How to Submit Your Claims

Basic Group Life, Dependent Life, Optional Life, Basic and Optional Accidental Death and Dismemberment Insurance

Life, dismemberment or loss of use claims:
Your Group Administrator will co-ordinate claim forms and advise procedures.

Waiver of Premium: " Notice of Disability/Sickness should be provided to your Group Administrator no later than 2 months from your last day worked. " Once the Group Administrator and the Carrier have been notified, all forms for application of benefit will be sent to you for completion. Please return these forms to your Group Administrator.

Optional Long Term Disability Insurance " If you are participating in the long term disability insurance plan and it appears that you will be off work for a period of more than 119 days, you should obtain the appropriate claim forms (Early Notice Form and Proof of Claim) within 2 months from last day worked from your Administrator. Upon completion, all forms must be returned to your Group Administrator.

Notice and Proof of Claims

1. Notice of Claim
   To permit prompt assessment of Waiver of Premium and Long Term Disability Benefits and early participation in rehabilitation programs, written notice of claim must be received by the insurance company (Early Notice Form) within ten (10) months from the last day worked.

   It is recommended that the Notice of Claim (Early Notice Form) be completed within two (2) months from the last day worked and forward to the insurance company. Failure to furnish such notice within the time required shall not invalidate nor reduce any claim, if it is not reasonably possible to furnish the notice within such time, provided the notice is given as soon as is reasonably possible.

2. Proof of Claim:
   Long Term Disability benefits under this Policy will only be payable for periods for which the insurance company has received satisfactory proof that the Employee is entitled to benefits.

   The claimant must provide information required to prove the Employee's entitlement to benefits and must also authorize the insurance company to obtain information from other sources for this purpose. Proof of claim must be submitted within six (6) months of receipt of the notice of claim; thereafter, whenever the company requests information or authorization, it must be submitted within six (6) months.

   Failure to furnish such proof within the time required shall not invalidate nor reduce any claims, if it is not reasonably possible to furnish the proof within such time, provided the proof is given as soon as is reasonably possible.

   Written proof of disability will not be accepted if received by the insurance company more than ten months after the date of disability, or more than six months after termination of the policy. Please note that even if benefits are payable from Workers' Compensation, which may totally offset the long term disability benefit, a notice of disability should be submitted for long term disability benefits within the specified time period.

Optional Critical Illness
Your Group Administrator will co-ordinate claim forms and advise procedures

Supplementary Health Insurance

Hospital Insurance:

• Present your identification card upon admission to hospital.
• The hospital will forward your claim directly to the Insurance Company Benefit Payments Office for payment of eligible expenses.

Prescription Drugs:

• Present your identification card to the pharmacist when purchasing eligible drugs.
• You pay the pharmacist's professional fee and any applicable surcharge while the cost of the eligible ingredient is payable under this program.
• For any prescription drug requiring Special Authorization, please refer to the section titled "Special Authorization" in this booklet.

Vision Care:

• Obtain a Claims Submission form from your Group Administrator.
• Obtain a completed Vision Care Claim form from the provider of service (i.e. Optometrist and Optician).
• Complete the Claims Submission form, attach a paid-in-full receipt and the completed Vision Care Claim form, and forward to the Insurance Company Benefits Payments Office.

Extended Health:

• Obtain a Claims Submission form from your Group Administrator.
• Attach a paid-in-full receipt which shows:
  • Patient's name,
  • Date and nature of treatment, and
  • Complete itemization of charges.
• Forward the above items to the Insurance Company Benefits Payments Office.

The address of the Desjardins Financial Benefits Payment Office is:
430 Topsail Road (Village Shopping Centre)
P. O. Box 97
St. John's, Newfoundland · A1E 4N1 Telephone: 1-877-838-7763
Fax: (709) 747-8476

Note: All claims must be submitted to the insurance company as soon as reasonably possible but not later than one year after the date the claim was incurred.
 
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