Claims Procedures / Forms
Important Information for Claim Submissions
Please be sure to include the following information on all claim forms before they are submitted:
- Group Policy Number and Division Number
- Name of Policyholder
- Plan member name
- Plan member certificate number
- Plan member’s full address
- Signature of plan member (employee)
If the claim is for a dependent (spouse / partner or child), the claim should also include:
- The name and birth date of each dependent
- Complete a Supplementary Medical Benefits Claim Form
- Attach the original receipts.
- Claims for Massage, Psychologist or Physiotherapist must include a Doctor’s prescription with original submission.
- Expenses that are associated with this form other than prescriptions are listed in your Benefit Booklet in the section name Summary of Health Care Maximum
- Complete a Standard Dental Claim form from your dental insurance carrier.
- For any procedures that are not listed in your benefit booklet a predetermination should be submitted prior to having the procedure performed.
Short Term Disability
If a plan member is absent from work due to sickness or accident, a Short Term Disability Claim Form must be provided to the plan member. The claim must be submitted within seven days of the date the disability began while the plan member is still disabled and absent from work.
Once the plan member returns to work, an Advice On Return Of Absent Plan Member needs to be submitted. This form is provided by Equitable Life upon approval of Short Term Disability.
Long Term Disability
NOTE: It is very important for the Employer to establish a Long Term Disability Policy and provide the information to all employees in writing. The Long Term Disability Policy should outline the time span for which the plan member is entitled to receive health and dental benefits. The average time of coverage entitlement may vary from as little as 3 months to a total of 3 years.
If a plan member is absent from work due to illness or accident, and it appears as though they will not return for at least the elimination period or the LTD Plan, a Long Term Disability Preliminary Notice of Claim Form is required by Equitable Life within 31 days of the date the disability began.