Industrielle Alliance, Insurance and Financial Services


Retour vers la page d'accueilHome Page|To Reach Us|Site Map|Available Positions|Français 

Search

Our Company Life's Turning Points Individual Products and Services Group Products and Services Careers Investor Relations
Group Products and Services



Printer friendly version
 

Produits et services collectifs


Group Insurance


Claims


How do I submit a medical expense claim?

How do I submit a dental care claim?

How do I submit a claim when the same event is covered under two insurance contracts?

How do I know whether my medical expense or dental care claim has been settled?


Definitions


What is meant by a “deductible"?

What is meant by “dental fee guide"?

What is meant by “coordination of benefits"?


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?

What benefits am I entitled to?


Group Insurance


Claims


How do I submit a medical expense claim?

For all medical expense claims, including vision care claims, complete a Claim Request - Medical Expenses (PDF - 203 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



Back to the top of the page

How do I submit a dental care claim?

You may use the Industrial Alliance Claim Request - Dental Care (PDF - 48 KB) or your dentist's form.

  • 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

 



Back to the top of the page

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.



Back to the top of the page

How do I know whether my medical expense or dental care claim has been settled?

There are three ways you can check the status of your claim:

  1. By accessing your group insurance file on our secure website CyberClient
  2. By using our IA Mobile app on your iPhone or Android device
  3. By contacting Customer Service



Back to the top of the page

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.



Back to the top of the page

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.



Back to the top of the page

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.



Back to the top of the page

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.



Back to the top of the page

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.



Back to the top of the page



View and print PDF documents with Acrobat Reader.