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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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