Manulife Financial CoverMe

CoverMe™ Claims Information

Are you looking for information about your claim? Do you have a question about how to make a claim? This section has a collection of tools and forms to help keep you informed.

If you wish to speak to someone, our customer service representatives will be happy to help you. The claims contact information for each product is also listed below in Claims Inquires.

Health Claims

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)

Dental Claims

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)

Critical Illness Claims

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)

Life Claims

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)

Travel Claims (for travelling Canadians)

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

Travel Claims (for visitors to Canada)

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

Travel Claims (for students)

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

How long do I have to submit a health and dental claim?

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.

How quickly will my health or dental claim be processed?

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.

How do I submit a health or dental claim?

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/knowledge-centre/forms-library.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.

 

Important Notes Regarding the Submission of Your Claims

Request for additional information from your health care practitioner
For the purpose of assessing your claims, you may be asked to provide Manulife Financial with additional medical information. In this event, our claims staff will advise you of the specific information that is required in order to complete the assessment of your claim. You will be responsible for any costs associated with obtaining this information. Manulife Financial will generally accept an explanatory note that is written on a medical script pad from the medical practitioner, but on occasion, more detailed information may be required.

Medically Necessary
In order to be considered for payment, eligible health claims must be deemed medically necessary under the terms of your policy. Preventative dental claims are allowable to the extent they are defined under your policy.

Counter Offer Exclusions
If your policy was issued with any exclusion, as described in a counter offer agreement made with you, claims are not eligible if they relate to these exclusions. This means that any treatments (including but not limited to medications) relating to the policy exclusion will be exempt from payment. In the event that a treatment, medication or health service, that would otherwise be used to treat an excluded condition is being used to treat an unrelated medical condition, you will be required to provide us with supporting information to this effect from your treating medical practitioner, at the time you submit your claim, in order for it to be considered for payment.

Claims Review
Manulife Financial is committed to providing cost-effective insurance coverage to its Insureds. To this end, our Claims Review Process is designed to verify that claim payments are being made in compliance with the terms of the policy. As such, claims submitted within the first two years that a policy or newly added coverage is in effect, other than dental claims, may be selected for a claims review from time to time.

Deadline for Submission of Claims
Full written claims satisfactory to Manulife Financial must be submitted within 12 months from the date charges are incurred. Faxes and photocopies of documentation are not acceptable.

When/How will I know if my claim has been approved?

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.

  • Health & Dental Claims on SecureServe®

    We've got you covered with 24-hour-a-day, seven-day a week access to relevant, reliable and secure benefit plan information at your fingertips. By logging onto Health and Dental: SecureServe®, our automated claims information site, you can:

    Access your claims activity
    in the last 12 months

    Find benefit details
    including dollar
    maximums

    Track the status of your
    claim

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