For all medical expense claims, including vision care claims, complete a
Claim
Request - Medical Expenses (PDF - 115 KB) and attach the original
receipts.
Make sure your group
number, the policyholder's name and your certificate number
are entered on the
form.
Keep a photocopy of the form
and the receipts in case Industrial Alliance does not receive your original
claim.
Send the original of the form and the receipts to
the following address according to your region:
Quebec
Industrial Alliance Insurance and Financial
Services Claims Department, Group Insurance PO
Box 800 Station Maison de la Poste Montreal, Quebec H3B 3K5
Ontario, Atlantic and Western Provinces
Industrial Alliance Insurance
and Financial Services Claims Department, Group Insurance PO Box
4643 Toronto Station "A" Toronto, Ontario M5W
5E3
Make sure your policy
number, the policyholder's name and your certificate number
are entered on the
form.
Make sure that Part 1 is
completed in full and signed by the authorized person in your dentist's
office.
Make sure that Part 3 is
completed in full and that you sign the Member
Confirmation/Authorization
section.
Keep a photocopy of the form
and the receipts in case Industrial Alliance does not receive your original
claim.
Send the original of the form to the following address according to your
region:
Quebec
Industrial Alliance Insurance and Financial
Services Claims Department, Group Insurance PO
Box 800 Station Maison de la Poste Montreal, Quebec H3B 3K5
Ontario, Atlantic and Western
Provinces
Industrial Alliance Insurance
and Financial Services Claims Department, Group Insurance PO Box
4643 Toronto Station "A" Toronto, Ontario M5W
5E3
How do I submit a claim when the same event is covered under two insurance contracts?
Use the following examples as a guide when you wish to submit a claim for
an event covered under two insurance contracts.
Example
1
You: Insured by Industrial Alliance as a member Your spouse
: Covered by a group plan of another insurer Situation: You
have incurred expenses covered by your insurance contract.
If you are
covered by Industrial Alliance as a member, all the expenses you have incurred
must first be submitted to Industrial Alliance. Once Industrial Alliance has
reimbursed you, any unpaid portion of the claim must be submitted to your
spouse's plan for reimbursement.
When you submit your claim to your
spouse's insurer, attach photocopies of the receipts and the explanation of
benefits paid by Industrial Alliance.
Example
2
You: Insured by Industrial Alliance as a member Your spouse
: Covered by a group plan of another insurer Situation: Your
spouse has incurred expenses covered by his or her group insurance.
If
the expenses are incurred for your spouse as a member of another group plan:
Your spouse must first submit
the claim to his or her insurer.
Once your spouse has been
reimbursed, you must submit the unpaid portion of the claim (if any) to
Industrial Alliance.
When you submit a claim,
attach photocopies of the receipts and the explanation of benefits paid by
your spouse's insurer.
Example 3
You: Insured by Industrial Alliance as a member Your dependent
child: Covered by your group plan and your spouse's group
plan
If the expenses are incurred for a dependent
child who is covered under your plan and your spouse's plan:
The claim regarding a
dependent child must first be submitted to the group plan of the person
(father or mother) whose date of birth (day and month) comes first in the
calendar year.
Once the claim submitted
regarding the dependent child has been paid, you must submit the unpaid
portion of the claim to the other insurer.
When you submit a claim,
attach photocopies of the receipts and the explanation of benefits paid by the
other insurer.
N.B.: If the parents are separated or divorced, submit
the claim first to the plan of the person (father or mother) who has custody of
the child.
How do I know whether my medical expense or dental care claim has been settled?
How do I submit a medical expenses claim and/or a Health Spending Account claim (HSA)?
For all medical expenses claims, including vision care claims, complete
Claim
Request - Medical Expenses/HSA (PDF - 58 KB), sign the form and attach the original
receipts.
If you
wish to have a portion not covered by your group policy to be paid
under your Health
Spending Account
, please complete the appropriate HSA sections
.
