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Local
721 Rodmen Benefit Fund - Claim Instructions
To
assist you in filing a claim you will find below a step-by-step
outline of the procedure that you should follow.
Life Insurance
1.
Notify the Administrator's
office immediately.
2. An original death certificate or Medical Examiner's Report
should be submitted to the Administrator as
soon as it can be obtained.
3. The Life Insurance
benefit will be paid as soon as
satisfactory proof of death is furnished.
Accidental Death and Dismemberment
11. Notify the Administrator's
office immediately.
2.
An original Medical Examiner's Report should be submitted to the Administrator's
office as soon as it can be obtained.
3. The Accidental Death
and Dismemberment benefits will be
paid as soon as proof of such loss has been furnished.
Weekly Indemnity and Long Term
Disability
1. Make application to the
Employment Insurance Commission
for sick benefits in the first week of your disability.
2. Obtain claim
forms from the Administrator's
office or your local union office.
3. Follow the instructions on the claim forms; you complete part,
your doctor completes part, and for Weekly Indemnity benefits,
your last employer completes part.
4. Mail the forms to the Administrator.
5. Once the claim is processed you will receive
payment directly from the Administrator.
Drugs and Supplementary Health
1. Obtain
original receipts which clearly itemize expenses which
have been paid for covered services, and send them to the
Administrator's
office.
2. The Administrator
will issue a cheque for the approved expenses and mail the cheque to you.
The Plan reserves the right to decline to make
"assigned" payments.
Dental
1. When you or your dependents have incurred
covered
dental expenses, please obtain a dental claim form from the
Administrator's
office or local union office and have your
dentist complete his portion.
2. A separate claim form must be used for
each individual.
3. Complete your portion of the form and send
it to the Administrator's
office.
4. The Administrator will issue a cheque for
the approved expenses and mail the cheque to you.
5. If you wish to have insurance payments
paid directly to your dentist,
complete the "assignment" portion of the claim form.
Please
refer to the Pre-authorization provision included under
the Dental Benefits section,"go there now".
Please Note: Only the
member has the right to sign the assignment portion of the claim form
authorizing the administrator to make payment directly to the dentist. The
Plan reserves the right to decline to make "assigned" payments.
Vision
1.
Obtain original receipts which clearly itemize
expenses which
have been paid for covered services, and send them to the
Administrator's office.
2. Attach
receipts and send them to the Administrator's office.
3. Once the
claim is processed, you will receive payments for the approved expenses
directly from the Administrator.
The Plan reserves the right to decline to make
"assigned" payments.
Please Note: Your receipt
for payment of glasses or contact lenses must not include any charge for
the eye examination. The cost of glasses is covered by your benefit plan,
but the eye examination charges are the responsibility of OHIP. Make sure
the patient's name is stated and the receipt is clearly dated.
Reimbursement will be based on the date the glasses are paid for not the
date they were ordered or picked up.
On all claims be sure to include:
(a) Your
name (clearly written or printed) as listed on your employer's payroll.
(b) Your full address.
(c) Your Social Insurance Number.
(d) Your telephone number including area code.
(e) Your present or most recent employer.
(f) Your Union Local Number and identification as a Rodman.
(g) All claim forms and original drug receipts.
What if I have a small claim?
Since it is expensive to issue cheques it is
recommended that small claims be held until you have accumulated at least
$30 worth per claimant before submitting them to the Administrator.
Is there a time
limit for submitting claims?
Death claims under the Life Insurance benefit
must be submitted within 6 months of the date of death.
Accidental Death and Dismemberment losses must occur within one year of
the date of the accident and a claim must be submitted within 6 months of
the date of the loss.
Weekly Indemnity claims must be submitted within 90 days of becoming disabled.
Long Term Disability claims must be submitted within 90 days after the end of the waiting period
(52 weeks).
Supplementary Health, Vision Care
and Dental claims must be submitted within 12 months of incurring the expense, and
within 6 months of the date your coverage terminates.
Legal action to recover benefits under this Plan must
begin within
two years (six years for Life Insurance) of the date of loss.
Maritime Life shall have
the right and opportunity to examine any person whose injury or illness is
the basis of claim, when and as often as it may reasonably require during
the pendency and payment period, if any, of such claim.
What if my spouse
also has group insurance?
In the event that you or your
dependents are covered under more than one Group Supplementary Health Care
or Dental plan, the Coordination of Benefits provision ensures that,
although claims may be made under more than one plan, total reimbursement
received does not exceed 100% of the actual expenses incurred.
Where both you and your spouse are working and have family coverage
under your respective plans, claims should be submitted as follows:
Your claims should be submitted
to the Rodman's Plan first and then, if there is any unpaid balance,
submitted to your spouse's insurance company along with a copy of your
statement of benefits.
Your spouse's claims should be
submitted to his/her insurance company first and then, if there is any
unpaid balance, submitted to your Plan along with his/her insurer's
statement of benefits.
Dependent children's claims
should be submitted first to the insurance company covering the parent
whose day and month of birth occurs earlier in the calendar year. If there
is any unpaid balance, the claim is then submitted to the other parent's
insurer along with the statement of benefits. For example, if you are born
July 7th and your spouse is born February 23rd, your spouse's insurance
company is first payor for your dependent
children's claims.
What if my spouse also has group
insurance?
In the event that you or your dependents are covered
under more than one Group Supplementary Health Care or Dental plan, the
Coordination of Benefits provision ensures that, although claims may be
made under more than one plan, total reimbursement received does not exceed
100% of the actual expenses incurred.
Where both you and your spouse are working and have
family coverage under your respective plans, claims should be submitted as
follows:
Your claims should be submitted to the Rodman's Plan
first and then, if there is any unpaid balance, submitted to your spouse's
insurance company along with a copy of your statement of benefits.
Your spouse's claims should be submitted to his/her
insurance company first and then, if there is any unpaid balance, submitted
to your Plan along with his/her insurer's statement of benefits.
Dependent children's claims should be submitted first
to the insurance company covering the parent whose day and month of birth
occurs earlier in the calendar year. If there is any unpaid balance, the
claim is then submitted to the other parent's insurer along with the
statement of benefits. For example, if you are born July 7th and your
spouse is born February 23rd, your spouse's insurance company is first payor for your dependent children's claims.
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