Health & Wellness Claim Form

Important Notice

Direct billing by service providers has been limited to Dental, Drugs, Ambulance and Hospital Room Charges. ALL MEMBERS WILL BE REQUIRED TO FIRST MAKE PAYMENT TO ALL OTHER SERVICE PROVIDERS and then submit their claims to the ACAW Trust Funds office. All other direct billing by service providers has been put on hold until further notice. There will be no exceptions to this notice. Thank you for your patience in this matter.

Making Claims

The Health & Wellness claim form with instructions for submitting the claim is available in pdf format below. If your health care provider asks you for a contract or ID number, explain that the Plan is self funded so there is no contract or ID number. If a contract number is required, use your Union Local number. If a personal ID number is required, use your Union ID number.

Medical expenses related to a work injury covered by Workers’ Compensation are not covered by the Supplementary Health Care Plan. Submit the claim for these expenses directly to the WCB for reimbursement. Some pharmacies will also bill the WCB directly.

Deadlines for Submitting Claims to the Plan Office

Supplementary Health Care and Dental claims – Claims must be received by the Plan Office within one year of the date the expense was incurred.

Processing and Paying Claims

If you submit your claim by mail, please allow at least three weeks for processing and payment. If you drop your claim off at the Plan Office, allow at least two weeks for processing and payment. Periods of high claims volume and holidays can require longer processing time. Your patience and consideration are appreciated.

You can avoid delays and help us to better serve you by:

Ensuring forms contain all of the required information, including the member’s signature.

Submitting fewer receipts at one time (five receipts can be processed more quickly than 25 receipts)

Proof of Payment

Receipts where payment is showing as “cash” is not always an acceptable form of payment. When processing claims, we will request a valid traceable and identifiable confirmation of payment.

This means you will need to submit a copy of your payment transaction with your claim to confirm the claim was paid in full. We recommend you keep a copy of some other identifiable payment confirmation, such as a cancelled cheque (copy is acceptable if both sides of the cheque are provided), an authorized electronic credit card receipt and/or credit card statement, direct payment/debit receipt or bank statements.

Note: Any information on a credit card or bank statement that does not pertain to the claim awaiting payment may be omitted.