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Health and dental claims

You must be the main cardholder on your plan to submit claims. That means the main cardholder must submit claims on behalf of their spouse or dependents.

What types of claims can be submitted this way? Most benefits under your health and dental plan, including:

Health professional services
Virtual / online health care services
Dental care
Vision care

Drugs
Medical supplies and equipment
Managing Chronic Disease
Health Spending Account / Personal Wellness Account

Step 1. Make sure you have all the required documents.

Claiming requirements can vary based on the type of benefit and your particular plan. You can find specific claiming requirements for each benefit in the coverage section of the Medavie Mobile app or the Member Services Site, or in your benefits booklet.

Always required:

Receipt for your payment

May be required for specific benefits*:

Prescription from a physician or other health professional
• Itemized statement describing all services rendered*
Medical assessment/evaluation completed by health professional*

Claiming Requirements for Frequently Used Benefit Categories:

Medical Equipment
CPAP/BiPAP Machine

Orthopedic Shoes

Custom Orthotics (Molded Arch Supports)

Surgical Stockings (Graduated Pressure Supports)

Insulin Pumps

*In some cases, this information will be included on the receipt given to you by your health professional at the time of service. Otherwise, specialty forms for certain benefits are available for download and will need to be completed by your health professional.

Keep in mind that health services must be provided by a Medavie Blue Cross-approved health professional to be eligible for coverage. You can find an approved provider through the Medavie Mobile app, or use our online search tool to find one who offers ePay direct payment service.

Step 1. Make sure you have all the required documents.

Claiming requirements can vary based on the type of benefit and your particular plan. You can find specific claiming requirements for each benefit in the coverage section of the Medavie Mobile app or the Member Services Site, or in your benefits booklet.

Always required:

Receipt for your payment

May be required for specific benefits*:

Prescription from a physician or other health professional
• Itemized statement describing all services rendered*
Medical assessment/evaluation completed by health professional*

Claiming Requirements for Frequently Used Benefit Categories:

Medical Equipment
CPAP/BiPAP Machine

Orthopedic Shoes

Custom Orthotics (Molded Arch Supports)

Surgical Stockings (Graduated Pressure Supports)

Insulin Pumps

*In some cases, this information will be included on the receipt given to you by your health professional at the time of service. Otherwise, specialty forms for certain benefits are available for download and will need to be completed by your health professional.

Keep in mind that health services must be provided by a Medavie Blue Cross-approved health professional to be eligible for coverage. You can find an approved provider through the Medavie Mobile app, or use our online search tool to find one who offers ePay direct payment service.

Step 2. Submit the documents to us.

For the simplest process and quickest turnaround time, we encourage you to submit the documents using the Medavie Mobile app or the Members Services Site. Here’s how to do that:

Submitting a claim using Medavie Mobile

• If you haven’t already, download the app from the App Store or Google Play.

• Log in using the same email and password you use for the Member Services Site (or register for an account if this is your first time using our online tools).

• Tap ‘Submit a Claim’ on the app dashboard.

• Select your claim type. If you can’t find your claim type in the list, select ‘Other’ at the bottom of the list.

• You’ll be walked through a series of questions related to your claim. Depending on the type of claim you’re submitting, you may be asked to indicate your health professional. You can search for them by entering their last name and city. If you can’t find your health professional in our search results, you can enter the information manually.

• Use your device’s camera to take photos of all documents identified in step (1). Take one photo per document. If you already have photos or scans of your documents, you can attach them from your photo library. Tip: make sure your photo is clear and bright—blurry or dark photos can be difficult for us to read and may cause delays.

• If you haven’t already entered your bank account information for direct deposit of your reimbursement, you’ll be prompted to do so before submitting your claim.

• Hit ‘Submit’ and you’re done! Please note that if you have multiple claims to submit at one time, you’ll need to complete this process for each one separately.

Please note that if you have multiple claims to submit at one time, you’ll need to complete this process for each one separately.

Submitting a claim using the Member Services Site

• Ensure you have photos or scans of all documents identified in step (1). You can submit them in a variety of formats—JPG, PDF, BMP and TIFF.

• Log in using the same email and password you use for the Medavie Mobile app (or register for an account if this is your first time using our online tools).

• Click on ‘eClaims’ in the top menu bar.

• Answer the questions and ensure you’ve entered your bank account information for direct deposit of your reimbursement.

• Attach the photos or scans using the ‘Choose File’ button. You can attach multiple files to your submission.

• Agree to the On-Line Claim Submission Agreement by clicking the checkbox, then click ‘Submit’. You’re done!



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Submitting a claim by mail

If you’re unable to use Medavie Mobile or the Member Services Site, you can submit all required documents identified in step (1) by mail to the address on your claim form. Please note that if you submit a claim by mail, you’ll be required to include a completed paper claim form.

You can download the relevant claim form here

Step 3. What's next?

Your wait time will depend on the type of claim, how it was submitted, and our current claims volume. Once there is a decision on your claim, you’ll be notified by email. If you use the Medavie Mobile app, you’ll also get a push notification if you’ve allowed notifications.

The detailed information will be available in your claims history (‘View My Claims’ in the Medavie Mobile app, ‘Statements’ on the Member Services Site). There is currently no way to check the status of your claim while it’s still being processed. If your claim results in a reimbursement, it’ll be deposited directly into your bank account. Depending on your bank and when the deposit is made, there can be a slight delay before your bank account reflects the reimbursement.

If you submit through fax or mail, you’ll receive a cheque in the mail if you haven’t set up direct deposit. To get your money back faster, sign up for direct deposit.

Step 3. What's next?

Your wait time will depend on the type of claim, how it was submitted, and our current claims volume. Once there is a decision on your claim, you’ll be notified by email. If you use the Medavie Mobile app, you’ll also get a push notification if you’ve allowed notifications.

The detailed information will be available in your claims history (‘View My Claims’ in the Medavie Mobile app, ‘Statements’ on the Member Services Site). There is currently no way to check the status of your claim while it’s still being processed. If your claim results in a reimbursement, it’ll be deposited directly into your bank account. Depending on your bank and when the deposit is made, there can be a slight delay before your bank account reflects the reimbursement.

If you submit through fax or mail, you’ll receive a cheque in the mail if you haven’t set up direct deposit. To get your money back faster, sign up for direct deposit.

Questions?

Are there any claims I can’t submit electronically?

We currently require paper submission for these claim types:

  • Life
  • Disability
  • Accidental Death & Dismemberment
  • Critical Illness
  • Travel

How long do I have to submit a claim?

Claim submission deadlines can vary based on the type of benefit and your particular plan. You can find specific claim provisions for each benefit in the coverage section of the Medavie Mobile app or the Member Services Site.

Questions?

Are there any claims I can’t submit electronically?

We currently require paper submission for these claim types:

  • Life
  • Disability
  • Accidental Death & Dismemberment
  • Critical Illness
  • Travel

How long do I have to submit a claim?

Claim submission deadlines can vary based on the type of benefit and your particular plan. You can find specific claim provisions for each benefit in the coverage section of the Medavie Mobile app or the Member Services Site.

Claim forms

Do I need to complete a claim form?

  • If you use the Medavie Mobile app or using the Member Services Site, you do not need to complete a separate claim form for most* health claims.
  • If you submit your claim by mail, you will always need to complete a paper claim form. You can download the relevant form here.

*Some benefits do require specific forms to be completed by your health professional, regardless of how you submit your claim. Sometimes your health professional will give this to you at the time of service. Otherwise, you can download the form below, and submit it using the mobile app or website once completed.

Specialty forms are required for: