How to submit Group Benefits claims

For health and dental and travel expenses

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One of the best things about Group Benefits insurance is knowing some of your health and dental expenses are covered by your plan.

In addition, some programs include travel insurance that covers travel expenses incurred due to an emergency medical event, trip interruption or trip cancellation.

Group Benefits customers can start a travel claim through the Global Excel Management (GEM) claims portal to start a claim. Or, for more details about making a Group Benefits travel claim, please click on Travel expense claims to find added information below.

CoverMe or Affinity customers: Please start your travel claim by logging in to our Active Care Management/Manulife (ACM) portal to register and start a claim. Or, visit our CoverMe or Affinity customer travel page to learn more.

For CoverMe™ or Affinity policyholders

If your travel insurance is not through a Group Benefits plan, the travel claim process is different. We explain how you start that process.

Learn more

Health and dental expense claims

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Is it covered? Your coverage Prepare a claim Send it in Receive your funds


Before you incur any health or dental expenses, it’s important to know what your plan covers and what it doesn’t. Take some time to review any information materials, like your benefits booklet* (Click Coverage in the left navigation, then Your Benefits. Your booklet is included under Your Benefits, subheading View Benefits Booklet.), and consider these health expense categories before you spend any money: prescription drugs, medical equipment and provider coverage.

Prescription drugs

In some cases, a drug you’ve been prescribed may need to go through a pre-approval process. That’s because the exact drugs covered under your plan may differ from other plans, depending on the benefits your employer provides.

You can confirm if a drug is covered under your plan by reviewing your benefits booklet. If you’re still not sure, simply send us the following information to confirm:

  • drug name
  • DIN number (Drug Identification Number)
  • method for taking the drug
  • dose of the drug
  • where the drug is given (if applicable)
  • Drug prior authorization form (PDF) (Google Chrome: Right-click the link and select Save link as... to download the form)

Estimates and preapprovals

For expensive equipment or procedures, before you buy, it’s always a good idea to check that your claim will be covered when you send it in. You can ask your medical service or equipment provider to provide you with a cost estimate. You can then send it in for us to review.

To send your estimate to us online, go to the plan member site for your group benefits, sign in and attach a copy of your estimate. Make sure you clearly label it as an ‘estimate’ (not a cost you've already incurred) so that we know exactly what you need.

We recommend your providing us a cost estimate for the following:

  • Medical equipment that costs more than $500
  • Expensive dental work (your dentist knows what we need, and most can submit an estimate directly to us for you, or you can submit it to us yourself online)


Before you incur any health or dental expenses, remember the following:

What services does my plan cover?

To see what services your plan covers:

  1. Sign in to your plan on the website.
  2. Click on the Group Benefits tile, then click “Go” under the plan you want to access.
  3. Under Coverage in the left navigation, click Your Benefits, then View Benefits Booklet.
If your plan does not include an online Benefits Booklet, your plan administrator at work may be able to supply you with information about services your plan covers. You may also contact our Customer Service Centre to inquire about coverage for a specific type of expense.
 

Another health plan may cover some of your expenses

Another health plan may help cover some of your expenses. If that’s the case, please send us a statement indicating how much of your claim the other plan paid. We call the process of getting expenses covered by more than one plan Coordination of benefits, or COB.

Your province’s health plan may also cover some of your expenses

Your province’s health plan may also help cover some of your medical and health expenses. To find out if that’s the case:

  • Ask your doctor or health professional if your province’s health plan covers part of the cost.
  • If you sent a claim to your province’s health plan and they turned it down, send us a statement from them explaining their decision.
  • If your province’s health plan should cover your claim, but you’re not sending a claim to them, provide us a note to tell us why.
For more information about provincial health plans across Canada, follow these links:
 

In some cases, your provider can submit your claim directly to Manulife on your behalf. To confirm if that’s the case, please check with your provider.

How do I submit my drug claim online?

Here are the steps to submit a drug claim in those instances:

  1. Sign in to your plan on the website.
  2. Click on the Group Benefits tile, then click “Go” under the plan you want to access.
  3. Click on Claims, then on Submit a claim.
  4. Click Continue, then select your answers to the questions about:
  • how we should reimburse you for the claim
  • service provider type
  • family member the claim is for

If you’re filing a claim yourself, depending on the claim, you may need to send us additional information, including pictures, receipts, images or x-rays. Click on the links below to learn more about certain claims and what you need to send us to get your claim covered.

Note: You can send us a picture instead of mailing us a paper copy of an item or receipt, but please make sure that the picture you send us is clear (if the picture is blurry and we can’t see the details, we’ll have to ask you to send it to us again).

Here’s what you need to include with your claim:

  • a copy of the original receipt that shows:
    • the name of the person who needed the ambulance
    • the date of service
    • a description of the service

Here’s what you need to include with your claim:

  • a medical doctor’s referral
  • a copy of any statements you get from your provincial plan
  • a copy of the original receipt that shows:
    • the name of the person who needs the prosthesis
    • the date of service
    • the cost of the prosthesis

If this prosthesis is a replacement, and you are not claiming the new prosthesis through your province’s health plan, or if coverage was declined, include a medical doctor’s referral that shows:

  • the age of the existing prosthesis
  • the reason it is being replaced
  • the reason why the province’s plan won’t cover it, or why you didn’t claim it through your province’s plan

If you are submitting a claim for a repair, include an estimate for repair that shows:

  • the type of prosthesis being repaired
  • the cost to repair
  • the age of the prosthesis

Here’s what you need to include with your claim:

  • a copy of the original receipt that shows:
    • the name of the person being tested
    • the name of the test
    • where the test was done
    • a breakdown of the costs
    • the total amount charged for the test

Here’s what you need to include with your claim:

  • a copy of the original receipt that shows:
    • the name of the person who needs the hearing aid
    • the date of service
    • the cost of the hearing aid
  • a copy of any statements you get from your provincial plan
  • if your province’s health plan doesn’t pay for any of the hearing aid cost, include a medical doctor’s referral if the hearing aid costs more than $3000.00

Here’s what you need to include with your claim:

  • a medical doctor’s referral that shows:
    • why you need the product
    • diagnosis or medical condition you need the product for
    • the medical reasons why you need a hospital bed rather than a regular bed
    • an estimate for how long you’ll need the hospital bed
  • a receipt that shows either the rental cost or the purchase price for the hospital bed
  • a quote with the cost for buying the equipment, if you’re renting the item
  • a copy of any statements you get from your provincial plan

Insulin pump supplies are a type of medical equipment.

Here’s what you need to include with your claim:

  • a copy of the original receipt that shows:
    • the name of the person who needs the equipment
    • the date of purchase
    • a description of the items
  • Include one of these documents:
    • a medical doctor’s referral that includes a diagnosis or medical condition you need the product for
    • a statement from your province’s health plan confirming that they cover the supplies

We only pay for expenses that are more than your provincial grant amount.

Here’s what you need to include with your claim:

  • a medical doctor’s referral that shows:
    • why you need the equipment
    • how long you’ll need the equipment
    • a description of activities the equipment will be used for
  • tell us if you’re buying this equipment for the first time, or tell us the reason you’re replacing this equipment
    • if you’re replacing this equipment, tell us how old it is and why you’re replacing it
  • a copy of the original receipt that shows:
    • the name of the person who needs the equipment
    • the date of purchase
  • a quote with the cost for buying the equipment, if you’re renting the item
  • a copy of any statements you get from your provincial plan

We may ask you for more information to help us check your claim.

Here’s what you need to include with your claim:

  • a medical doctor’s, chiropodist’s or podiatrist’s referral that shows:
    • why you need the product
    • diagnosis or medical condition you need the product for
  • a copy of the original receipt that shows:
    • the name of the manufacturer and the model name and/or model number of the shoes
    • the name of the person who needs the shoes
    • a breakdown of the expenses (shoes and adjustment costs)
    • the date the shoes were given out, or the date you fully paid for them
  • a copy of any statements you get from your provincial plan
  • for custom shoes only: a receipt showing that the shoes were made from a cast of the person’s feet — a cast is a model of a person’s feet that the shoes are built on

Slippers, workboots, and sandals are not covered.

