What you need to know about submitting health and dental claims

Requests for more information

Sometimes, we need more information from your health care provider to assess your claim. You are responsible for any costs associated with getting this information. Usually, we accept an explanatory note written on your health care provider's medical script pad. However, occasionally, we will ask for more detailed information.

Costs associated with excluded conditions

Sometimes, we make counter offer agreements that exclude specific health conditions. We cannot pay for any treatments – including but not limited to medications – that relate to an excluded condition. Your health care provider must explain if a treatment that can be used for an excluded condition is being used to treat an unrelated condition. Include this explanation when you submit your claim.

Costs that aren't medically necessary

Health claims must be deemed medically necessary under the terms of your policy. Dental claims for preventative services are allowable if your policy covers them.

Costs submitted after 12 months

To consider a claim, we must receive all the information we need within 12 months of the date you paid the costs you're claiming.

Selecting your claim for review

Manulife is committed to providing cost-effective insurance coverage to our customers, so we routinely review claims to make sure that payments comply with the terms of a customer's policy. Any claims you submit within your first two years of coverage may be selected for a claims review. Dental claims may be selected for a claims review beyond your first two years of coverage.

How to ensure your claims are processed efficiently

Prescription drug receipts must be receipts (not statements) and show:

  • Name of drug
  • Drug identification number (DIN)
  • Date of service
  • Prescription number
  • Prescription strength and quantity
  • Drug cost
  • Dispensing fee (if applicable)
  • Complete address of pharmacy
  • Currency (if not Canadian dollars)

All other receipts must be on the printed letterhead of the person or company providing the service and show:

  • Name of patient
  • Date(s) of service
  • Description of service
  • Cost of each service
  • Complete address of provider
  • Currency (if not Canadian dollars)

Your attending physician must authorize services from a Psychologist or Speech Pathologist/Therapist before we can consider your claim.

For all extended health care services, we only pay claims after you have reached the annual maximum in your government health insurance plan. Your medical practitioner must include documentation stating the date you reached that annual maximum. Any costs within the eligible per-visit government health insurance plan allowance are not covered and are your responsibility. Please refer to your Schedule of Benefits for your coverage details.

When your dentist submits your claim directly to us, all you have to do is show your identification card to confirm that you're covered for the services your dentist provided. If your dentist does not submit your claim directly to us, you must send us the dentist-completed standard dental claim form approved by the Canadian Dental Association.

When you buy prescription lenses, frames or contact lenses, send us the receipt from the provider along with the provider-completed Manulife extended health care claim form.

If you're in Canada or the United States, call us at 1-800-805-1008 to make an emergency medical claim under your travel coverage. If you're in a different country, refer to your Manulife world assistance card for the telephone numbers of the appropriate emergency assistance centres and call us collect.

Before you arrange for any of these, ask for a cost estimate and send it to us. We will let you know how much we will pay. Keep in mind that most government health insurance plans also contribute towards these costs.

When you submit your claim, you must include:

  • Original receipt
  • Copy of government health insurance plan contribution statement (including the portion paid)
  • Written prescription/functional assessment from a certified plan authorizer

Call 1-800-268-3763 to speak to a customer service professional. You must complete nursing approval forms before starting homecare and nursing services.

Before you or anyone insured under your plan agrees to major dental work, ask the dentist for an outline of the proposed treatment plan and cost estimate and send them to us. Often, it helps to include x-rays so we can assess the treatment. We will let you know how much we will pay.

Call 1-800-268-3763 and we will tell you what documentation we need. You can also write to us:

Affinity Markets
P.O. Box 670, Stn Waterloo
Waterloo, Ontario
N2J 4B8