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Continuous Improvement – New Forms

News Release

As mentioned in the Continued Improvement in Group Insurance communiqué issued in November 2012, Industrial Alliance is committed to providing superior service through continuous improvements to its various processes. In accordance with this commitment, the extensive review of our Health and Dental claims process resulted in the following new forms and updates to a current form:

New Forms*:

  • Health Spending Account (HSA) Claim Form (New number: F54-383/F54-383A)
    • This form is used to request the reimbursement of expenses using the plan member’s HSA.
    • This new HSA form replaces the following forms that are now discontinued and should no longer be used:
      • HSA Claim Form (F54-780/F54-780A)
      • Medical Expenses - HSA Claim Form (F54-840/F54-840A)
      • Dental Care - HSA Claim Form (F54-839/F54-839A). 
    • This unique form simplifies the submission of claims, eligible for reimbursement under an HSA account, since the plan member can now use a single form for all types of benefits.
  • Home Care Questionnaire (F54-896/F54-896A)
    • This questionnaire is used to determine the eligibility of a reimbursement request under the home care benefit and was created to obtain the required information from physicians more efficiently.
  • Nursing Care Questionnaire (F54-898/F54-898A)
    • This questionnaire is used to determine the eligibility of a reimbursement request under the nursing care benefit and was created to obtain the required information from physicians more efficiently.
  • Travel Insurance Claim Forms (CanAssistance)
    • A new guide was created containing claim forms for emergency out-of-province medical expenses. Plan members can now select and fill out the appropriate form according to their province of residence.
    • Previously, a single form was available and plan members were often asked to provide additional information, delaying the treatment of their claims. This new guide considerably reduces these delays since it contains all the required province-specific forms, enabling timely processing by CanAssistance, our out-of province medical assistance service provider.

Updated Form*:

  • Medical Expenses Claim Form (F54-326/F54-326A) 
    • This form has been extensively updated and is used to request the reimbursement of expenses, or obtain an estimate, for prescription drugs, paramedical services, vision care, ambulance transportation and orthopedic and therapeutic devices.
    • The updates to this form include the addition of claim submission guidelines, which provide a wealth of information to plan members filling out the form, greatly clarifying and improving the effectiveness of the claims process. In addition, the coordination of benefits (COB) section has been overhauled and helpful instructions have been added to assist plan members in its completion. Another important modification to this form is the possibility for plan members to use it to obtain an estimate of what may be covered under their plan.

How to access the forms:

The forms listed above are available on our website (www.inalco.com) and in the “Public Forms and Documents” section of the CyberClient login page. If you have any questions about these forms, please contact your benefits advisor or your Industrial Alliance group account executive.

*Depending on the benefits included in your plan, some of these forms may not be used in the context of your specific coverage.