Here’s what you need to include with your claim:

  • a referral showing the medical reason for the orthotics
  • copies of the biomechanical evaluation and gait analysis
  • a description of how the orthotics were created, which must include:
    • casting technique
    • type of raw materials used
  • a copy of the original receipt that shows:
    • the orthotics have been given out to you, or
    • you’ve fully paid for them

You can attach this information as one file, or a few separate files. Your referral may need to be from a licensed doctor, podiatrist, or chiropodist. Some plans may have different rules for referrals. Check your booklet to find out yours.

Here’s what you need to include with your claim:

  • a medical doctor’s referral that shows:
    • the medical reason for the oxygen
    • an estimate for how long you’ll need oxygen therapy
    • confirmation that you are able to move on your own. If yes, how many hours per day and per week?
    • whether you are able to leave your home
  • an estimate from the oxygen supplier that includes:
    • a description of the oxygen system and reasons they recommend that system
    • the cost to buy the system, including accessories
    • if you can’t buy the system, what is the cost to rent, including accessories?
    • if you need more than one type of oxygen system, tell us why the second system is needed
  • any supporting oximetry reports
  • a copy of any statements you get from your provincial plan

Send in an estimate before you send in your claim.

Here’s what you need to include with your claim:

  • a letter from a medical doctor that shows:
    • a diagnosis and description of the medical condition
    • an estimate for how long the patient will need nursing care
    • how many hours per day is care needed?
    • a list of orders for the care
    • a copy of the doctor’s order for nursing care
    • a list of drugs the nurse will be giving, including strength, dosage, and method of administration
    • a confirmation of the level of nursing needed (R.N., R.P.N., L.P.N., Health Care Aide, etc.)
    • where the services will be provided (the patient’s home, hospital, nursing home, other)
  • information from the nursing company:
    • the name and address of the agency providing the services
    • the type of nurse they are sending and the hourly rate
  • if your province’s home care program is also providing nursing care in the home, include a detailed description of their services, including:
    • how many hours per week your province’s home care plan covers
    • a description of who is providing the service (their title and whether they’re an RN, RPN, or PSW)
    • if the home care plan doesn’t cover service, explain why it isn’t covered

Here’s what you need to include with your claim:

  • a medical doctor’s referral (once every 12 months) that shows:
    • why you need the stockings
    • the diagnosis or medical condition you need the stockings for
  • a statement showing your provincial plan paid part of the cost (if needed)
  • a copy of the original receipt that shows:
    • the name of the person who needs the stockings
    • the date of the service
    • a breakdown of the expenses
    • the gradient or compression factor
    • the stocking style (knee high or full length)
  • a description of activities the stockings will be worn for
  • indication of whether the stockings were custom-made or stock

Here’s what you need to include with your claim:

  • a copy of the original receipt that shows:
    • the name of the person who needs the supplies
    • the date
    • the full cost of the supplies
  • a copy of any statements you get from your provincial plan

We only pay for expenses that are more than your provincial grant amount.

Here’s what you need to include with your claim:

  • a medical doctor’s referral that shows:
    • the medical reason for the wheelchair
    • the type of wheelchair – is it a scooter, a manual wheelchair, or an electric wheelchair?
    • an estimate for how long you’ll need the wheelchair
    • if you already have a wheelchair, how old is it and why are you replacing it?
    • if the doctor is recommending an electric wheelchair, they should include details about why they are recommending electric instead of manual
    • the note should tell us:
      • if you can move a manual wheelchair on your own
      • how far you can move it
      • what activities you’ll use the wheelchair for
    • how long will the wheelchair help you to move on your own

This information helps us understand what type of equipment your doctor thinks you can operate.

  • a copy of any statements you get from your provincial plan
  • a copy of the original receipt that shows:
    • the name of the person who needs the wheelchair
    • the date of purchase
    • a breakdown of costs, including any accessories

For ‘out of province’ coverage or ‘out of country’ medical referrals:

If you need medical help when traveling out of province, send your claim to your province’s health plan first, as many items should be covered. You can then send us copies of your receipts along with the statement that shows what was covered by your provincial plan.