Make sure your group number, the
policyholder's name and your certificate number
are included on the form.
Keep a copy of the form and the receipts in case your original
claim fails to reach Industrial Alliance.
Send the original form
and the receipts to the following address according to your
home region:
Quebec
Industrial Alliance Insurance and Financial
Services Claims Department, Group Insurance PO Box 800 Station Maison
de la Poste Montreal, Quebec H3B 3K5
Ontario, Atlantic and Western Provinces
Industrial
Alliance Insurance and Financial Services Claims Department, Group
Insurance PO Box 4643 Toronto Station "A" Toronto, Ontario M5W
5E3
How do I submit a dental care claim and/or a Health Spending Account claim (HSA)?
Make sure your policy number, the
policyholder's name and your certificate number are included on the form.
Make sure that Part 1 is
completed in full and signed by the authorized person in your dentist's
office.
Make sure that Part 3 is
completed in full and that you signed the Member Confirmation/Authorization
section.
Keep a copy of the form
and the receipts in case your original claim fails to reach Industrial
Alliance.
Send the original form to the following address
according to your home region:
Quebec
Industrial Alliance Insurance and Financial Services Claims Department,
Group Insurance PO Box 800 Station Maison de la Poste Montreal,
Quebec H3B 3K5
Ontario, Atlantic and Western Provinces
Industrial Alliance Insurance and Financial Services Claims
Department, Group Insurance PO Box 4643 Toronto Station "A" Toronto,
Ontario M5W 5E3
Definitions
What is meant by a “deductible"?
The deductible is the portion of the cost of medical
services and dental care that is entirely payable by the insured person. It is
therefore the eligible amount that you must pay before your plan pays you a
benefit. Deductibles are applied on a calendar-year basis, i.e., from January to
December.
What is meant by “dental fee guide"?
The dental fee guide s a fee schedule established by the
provincial dental associations. If your dentist charges in excess of the fees
indicated in the fee guide, the excess amount is not covered by your plan. All
dental claims are paid according to the fee schedule specified by your
plan.
What is meant by “coordination of benefits"?
Coordination of benefits is a claim procedure followed by
the insurance industry for employees and dependents covered by two or more
policies to ensure that no individual is reimbursed for more than 100% of the
cost of the services rendered or benefits received.
Other Subjects
My plan provides for the reimbursement of prescription drugs through the drug payment card, but I'm having a problem with the card. Why?
If you presented your drug card to your pharmacist and you do not
understand why your claim was rejected or not paid in full, you or your
pharmacist may contact our Customer Service Department at
1-877-422-6487. Our
customer service agents will be able to provide you with an
explanation.
What benefits am I entitled to?
Information booklets are distributed to members. They describe all the
benefits you have under your group plan and include an easy-to-use table of
contents that will help you find the section you are looking for.
To find out if you are covered
If you require confirmation of coverage prior to incurring
medical expenses or dental care expenses, please submit your request in
writing to the following address, according to your region:
Quebec and Atlantic Provinces
Industrial Alliance Insurance and Financial Services
Claims Department, Group Insurance
680 Sherbrooke Street West, 9th Floor
PO Box 790, Station B
Montreal, Quebec H3B 3K6
Ontario and Western Provinces
Industrial Alliance Insurance and Financial Services
Claims Department, Group Insurance
522 University Avenue
Toronto, Ontario M5G
1Y7
You will receive
written confirmation of your coverage. Please provide as much detail as
possible, including your physician's recommendations as well as a description of
the medical or dental services recommended.
To obtain further information
You may also contact the Customer Service Department
at 1-877-422-6487 for basic policy information However, our customer service
agents cannot confirm your coverage by telephone.
How may I obtain access to Industrial Alliance's automated inquiry system?
To find out how to obtain access to our automated inquiry system, contact
our Customer Service Department at
1-877-422-6487
or e-mail us at the following
address: groupinsurance@inalco.com .
