GENERAL
The information provided below applies to all claims except Ontario Health Plan claims which are covered later under this section under ONTARIO HEALTH PLAN.
Claims should be made as soon as possible to ensure prompt payment. Written notice of a claim must be submitted within ninety (90) days of the date the claim arises.
Claims must be made on forms available from the Administrator, or the Union Office.
All claims are to be sent to the Administrator and should clearly indicate the following:
(a) the name of the Plan, which is the Asbestos Workers Local 95 Benefit Fund;
(b) your name, address, and social insurance number;
(c) if your claim is for a dependent, the dependent's first name, age and relationship to you.
Please mail all claims to:
BENEFIT PLAN ADMINISTRATORS LIMITED
P.O. Box 6020, Stn. "B"
Etobicoke, Ontario
M9W 7A3
Phone : (416) 745-6466
LIFE INSURANCE AND PAID-UP LIFE INSURANCE
The claim form can be obtained from the Administrator for these benefits. You should acquaint your beneficiary with the fact that one of the first duties to be performed, in the event of your death, is to write immediately to the Administrator. The claim form will then be returned with specific instructions as to how it is to be completed.
LABOUR ACCIDENT MONEY PROGRAM
To claim benefits under the Labour Accident Money Program, you or your beneficiary should contact the Administrator or your Union Office.
WEEKLY DISABILITY INCOME/LONG TERM DISABILITY INCOME
In order to claim benefits, you must file a claim form. Sections on that form must be completed by the Union Office and your doctor.
The following information must be on the claim form:
(a) the name of the Plan, which is the Asbestos Workers Local 95 Benefit Fund;
(b) the date you last worked.
In addition, Weekly Disability Income claims should contain the Policy Number : 5916.
Your physician should complete the "Attending Physician's Statement" portion of the claim form. Make sure your doctor clearly indicates the diagnosis of the disability, the date, or dates, of consultation and the type, or types, of services rendered.
In order to avoid delay in payment, please make certain that all required information has been provided.
YOU MUST BE UNDER THE CONTINUOUS CARE OF A MEDICAL DOCTOR TO QUALIFY FOR WEEKLY DISABILITY INCOME AND LONG TERM DISABILITY INCOME BENEFITS.
NOTE: U.I.C. will provide you with a letter of disentitlement if you are not eligible to receive U.I.C. disability benefits. You must submit the letter of disentitlement from U.I.C. with your claim form, in order for Weekly Indemnity or Long Term Disability benefits to be paid under this Plan.
EXTENDED HEALTH CARE
Your claim, or claims, should be listed separately, and also by insured individual on the Extended Health Care Expense Statement. The claim form should be submitted to the Administrator every two (2) or three (3) months, together with the appropriate receipts.
NOTE: IN ORDER FOR YOUR CLAIM TO BE PAID PROMPTLY, IT IS NECESSARY FOR DRUG EXPENSES TO BE LISTED SEPARATELY. FAILURE TO DO SO WILL RESULT IN YOUR FORM BEING RETURNED TO YOU FOR COMPLETION.
When submitting the completed form, all receipts must be attached, including those being accumulated to prove satisfaction of the deductible. Bills must be complete. Each bill, other than for drugs, must show:
(a) your name and address;
(b) the patient's full name and address;
(c) the date, or dates, the service was rendered;
(d) the date, or dates, the purchase was made;
(e) the Policy Number which is 5916;
(f) the name of the Plan which is the Asbestos Workers Local 95 Benefit Fund;
(g) your social insurance number.
In addition, each drug bill must show:
(a) the patient's full name;
(b) the name of the medication;
(c) the date of purchase;
(d) the charge for cash items.
NOTE : CASH REGISTER RECEIPTS, OR LABELS FROM CONTAINERS ARE NOT ACCEPTABLE.
VISION CARE
Claim forms may be obtained from the Administrator or from the Union Office. Please complete the information required and ensure that the form contains all the following:
(a) your full name and address;
(b) patient's full name and address;
(c) the name of the Plan, which is the Asbestos Workers Local 95 Benefit Fund;
(d) your Social Insurance Number;
(e) cost for lenses;
(f) cost for frames;
(g) signature of supplier;
(h) paid receipt of purchase must be attached to the completed claim form.
NOTE: Send the completed claim form and receipt(s) to the Administrator.
DENTAL CARE
A Dental claim form should be completed by you and your dentist for each patient at the time the treatment takes place. The completed claim form should be submitted to the Administrator every two (2) to three (3) months, if possible. Be sure the Policy Number which is 5916 is on the claim form.
ONTARIO HEALTH PLAN
Present your Ontario Health Plan identification certificate to your doctor at the time of treatment. Each doctor in the Province of Ontario is supplied with claim cards by the government.
Your doctor or practitioner will submit the claim card directly to the Ontario Health Plan in order to receive payment for services rendered.
Government legislation requires that all Ontario Health Plan claims be made directly to the Ontario Health Plan.
NOTE: Do not send Ontario Health Plan Claims to the Administrator. (Otherwise payment will be delayed.)
CHANGE OF YOUR STATUS
All changes which affect your status, or your family's insured status, must be reported WITHIN THIRTY (30) DAYS of their occurrence, to the Administrator.
These changes include:
(a) your marriage;
(b) the addition of newborn and adopted children;
(c) the marriage of any dependent children;
(d) the date any dependent child, under age twenty one (21), becomes self supporting;
(e) confirmation that your dependent child has attained age twenty one (21), if not attending school.
