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Submit a Claim Form

Access Claim Forms, Print Them Off and Submit Via Mail

Note: Forms are provided in Adobe PDF format. A recent version of Adobe ReaderOpens in new window or Adobe Acrobat may be required to open, read and print a form on your system.

Submit Health or Dental Claim Forms Digitally

You can also submit all your health and dental claims through the My Benefits app or through your Online Group Benefit Solutions account.

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We're Here When You Need Us.

Whether you need to make a claim or have a question about our services, we can help.

How to Make a Claim

Please review your Employee Benefits Booklet to understand what your benefits cover and complete the appropriate steps below to file your claim:

Depending on the type of claim, you may be able to file online, from your smartphone, or have your service provider file electronically for you (check with your provider).

Health and Dental Claim Tips:

Before making a claim, you can view your eligibility or submit a “mock” claim to confirm your coverage, how much will be paid and any limits or conditions under your plan. There are two ways to do this:

If you or your dependents are covered under more than one benefit plan (for example, your spouse's plan), you can claim up to 100% of an eligible expense by coordinating your benefits under both plans.

How to coordinate your benefits:

  • Submit your claim under your plan first, and send any remaining balance to your spouse’s plan.
  • Your spouse's claims should go to his or her plan first, with any remaining balance sent to your plan.
  • Dependent children are covered first by the plan of the parent whose birthday falls earlier in the year. So, if your birthday falls in January and your spouse's birthday is in March, you should submit your child’s claims to your plan first.
  • You will receive an Explanation of Benefits (EOB) statement from the first insurance company you file with showing how much of the claim has been covered. Submit the EOB statement, along with copies of your expense receipts, to the second insurance company in order to claim any remaining eligible balance.

Not sure if a service is covered? We recommend that you get pre-authorization from us first before you receive any service valued over $300. This can help avoid surprises and out-of-pocket expenses in case a certain service isn’t covered.

Some health and dental providers can submit claims to us on your behalf, and let you know if you owe any amounts due to deductibles and reimbursement levels. Check with your provider to see if this option is available.

Once we receive your completed claim form, we will acknowledge our receipt of it within one business day. We will schedule a telephone call with the assigned disability claims specialist, and make a decision to approve—or ask for more information—within 10 business days. You will be provided with a status of your claim every 30 days until a decision is made.

We recommend submitting your completed claims forms (client + authorization, employer and physician statements) 8 weeks prior to the end of the elimination period to ensure a timely decision.

  • Complete the sections on the form that apply to you, and have your doctor complete the ‘attending physician’s’ section of the form
  • Be sure your doctor includes a specific diagnosis and indicates how your condition affects your ability to do your job
  • Your doctor will also need to list all treatments you are receiving, including surgery, medications, physiotherapy, etc.
  • Submit the form to your benefit administrator or human resources department so they can complete their section to confirm your absence

Make sure your claim form is accurate and completed in full, signed, and submitted with the paid receipt enclosed. We cannot accept photocopies and faxed receipts.

Always keep your personal information up-to-date (bank account, address, etc.) You can make updates easily by signing inOpens in new window to our Online Group Benefit Solutions service.

Ensure your Explanation of Benefits claim statements are correct and double-check receipts to be sure you received what is being charged to your plan. Providing false claim documents or exaggerating services constitutes fraud. If you realize you have made a mistake after submitting a claim, let us know right away so we can help correct the situation.

Please contact Allianz Global Assistance:

Visit:

Call:

  • 1-855-603-5571 (in Canada or USA) or
  • 1-905-608-8251 (collect from anywhere in the world).

This toll-free call centre is available 24 hours a day, 365 days a year worldwide, and can help to ensure you get the care you need without incurring unnecessary out-of-pocket expenses.

Your ID card also contains contact information in the event of an emergency. Prior to seeking medical treatment, it is important to call the number listed on your ID card as soon as possible.

Travel Tips:

Prior to travelling, review your Employee Benefits Booklet to understand what your benefits cover.

  • If you have a medical emergency while on your trip, one toll-free phone call puts you in touch with a multilingual coordinator who can help you—24 hours a day, seven days a week.
  • Call 1-855-603-5571 (in Canada or the U.S.) or 1-905-608-8251 (collect from anywhere in the world)
  • If the medical emergency prevents you from calling before receiving treatment, we ask that you (or someone else on your behalf) call us at the earliest opportunity.

To make a claim for short term disability, the AWI/STD/ATP – STD Disability Claim FormOpens PDF in new window must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed within the form:

  • You (the employee) complete: Client’s Statement
  • Your employer completes: Employer/Carrier Statement
  • Your doctor completes: Attending Physician’s Statement – Short Term Disability Claim.

To help avoid delays, all forms should be completed in full and submitted to intake@rbc.com as soon as possible.

Dealing with a disability can be stressful. We’re here to help support you and make things as easy as possible. Review the following for an overview of what to expect when making a disability claim.

  • Make sure all required claim forms are completed and submitted as early as possible—ideally at least 8 weeks prior to the end of the elimination period.
  • While on claim, focus on your recovery and follow any treatment program that your physician recommends.
  • Keep in touch with your disability claims specialist and your employer.
  • See the below for additional guidance on what to expect throughout the claims process.

To make a claim for long term disability or a stand-alone life waiver of premium, the Group Disability Claim Form must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed:

You may select which form to have completed based on your condition. Otherwise, the General FormOpens PDF in new window may be used.

To help avoid delays, all forms should be completed at least 8 weeks before the end of the elimination period (i.e. the waiting period before benefits are paid).

Dealing with a disability can be stressful. We’re here to help support you and make things as easy as possible. Review the following for an overview of what to expect when making a disability claim.

  • Make sure all required claim forms are completed and submitted as early as possible—ideally at least 8 weeks prior to the end of the elimination period.
  • While on claim, focus on your recovery and follow any treatment program that your physician recommends.
  • Keep in touch with your disability claims specialist and your employer.
  • See the below for additional guidance on what to expect throughout the claims process.

To make a life insurance or accidental death claim, the Group Life/Accidental Death Notice of ClaimOpens PDF in new window must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed within the form:

  • The employee’s beneficiary completes: Client’s Statement
  • The employer completes: Employer’s Statement
  • The employee’s doctor completes: Physician’s Statement (should be submitted for all accidental death claims and for all life claims in any amount)

To make a loss of use or dismemberment claim, the Loss of Use/Dismemberment Notice of ClaimOpens PDF in new window must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed within the form:

  • You (the employee) complete: Client’s/Employee’s Statement
  • Your employer completes: Employer’s Statement
  • Your doctor completes: Attending Physician’s Statement

Check a Claim’s Status or Get Help with a Claim

To check your claim’s status or get help with a claim contact:

Health & Dental

Life, AD&D, Disability or Critical Illness

Travel

Contact Allianz Global Assistance:

Understand prescription drug costs and how to save money when making a claim.

Plan Member FAQs

Don’t see your question? Please contact your Plan Administrator or call us at 1-855-264-2174.

Contact Us for Assistance—We Can Help.

Claims, Services, or General Questions

  • Toll-Free 1-855-264-2174 Mon-Fri: 8am 8pm, ET
  • Email us for Life, AD&D, Disability & Critical Illness
  • Email us for Health & Dental

Technical Assistance and Registration

  • Call us at 1-855-264-2173, Monday to Friday: 8am to 8pm, ET