HOW TO SUBMIT A CLAIM Updated: July 2010 EXTENDED HEALTH CARE EXPENSES GENERAL INFORMATION – SUN LIFE How do I submit my extended health care expenses to OMA-OPIP and UWO HCSA through Sun Life? Both the UWO HCSA (Health Care Spending Account) and OMA-OPIP benefit plan policy year runs from January 1st to December 31st. All extended health care claims must be submitted to Sun Life by the end of March in the following year for previous year’s expenses. What claim form do I use to submit my expenses? All extended health care expenses are submitted to Sun Life using a paper claim form. Links to the forms and instructions are below There is a UWO form that will allow Sun Life to automatically coordinate your expenses to be paid through the OMA-OPIP plan (Policy No. 50131) first and any unpaid expenses will be reimbursed through the UWO HCSA (Policy No. 150033) provided funds are available. Can I claim vision care expenses under the UWO HCSA or OMA-OPIP plan? The OMA-OPIP plan does not provide vision care coverage. You can claim your vision care expenses under the Sun Life UWO HCSA (Policy No. 150033) if funds are available. Link to form and instructions are below. How can I contact Sun Life with any questions I may have about the OMA-OPIP plan or UWO HCSA? The OMP-OPIP number is 1-866-527-9260 or online contact [email protected] Link to UWO forms and general information http://www.uwo.ca/humanresources/facultystaff/comp/benefits/clinical/forms.htm FORMS AND INSTRUCTIONS TO SUBMIT EXTENDED HEALTH CARE CLAIMS 1. PRESCRIPTIONS http://www.uwo.ca/humanresources/docandform/forms/benefits/SunLife-EHC-HSA-E.pdf Section #1 – complete with your personal information. The OMA-OPIP contract information is already entered into the form. Please contact OMA if you do not know your OPIP ID number. Each submission will first be claimed against your OPIP deductible (family coverage has a deductible of $2,000). Section #2 – go to the section that begins "Are you also a member of another benefit plan?" - select single or family coverage and insert your Sun Life Member ID number which is the same as your UWO ID number. Sun Life will automatically reimburse any outstanding balance from the HCSA if you have funds available. Section #3 – tick the second option – “You want us to assess this claim under your Extended Health Care benefit first and then assess any unpaid balance under your HSA. “ Please also follow use this form for: Hospital Services, Medical Services, Supplies and Equipment, Private Duty Nursing, Hearing Aids, Ambulance and Paramedical Services. 2. EXPENSES NOT COVERED UNDER OMA-OPIP For services not covered under OMA-OPIP such as Vision Care and the balance of any Dental Claims. Please use the Heath Spending Account Claim form – link http://www.uwo.ca/humanresources/docandform/forms/benefits/SunLife-HSA-150033-E.pdf Section #1 – complete with your personal information. The HCSA contract information is already entered into the form. Insert your Sun Life Member ID number which is the same as your UWO ID number. Section #2 – complete with details of your expenses and include the original receipts. Please remember to always keep copies of your receipts before submitting. Please note that you have separate coverage for Dental expenses from Great West Life (see below). DENTAL EXPENSES GENERAL INFORMATION – GREAT WEST LIFE How do I submit my dental care expenses to Great West Life? Your dental plan is through Great West Life (Policy No. 162521). The policy year is January 1st to December 31st each year. Your dental expenses can be submitted electronically to Great West Life through your dental office. Reimbursement will be sent in the form of a cheque or, if elected, deposited into your bank account. For paper claim, you have 15 months from the date of service to submit your dental expenses to Great West Life for reimbursement. Can I claim the unpaid dental care expenses from Great West Life under the UWO HCSA or OMA-OPIP plan? The OMA-OPIP plan does not provide dental coverage. Any unpaid dental care expenses can be submitted to the Sun Life UWO HCSA for reimbursement if you have funds available. See detailed instructions above. GWL online service - http://www.greatwestlife.com/001/Client_Services/Group_Plan_Members/index.htm ON-LINE ACCESS WITH SUN LIFE (UWO HCSA & OMA-OPIP) How do I access my HCSA Information on line for the UWO HCSA with Sun Life? If you have already signed up under the OMA-OPIP, you can use the same sign on and ID to access your HCSA for the OMA-OPIP plan (Policy #50131). On your personal page you will just click on the Health Care Spending Account (Policy #150033). If you still need to register for on–line access with Sun Life, go to www.sunlife.ca/member. You will see “don’t have an access ID? Register Now”. Step by step directions are provided in order to give you online access. You can also contact Sun Life directly at 1-800-361-6212 between 8 a.m. and 8 p.m., Monday to Friday for assistance. To register you will need your HCSA policy number (150033) and your ID Number to register. ON-LINE ACCESS WITH GREAT WEST LIFE (DENTAL) How do I access my Dental Information on line with Great West Life? If you do not have an Access ID and password with Great West Life already, sign up for the web access. Go to www.greatwestlife.com. You will see on the left hand side “Group Net for Plan Members”, then go to “New User-Register Now” and follow step by step directions. You will need your policy number (Policy #162521) and identification number to register. You can also contact Great West Life directly at 1-800-957-9777 between 7 a.m. and 6 p.m. central time, Monday to Friday for assistance. EXTENDED HEALTH BENEFITS OR DENTAL EXPENSES – COVERAGE UNDER ANOTHER CARRIER How do I submit a dental claim if I have another insurance plan through my spouse or another carrier? All dental care expenses should be submitted to Great West Life first and any other carrier after. Any unpaid portion of your dental expenses may be eligible under another insurance plan you may have. Using the “claims statement” or “explanation of benefits” provided by Great West Life, you can submit this document, along with the other insurance carrier claim form for reimbursement for the amount not paid by Great West Life. However, as each member’s situation may be different, we ask that you contact Trudi St. Marie or Jennifer Behie of Zavitz Insurance Inc. at (519) 667-0116 to assist you with the process of submitting claims to best maximize your benefit plans available. How do I submit an extended health care claim if I have another insurance plan through my spouse or another carrier? All extended health care expenses should be submitted to the OMA-OPIP plan with Sun Life first to be applied to the deductible. The exception is Vision Care as this is not a covered expense under the OMAOPIP plan; however, it is eligible under the UWO HCSA if you wish to claim under this plan. Any unpaid portion of your extended health care expenses may be eligible under another insurance plan you may have. Using the “claims statement” or “explanation of benefits” provided by Sun Life, you can submit this document, along with the other insurance carrier claim form for reimbursement for the amount not paid by Sun Life. However, as each member’s situation may be different, we ask that you contact Trudi St. Marie or Jennifer Behie of Zavitz Insurance Inc. at (519) 667-0116 to assist you with the process of submitting claims to best maximize your benefit plans available. ZAVITZ INSURANCE INC. CONTACT INFORMATION For questions, clarification or assistance, please feel free to contact Jennifer Behie or Trudi St. Marie at 439 Dundas St., London ON N6B 1W1 Tel: (519) 667-0116 Toll Free: 1-888-347-2437 Fax: (519) 667-0135 Email: [email protected] Email: [email protected]