CoverMe™ Claims Information

Manulife Financial
Affinity Markets Health Claims
P.O. Box 4214, Stn A
Toronto, Ontario
M5W 5M4

Phone: 1-800-COVER ME®
(1-800-268-3763)

Manulife Financial
Affinity Markets Dental Claims
P.O. Box 4215, Stn A
Toronto, Ontario
M5W 5M6

Phone: 1-800-COVER ME®
(1-800-268-3763)

Manulife Financial
Affinity Markets
P.O. Box 4215, Stn A
Toronto, Ontario
M5W 5M6

Phone: 1-800-590-0970
Or 1-800-COVER ME®
(1-800-268-3763)

Manulife Financial
Affinity Markets
P.O. Box 4215, Stn A
Toronto, Ontario
M5W 5M6

Phone: 1-800-590-0970
Or 1-800-COVER ME®
(1-800-268-3763)

CoverMe Travel Insurance
c/o Active Care Management
P.O. Box 1237, Stn. A
Windsor, ON N9A 6P8

Phone toll-free from within North America: 1-888-881-8013

Phone collect from outside North America: +1-519-945-9246

CoverMe Travel Insurance
c/o Active Care Management
P.O. Box 1237, Stn.A
Windsor, ON N9A 6P8

Phone toll-free from within North America: 1-877-878-0142

Phone collect from outside North America: (519) 251-5166

CoverMe Travel Insurance for Students
c/o Active Care Management
P.O. Box 1237, Stn.A
Windsor, ON N9A 6P8

Phone toll-free from within North America: 1-877-331-3134

Phone collect from outside North America: (519) 251-7401

To be eligible for reimbursement, individual claims must be submitted within 12 months of the date on which service charges were incurred. For example, a claim for services billed on February 25, 2009, must be submitted by February 25, 2010.

Note: A claim should only be submitted once the total of service bills exceeds the deductible amount, if applicable. When claiming small fee amounts, please accumulate receipts and submit once claims total a reasonable sum.

As long as your claim form is complete and accurate, it will be processed within five business days of receipt. Cheques are typically issued within one day of processing.

However, if information is missing, we may have to return the claim form to you, which will delay processing and payment.

Provider-Submitted Claims
For many health care services covered by your Plan, you may not need to fill out a claim form. Health Care providers such as Provincial or Territorial hospitals and pharmacies and many dentists and optometrists bill Manulife Financial directly for services covered by your plan. This means that you do not need to submit a claim form. When your pharmacist, dentist or hospital bills Manulife Financial directly, but the full amount of the claim is not covered by your policy, such as where you are required to make a co-payment under the Schedule of Benefits section of your Policy or where you have reached your benefit maximum at the time the service is rendered, you will have to pay the balance directly to the provider. It is therefore important that you make the provider aware of any restrictions/exclusions which may apply to your policy.

Insured-Submitted Claims
If for any reason your pharmacist, dentist, hospital or optometrist does not bill Manulife Financial directly, you are required to pay the provider and then submit your claim to Manulife Financial for reimbursement of the eligible expense. In addition, if your policy contains a counter offer with a policy exclusion, you may be required to submit your health claims directly to Manulife Financial. Claim forms can be obtained by calling 1-800-COVER ME® (1-800-268-3763), or by visiting our website at http://www.coverme.com/claims-information/claim-forms.jsp.

To submit your claim, complete a claim form attaching original receipts (not photocopies or faxes) and all pertinent documentation required for your claim (See "Submitting Claims Directly to Manulife Financial") and send to:

Health Claims
Manulife Financial, Affinity Markets
P.O. Box 4214, Station A
Toronto, Ontario M5W 5M4

Dental Claims
Manulife Financial, Affinity Markets
P.O. Box 4215, Station A
Toronto, Ontario M5W 5M6

Once your claim has been reviewed and deemed an eligible benefit, a reimbursement cheque will be mailed to you for the eligible portion of the benefit. Please retain the top portion of the cheque for income tax purposes.

