Claims

Submitting claims for your RTOERO insurance plans is similar to other insurance plans, so the processes may be familiar to you.

The Insurance Plans Booklet provides detailed information about your coverage and how to submit claims. And you can always contact us if you need help.

How to submit a claim

There are a few ways you can file a claim.

Your provider submits the claim directly

Pharmacy claims: Present your benefits card at the time of purchase and your pharmacist will send your claim electronically. If your pharmacist is unable to submit your claim electronically, the pharmacist can call the pharmacy helpline at 1-866-773-5467 (toll-free).

Dental, paramedical and vision offices with the ability to submit electronic claims can submit your claim for you directly. You may be asked to pay for the service upfront, depending on the practitioner’s arrangement.

Submit your claim online

You can submit through the online claims portal. You will receive a confirmation number, and your claim form and receipts will be filed in the Filed Plan Benefits folder in the Communications Centre. For audit purposes, original receipts may be requested at any time. Please keep your receipts for seven years. Once processed, an Explanation of Benefits statement will be filed in the Plan Benefits folder in the Communications Centre.

Submit your claim by mail

Download the claims form to submit your claim by mail. Make sure your claim form is complete, including your certificate number (ID#). Remember to sign each claim form. Please submit claims as directed on the form.

Submit your claim in person

You can have your claim processed while you wait at either of our walk-in locations Monday to Friday, from 8:30 a.m. to 4:30 p.m. (EST), excluding holidays:

  • 18 Spadina Road, Toronto – first floor
  • 1595 16th Avenue, Richmond Hill

How to set up direct deposit for your claim payments

Claim payments can be deposited directly into your bank account. Submit a VOID cheque to our insurance Service Administrator, and all future payments will be deposited to your account. Contact the Service Administrator at 1-877-406-9007 or [email protected] for more information. Use the same bank account for direct deposit as you use for premium deduction. If you do not choose direct deposit for your claim payments, you’ll receive a claim payment cheque by mail.

Tips and information about your claim submissions

  • Submit your claim as soon as possible, so you don’t forget. All claims must be submitted no later than the end of the calendar year following the year in which the expenses were incurred.
  • Claims for items (e.g., eyeglasses) will apply toward the maximum in the year the item was paid in full. Claims for services (e.g., chiropractor, physiotherapist) will apply to the maximum in the year the service was rendered.
  • Keep copies of your receipts. Photocopies of receipts are acceptable. Cash register and credit card receipts are not acceptable. File your receipts after you’ve submitted the claim and keep them for at least seven years.
  • Receipts must contain the patient’s name, the vendor or provider’s information, the date of service or purchase, a description of the item purchased and a breakdown of charges. Please note that the patient account statement does not contain the information required.
  • If a plan is cancelled, all claims must be submitted within 90 days of the cancellation date.

How to coordinate benefits between multiple plans

If you are covered under more than one insurance plan simultaneously, you can coordinate benefit payments from all plans. The total reimbursement cannot exceed the actual expense incurred.

Your claims should generally be submitted first to this plan. Your spouse’s claims should be submitted first to his/her plan, and your dependent children’s claims should be submitted first to the plan of the parent whose birthday (i.e., month and day) occurs earlier in the calendar year.

Please contact our insurance Service Administrator at 1-877-406-9007 or [email protected] to verify which plan pays first. If the other plan does not have a coordination of benefits provision, claims should be submitted first to that plan. If priority cannot be established by those means, benefits will be prorated between the plans.

A copy of the explanation of benefits from the other insurance carrier, a completed Extended Health Care claim form and photocopies of all receipts are required for consideration of the claim balance.

How to submit travel claims

If you have an emergency while traveling, call Global Excel Management immediately, before seeking treatment. If you can’t call yourself, have someone call on your behalf, or call as soon as medically possible. They’re available 24/7. The numbers are on your benefits card.

The agent you speak to will provide all the information required to file a claim. A claim will be opened, and they’ll give you instructions on how to access the online claimant portal to submit further documents, and review the status of your claim.

As with all other claims, it’s essential to keep your documentation. Full coverage and claim details are included in your Group Travel Insurance booklet.