Here’s what you need to include with your claim:

  • a copy of the original receipt that shows:
    • the name of the person being treated
    • the diagnosis or medical condition the person was treated for
    • the date of service
    • the details and cost for each service
    • the details of any discounts you received
    • your Global Excel Management case number, if you were travelling outside of Canada
  • whether the person was treated for the same diagnosis or medical condition before leaving Canada
  • the dates of the trip, including when the person left Canada, when they came back to Canada, and where they were travelling to
  • whether the person was covered under any other travel or group insurance plan

Here’s what you need to include with your claim:

  • a medical doctor’s referral that:
    • explains the diagnosis
    • confirms the referral
  • statements showing any payment or decline from your province’s health plan
  • a copy of the original receipt that shows:
    • the name of the person receiving the service
    • the date of service
    • the details and cost for each service


Here’s some help on how to send your claim in to us.

Collect your receipts

Put together all of the official receipt(s) from your health care provider(s). They should show a description of the product or service you paid for (we don’t need the credit card receipt or statement, just the provider’s official receipt from their office or store).

Can I submit my claim online?

Online

Yes, once you are registered on the site or app, you can submit your claims online. To do so:

On desktop:

  1. Sign in to your plan on the website, or mobile app.
  2. Click on the Submit a claim button (located in the top right corner of the screen, under Common Tasks). A Welcome message opens on the desktop. Click Continue.
  3. Follow the prompts.

On the app:

  1. Click on the Submit a claim button (top left corner of the app screen). The New Claim window opens.
  2. Under Claim types, choose the type of claim you wish to make.
  3. Follow the prompts.

Rules

You can submit your claim online if:

  • You incurred the expense in Canada
  • You have already paid for and received the service
  • The payment should be made to you
  • The claim is for you
  • The claim is for your spouse and they aren’t covered by another plan
  • The claim is for your dependant(s) if your spouse is not covered by another plan OR your spouse is covered by another plan, but you are the parent whose birthday (month and day) that falls earlier in the year
  • The service provider type is listed in the Online Claim Submission tool
  • Your plan includes the Online Claim Submission feature

Please submit all other claims on paper (instructions below).

If you are submitting a disability claim, you’ll be asked to provide some information and documentation to support your claim:

  • From your doctor: Attending Physician’s Statement (APS) form
  • From you: Plan member authorization, certification and agreement form

For a life and critical illness claim, you’ll be asked to provide some information and documentation to support your claim. 

Simply attach any supporting documents, if required (i.e., receipts, provincial coverage details, statements from other health plans). And that’s it!

Mobile app

Download the iOS or Android app, sign in, and submit your claims on the go! You may be asked to provide a receipt for your claim. Just scan or take a picture of it, attach it digitally, and send in the claim through the app.

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Paper claims

Where can I find the claim forms I need?

Find health and dental claim forms on our public website, or:

  • Sign in to your plan on the website
  • Click on the Group Benefits tile, then click Go under the plan you want to access
  • Under the Claims tab, click Claim forms
  • Narrow the list by type of form in the menu on the right side of the page

How do I submit my claim on paper?

To submit your claim on paper:

  1. Print and complete the appropriate health or dental claim form
  2. Attach your receipts and supporting documentation
  3. Mail it to the address on the form


How long does it take to process a claim?

It takes up to five business days to process a claim, provided you include all receipts and/or paperwork required to support the claim (when you first sent it in). Otherwise, the process may take longer.

If you have direct deposit, add one or two more business days for funds to be deposited into your account. If you receive your money by cheque, please add standard mailing timelines to that (to allow time for mail delivery).

Travel expense claims

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Online travel claims Timeline

Claims portal – An easier way to submit your travel claims

Group Benefits plan members can file a travel claim through the Global Excel Management (GEM) claims portal (instead of using traditional claim forms). Claims may be for out-of-pocket expenses incurred at the time of the emergency, when it may not have been possible to reach GEM. The claims portal provides a way to submit claims digitally, upload documents, and track your claim's status online.

