Medical Equipment Claim Submission Guidelines

Mrs.Grant

/ Group Benefits Customer Service /

MEDICAL EQUIPMENT CLAIM SUBMISSION GUIDELINES

When submitting medical equipment claims, use your regular Extended Health Care Claim form and attach the following information:

Ensure all applicable sections of the claim form are completed

From the Physician:

1. The diagnosis necessitating the equipment

2. The anticipated duration the equipment will be required

3. A description of what activities the equipment will be primarily worn for (daily living, sports etc...)

4. Verification if this is an initial purchase, or provide reason for replacement

From the Supplier:

1. An itemized receipt including patient name, date of service, charge of purchase

2. (If applicable) confirmation whether or not the item is eligible for funding through a provincial plan; if "yes," we require a copy of the Provincial plan's statement of payment

3. If item is being rented, we require a written quote from the supplier indicating the purchase price of that equipment

4. Copies of primary payment if COB is required

When Submitting the claim please include the following:

1. Ensure all applicable sections of the claim form are completed

2. Include an itemized receipt

3. Written confirmation of payment/ decline by the provincial plan (if required)

Please note; any costs associated in obtaining this information will be the responsibility of the patient. Please note that in some situations, depending on the type of equipment that is being inquired about, Manulife may request further information in order to confirm eligibility.

Please return this information to:

If you reside outside Quebec:

Manulife Financial Group Benefits

P.O. Box 1653

Waterloo, ON N2J 4W1

Upon receipt of this information, we will review and advise accordingly.

If you have any problems receiving information please phone. 1-800-268-6195.
www.manulife.ca
Manulife Financial and the block design are registered service marks and trademarks of The Manufacturers Life Insurance Company
and are used by it and its affiliates including Manulife Financial Corporation.