Personal Claims Procedures

 

Group Health/Employee Benefits claim

 

Group Health policy will reimburse plan members (employees and dependents) for covered expenses as a result of illness or an accident. In the event there is a claim, we recommend you contact us immediately and we require the following documents:

 

1. Completed Claim Form available here (stamped and signed by the attending physician/doctor/dentist). This must include:

 

  • Policy Number

  • Employee certificate number

  • Company stamp

  • Plan administrator’s signature

 

2. Original receipts for incurred expenses, indicating prescription number, patient’s name, date of purchase, name and quantity of drugs

 

3. Claims must be submitted no later than 90 days from the date expenses were first incurred

 

4. For death claims – please submit with Claim Form certified death certificate, certified birth certificate, Life Insurance certificate and a Coroner’s report if applicable.

 

Once the claim documents are submitted, the circumstances of the claim will be investigated by the insurer’s loss adjuster and a settlement between yourself and the Insurer’s will be made.