Step 1: Go to the GEM claims portal.

Step 2: Choose Start a Claim and follow the prompts and answer each question fully. (If desired, you can create an account on the Login page.)

Step 3: Submit your claim

As you prepare to submit your claim, we suggest you put together all official receipts that show an itemized description of the product or service paid for (proof of payment is required). Note that itemized medical invoices and itemized receipts (i.e., for out-of-pocket expenses) should be provided to prevent a delay in settlement of your claim.

Finally, we suggest you keep copies of everything related to your claim for your own records including:

  • Original itemized bills, itemized medical invoices, and itemized receipts
  • Any and all medical records or certificates provided at the time of treatment, including a diagnosis (e.g., an emergency room (ER) report, clinical documentation, a letter from your treating physician)
  • A copy of your medical records from the treatment facility, if you’re hospitalized and need to make a hospitalization claim
  • Any additional information relevant to your claim

Note: at the top of the claim form, there may be additional GHIP (government health insurance) forms that are required to be completed related to the out-of-province/country expense, depending on the province.

How long does it take to process a travel claim?

It’s our goal to process eligible claims promptly. To help us do so, please:

  • provide – as soon as possible – all of the medical information we need from your treating or family physician 
  • send in a fully completed claim form, including all requested supporting documentation, as listed on the previous tab (Online travel claims)
  • remember that we may need other information from the medical providers (e.g., doctors, hospitals), so our response time may be impacted by how long it takes for them to respond to our request

Frequently asked questions

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FAQ for health FAQ for travel

If we receive everything we need to process your health and dental claim (e.g., receipts, physician or dentist authorization for treatment), the process usually takes up to five business days from start to finish.

For customers who have direct deposit, any funds to be reimbursed could take one or two additional days before they reach your bank account. For those who receive reimbursed funds from us by cheque, standard mailing timelines also need to be added.

Manulife covers claims from many providers, but not all. To find an approved provider, or check to make sure we cover yours:

More questions? Visit our Group Benefits FAQ page for plan members.

It’s our goal to process eligible claims promptly. Depending on the type of claim and complexity, it could take a little longer than expected to complete the adjudication process. All Group Benefits travel claims are processed through the Global Excel Management claims portal.

To help us provide as efficient service for you as we can, please:

  • provide – as soon as possible, and if required – any medical information from your treating or family physician 
  • a fully completed claim form that includes all requested supporting documents
  • and please remember – we may need other information from your medical providers (e.g., doctors, hospitals), so our response time might be impacted by when we receive needed information from them

Before you submit a claim for a cancelled trip, you'll need to confirm the details of your trip cancellation coverage. You can do this by logging in to manulife.ca/groupbenefits (you’ll need your Manulife ID, or plan contract number, certificate number, and password).

  • Click on My benefits and View benefits booklet. You can find the travel insurance portion of your coverage from the table of contents. 
  • If you have Group Trip Cancellation coverage, after cancelling your trip (through the airline, agency, or travel supplier you purchased the trip from), please follow the steps outlined on the claim form, then submit your claim. 
  • Remember, if you are re‑booking your trip or receiving a credit to travel at a future date, there’s no need to submit a claim. 
  • If portions of your trip are not refundable, you can submit a claim (for that portion) online to the Global Excel Management Claims Portal. Include proof of the total amount of credit or refund you received with that claim.

Are you a CoverMe or Affinity travel insurance customer? If you are, the travel claim process is different from the Group Benefits travel claim process. 

We have a separate resource for CoverMe or Affinity travel insurance customers. If you need to make a claim, and you are not a Group Benefits customer, please visit our travel claim resource page written for you.

Need to confirm if you're a CoverMe or Affinity travel insurance customer? Here's how to know if that’s you:

  • You purchased your travel insurance through an alumni, professional or retail member site. These customers are referred to as Affinity customers. 
  • You purchased your travel insurance through the CoverMe website directly
  • You purchased your travel insurance through a Manulife Advisor

We’ve also published a full list of Affinity groups online for easy reference.

 

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