Insured with Canada Life Assurance Company
Policy No. 335645 – Division 10
Toll-free number: 1-800-957-9777
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Eligibility
The eligibility requirements are as follows as defined in our Group Policy Contract:
- You must be an Insurable Employee
- You must be Actively at Work
Coverage
| In-Canada Expenses | 80% of eligible expenses
90% of eligible expenses from Costco $25 annual deductible |
| Out-of-Country Unforeseen expenses |
100% of eligible expenses, up to the specified benefit plan maximum of your benefit class |
| Prescribed drugs purchased over the counter | Not eligible for reimbursement. |
All legally prescribed drug(s) must have a Drug Identification Number (DIN). Please contact Canada Life directly to confirm if coverage is available for your legally prescribed drug.
Prior Authorization Required
Certain prescription drug claims need to be approved by Canada Life before they can be considered for reimbursement. The Prior Authorization process helps Canada Life ensure that appropriate drug coverage is provided, and that prescribed drugs are considered a reasonable treatment for your condition.
If you want to know if your prescription drug is covered, you must contact Canada Life and request the Request for Information form for the appropriate drug. Send the form to Canada Life before, or along with, your first claim for the drug to be reviewed.
Reasonable and Customary Charges
Most benefit plans include coverage for Reasonable and Customary charges for dental and medical services. This is the lowest of the following:
- Representative pricing in the area where the treatment is provided.
- Prices are shown in the applicable professional association fee guide and the maximum prices established by law.
Coverage under more than one plan
When two or more plans are involved, one plan is the primary plan, and the carrier of that plan is the primary carrier (or insurer). The primary carrier pays its eligible amount first. The secondary carrier then reduces its payment by the amount by which total payments would exceed eligible expenses available through both plans. Eligible expenses are as defined in each carrier’s contract before limitations like your annual deductible, co-insurance, fee guides, and maximums are applied.
As a plan member, your claims should be processed through your benefit plan first. Claims for your spouse must be processed through your spouse’s plan first. Any remaining balance can then be processed through the other insurance plan.
When a child is covered under both parents’ plans, the plan of the parent whose birthday (month and day) falls earlier in the calendar year is billed first.
Submitting a claim
Assure will process all eligible prescription drug claims.
The Assure Card is an electronic payment system that provides on-the-spot claims submission of prescription drug claims at almost any pharmacy in Canada. It is a convenient, easy-to-use alternative to submitting claim forms. Plan members continue to pay 100% of the drug costs upfront; however, you present your Assure Card when having prescriptions filled. The pharmacist uses the card to confirm eligibility, drug coverage and remit your eligible drug claim directly to Assure for processing.
If/when a manual claim is required, please complete the claim form. Please note that you continue to use the same policy number (335645) and 9-digit identification number as your other extended health claims.
All other extended health claims will continue to be assessed directly by Canada Life.