Submitting Claims Directly to Manulife Financial
Receipts
Prescription Drugs
Original receipts (not statements) must show the name of the drug, drug identification number (DIN), date of service, prescription number, strength, quantity, drug cost and dispensing fee.

All Other Receipts
Receipts (other than prescription drug receipts) must be on the printed letterhead of the person or company providing the service and must clearly show:

• name of patient
• date(s) of service
• description of service
• cost of each service rendered.

Prosthetic Appliances/Durable Medical Equipment/Hearing Aids
Most provincial health plans contribute toward the cost of prosthetic appliances, durable medical equipment and hearing aids. It is recommended that a written estimate be obtained outlining the charges for the purchase or rental of medical equipment. Manulife Financial will review the estimate and advise you of the amount of benefits payable.

Claims for prosthetic appliances, durable medical equipment or hearing aids must be accompanied by the original receipt, a copy of the provincial health plan contribution statement (including portion paid) along with a written prescription/functional assessment from a certified plan authorizer.

Extended Health Care Services
Charges for the services of a registered:

• Chiropractor
• Chiropodist
• Osteopath
• Naturopath
• Podiatrist
• Registered Massage Therapist*
• Acupuncturist
• Psychologist*
• Physiotherapist*
• Speech Pathologist*/Therapist*

* These services require written authorization from your attending physician. Services payable under your policy, including the above mentioned Extended Health Care services, are only payable after any applicable Government Health Insurance Plan (GHIP) yearly dollar benefit maximum has been reached (refer to your Schedule of Benefits). Please refer to the section Claiming Benefits, when making a claim for these services. You must include documentation from your medical practitioner stating the date the GHIP yearly dollar maximum allowance was reached.

Note: Any billing amount within the eligible per visit GHIP allowance is not covered and is your responsibility. Please refer to your Schedule of Benefits for specific coverage.

Homecare and Nursing
Please call 1-800-COVER ME® (1-800-268-3763) and follow the prompts to reach the Individual Inquiry Department for information and nursing approval forms prior to commencing such services.

Dental Benefits
Dentists are encouraged to submit claims directly to Manulife Financial for reimbursement. This method is fast, economical and convenient for you, as you only need to show your identification card to confirm coverage for the services provided. If a dentist does not submit your claim directly to Manulife Financial, he/she will identify the services provided using the standard dental claim form approved by the Canadian Dental Association. This claim form must then be submitted to Manulife Financial.

Pre-Determination of Dental Benefits
When you, your Co-Insured or dependant is about to commence major dental work, we recommend that the dentist provide Manulife Financial with an outline of the proposed treatment plan, including the intended procedures and cost. (X-rays are often required to assess the treatment.)

Vision Benefit
To submit a claim for the purchase of prescription lenses/frames/contact lenses, use the standard Extended Health Care claim form and send it to Manulife Financial, together with the original receipt from the provider.

Accidental Death and Dismemberment Benefit
For details and additional information about the appropriate documentation required, please contact:

Life Unit
Manulife Financial, Affinity Markets
P.O. Box 4213, Station A
Toronto, Ontario M5W 5M3

Or call us at 1-800-COVER ME®
(1-800-268-3763)

Emergency Health Travel Coverage
To make a claim under your Emergency Health Travel Coverage within Canada and the U.S., call 1-800-805-1008. In the event of an emergency while outside of Canada or the U.S., refer to your Manulife Financial world assistance card for the telephone numbers of the appropriate Emergency Assistance Centres.

As long as your claim form is complete and accurate, it will be processed within five business days of receipt. Cheques are typically issued within one day of processing.

If information is missing, however, we may have to return the claim form to you, which will delay processing and payment.

To keep up-to-date on the status of your claim form, you can sign in to your Health and Dental SecureServe Log In. If you wish to speak to someone, our customer service representatives will be happy to help you.