dependants) can get up to 100% of your money back for your health and dental costs.

NOTE: If you have single coverage, then co-ordination of benefits does not apply to you.

Before you spend the money

Here are three things you can to do to be informed about your options and potential costs:

  1. Check your benefits booklet or contact OTIP Benefits Services to see what benefits or services are covered. If the benefit is not listed in your benefits booklet, you can contact OTIP Benefits Services to find out if it is covered.

  2. Make sure your provider is covered. You can check on My Claims to see:

    • If your orthopaedic shoes may be covered (scroll down to My benefits on My Claims home page) (NOTE: If you do not see the list of orthopaedic shoes, your plan does not include coverage for orthopaedic shoes.) 

    • If your provider is not covered by the insurer (Manulife) (scroll down to Wellness centre on My Claims home page)

  3. Get an estimate or pre-determination. For expensive equipment or procedures, it’s a good idea to check that your claim will be covered before you buy it. You can do this online in My Claims or complete the appropriate form. Consider sending in an estimate for the following item:

    • Medical equipment/services (e.g. private duty nursing), orthotics or orthopaedic shoes

    • Drugs that need pre-approval

    • Expensive dental work

For online estimates

For paper estimates

  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.

When you “Select service provider type,” scroll down to Other and select Estimate.

Be sure to write “ESTIMATE ONLY” on the form,  attach your supporting documents and mail to the address on the form.


One last note on claims…audits are healthy for you and your benefits plan

Just like your regular checkups with your doctor or service providers, Manulife, the insurer, periodically audits claims. Through the auditing processes, improper claiming behaviour may be suspected. In those situations, Manulife takes extra steps when processing and paying claims, which may lead to additional information requests or processing time. To help with the audit process, be sure to keep your receipts for 12 months from the date you submit a claim.

Benefits fraud, abuse, misuse, and overuse of benefits can happen. Let’s work together to help keep you and your benefits plan healthy!  

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