Manual Claim Forms

The manual claims process could take 4-6 weeks to get reimbursed. You must download and complete the appropriate form to submit a manual claim. Once all forms & supporting documents are completed, you need to mail in all information directly to Canada Life. If you have your banking information online with Canada Life, they will direct deposit the eligible portion. If you do not have your banking information included on your Canada Life account, a cheque will be mailed to you. Remember to keep a copy of all documents mailed for your records.

• Health Claim Form: If your claim is related to eligible health services such as prescription drugs, ambulance services, paramedical, medical equipment, or vision expenses, download and complete the Health Claim Form
• Dental Claim Form: If your claim is related to eligible Dental services, download and complete the Dental Claim Form

Once the appropriate form is completed, attach the original receipts and other documents to support your claim. Then mail the package to Canada Life to the address at the bottom of the claim form.

The following information is required on the claim form:

• Plan Number: 177890
• Division Number: Not Applicable Leave Blank
• Plan Name: University Students’ Council of Western University

Please mail your manual claim to Canada Life at the following address:

Winnipeg Benefits Payments
PO Box 3050 Station Main
Winnipeg, MB. R3C 0E6

Please note: You have 15 months from the date the eligible expense is incurred to submit manual claims to Canada Life for consideration under your student plan.

Pay-Direct Claims

Pay direct allows service providers to directly bill Canada Life for eligible expenses. Direct billing is dependent on each service provider’s billing practices.

For direct billing at vision care and paramedical providers, you must register with my.canadalife.com and update your address in the personal info section on your profile.

To access direct billing, students must show their Plan Card at the provider's office and just pay the portion that is not covered by the plan. If you do not have your Plan Card, you must generate your Plan Card.

Pre-Authorization

A pre-authorization is when a form is submitted to Canada Life for a health care service, treatment plan, prescription drug, or medical equipment to pre-determine whether or not it is covered by the plan. Canada Life requires pre-authorization for certain services before you receive them, except in an emergency. When submitting a pre-authorization form, you will receive approval along with the amount that will be covered or an explanation of why it may have been denied.

To submit a pre-authorization form, you need to download the form according to the services that you need for approval and submit the completed form to Canada Life. The following are the forms:

• Drug Exception Request Form: Download and complete the Drug Exception Request Form to request coverage of a drug that is not automatically covered under the drug plan. Before downloading and completing this form, please use our Prescription Drug Search Tool to find out if your medication is covered by the plan. This form must be completed by your physician. Email completed form to cldrug.services@canadalife.com
• Drug Prior Authorization Form: Some prescription drug claims may be covered for specific conditions or circumstances only, and/or in pre-defined amounts and need to be approved before you can apply for reimbursement. Use the form to request coverage of a drug that is covered by the plan but has a note advising you that prior authorization is required after using the Prescription Drug Search Tool. Each prescription drug has a form, please download it from Canada Life Drug Prior Authorizations Forms. This form must be completed by your physician.
• Health Claim Form: Download and complete the Health Claim Form to request coverage of medical equipment, appliances, and services covered by the plan. This form must be completed by the student and a physician's referral is required.
• Dental Prior Authorization: Please ask your dental office to submit a pre-authorization to Canada Life prior to treatment of specialist services and any treatment plan exceeding $500.

Once you have all sections of the form completed and signed, you can submit it online to Canada Life at https://my.canadalife.com under the Make a Claim and other claims section. You will be notified by email, and you will see the result on the my.canadalife.com website.

If you prefer a manual claim, please mail your form to Canada Life at the following address. You will be notified by mail.

Winnipeg Benefits Payments
PO Box 3050 Station Main
Winnipeg, MB. R3C 0E6

Policy Information

The insurance carrier for your student health & dental plan is Canada Life. For any claims or coverage inquiries, students must contact Canada Life directly at 1-800-957-9777. You will require your plan number (177890) and student ID number when calling.

If you wish to submit online claims, check balances, or consult claims status and history, visit the Submitting Claims section to know how to submit receipts for eligible expenses and get reimbursement.

my.canadalife.com is the website provided by Canada Life to manage your benefits. To register or sign in, visit my.canadalife.com

If you are having trouble registering or signing in, Call Canada Life weekdays from 8 a.m. to 8 p.m. ET at 1-888-222-0775 or chat with them online weekdays from 9 a.m. to 5 p.m. ET.

When accessing the Health and/or Dental claim form please use the below information as a guide to complete the required sections of the form:

• Plan Number: 177890
• Division Number: Not Applicable Leave Blank
• Plan Name: University Students’ Council of Western University

You are required to submit original copies of your manual claim form, receipts, and doctor's referral (if required) when sending in your manual claim to Canada Life by mail. Remember to always keep copies for your records.