In many cases, dental offices will submit your claim electronically on your behalf. Some dental offices choose not to send claims electronically, but may provide a claim form from their computer system with their portion already complete. You then simply complete your portion, sign the form and submit it for payment. If your dentist does not provide this service, you can obtain a Dental Claim Form online. Take it with you when you visit your dentist and ensure that all portions are fully completed to avoid delays in paying your claim.

NOTE: You should get an estimate

If you are about to undergo a costly course of treatment (i.e. more than $300), you should have your dentist submit a cost estimate (called a 'predetermination of benefits') to us showing the planned treatment and expected costs. We'll advise you by mail how much you will be reimbursed. Your dentist should submit x-rays for predeterminations of all major services. The x-rays will be promptly returned to your dentist once the review is complete.

To help avoid any delays in processing your claim, ensure that all sections of your Extended Health Benefit Claim form are complete and that your receipts are attached. IMPORTANT: Be sure to include the name of your plan sponsor or employer, and your plan number. Check with your benefit administrator if you are unsure of this number. Include your name and identification number. It is important to indicate if you have benefits under another plan such as your spouse's plan. If this information is not included, your claim cannot be processed.

If you're claiming expenses for a spouse or child, be sure to show their name and relationship to you, and show the name of your spouse's plan sponsor or employer or your child's post secondary institution if your child is an overage dependant.

Staple original receipts to your claim form before mailing, including the pharmacy receipt, not just the cash register receipt.

For paramedical practitioner services such as massage therapy and physiotherapy, please ensure that the practitioner's licence number is on the receipt. Having the practitioner include their registration or licence number will allow for a faster payment of your claim. Staple original receipts to the claim form along with a letter from your doctor if a doctor's approval is required - see your benefits booklet or contact us at 1-866-783-6847 to confirm.

Simply present your benefits card to the pharmacist when filling a prescription and the pharmacist will submit your claim electronically on your behalf. If your plan does not include a benefit card, you will need to pay for your prescription and then submit a claim for reimbursement in the same way you submit other types of health claims.

If you can't, or choose not to use your benefits card, keep all of your prescription drug receipts or ask your pharmacist for a year-to-date print out of your drug expenses. Submit these receipts with a completed Extended Health Benefit Claim form for reimbursement and tracking in our system.

For accuracy and efficiency and to keep an electronic history on OTIP's system, we recommend that you use your benefits card for all drug claims.

You can check the status of a claim by logging into the Plan Member Secure Site. Check under 'Claims' or 'Claims Inquiry' to see if your claim has been processed and how much was paid. If you have any questions, please contact us.

If you used the Plan Member Secure Site in the past and your plan number has changed, here are some important instructions for accessing prior claim information:

You can confirm the details of your coverage by logging into the Plan Member Secure Site, checking your benefits booklet, contacting your plan administrator or OTIP benefits services.

Information about the RTIP Gold Elite and ARM Prestige Elite health plans can be found by following the links below:

• RTIP Gold Elite
• ARM Prestige Elite

Most of OTIP's health benefit plans cover plan members while traveling outside their home province or country (for a certain period of time), and many also include Emergency Travel Assistance. Check your benefits booklet, call your plan administrator or contact OTIP benefits services to confirm that your plan includes these services. If you have emergency travel coverage, it will be indicated on the back of your benefits card. It's important to carry your card with you at all times when travelling as it contains information you will need to provide in the event of an emergency.

If you require medical assistance while travelling, before you seek treatment, contact the service provider listed on your benefits card as soon as possible so they can ensure you get the care you need without incurring unnecessary costs. The call centre is available 24 hours a day, 365 days a year worldwide.

Emergency Travel Assistance has four main components:

• Medical assistance services to help you secure treatment by a doctor or medical facility
• Emergency medical care, which covers the cost of emergency hospital and physician services
• Transportation services including ambulance services, return-trip transportation if necessary, and more
• Personal assistance, help with lost documents, assistance in accessing legal counsel and emergency messages and translation

Emergency Out of Country/Province Travel:

If an emergency should occur while travelling outside of your province of residence, please contact Mondial Assistance, formerly World Access, immediately or as soon as possible at one of the following numbers:

• In Canada and the United States: 1-800-265-9977
• In Mexico: * + 1-800-514-3702
• In the Dominican Republic: * + 1-888-751-4403
• International toll free: * + 800-9221-9221 **
  In other countries use operator to CALL COLLECT: 519-741-8450
• Fax: 1-800-446-7684

*Use Country Calling Code

**Here is a list of countries that are part of the international toll-free number:

OTIP does not provide a stability clause. While you are on vacation outside of your province of residence, the Insurer will not pay travel benefits for expenses incurred for a medical condition for which, prior to departure, medical evidence would suggest that treatment or hospitalization could be required while you are on the trip.

Please contact OTIP benefits services to verify coverage. We will need the Drug Identification Number (DIN) to confirm eligibility.

Through the Assistive Devices Program (ADP), the Ontario Ministry of Health now provides 100% reimbursement for standard insulin pumps to eligible adults with Type 1 diabetes. Approved patients can also receive a grant of $2,400 annually (paid each quarter) for insulin pump supplies.

If you require reimbursement for insulin pumps or supplies:

• Submit your application for funding to the ADP.
• After the ADP has responded to your application, submit a claim to OTIP for any remaining cost of the pump and supplies. When claiming through your OTIP benefits, remember to include proof of payment and all receipts.

Benefits paid by OTIP for insulin pumps and supplies will be reduced by the quarterly grant amount from the total cost on your receipts. The remainder will be paid to you in accordance with the provisions of your contract.

For more information on claiming through the ADP, visit the Questions and Answers: Insulin Pump Therapy page on the Ontario Ministry of Health and Long-Term Care's Web site.

To add, change or delete a dependant, or if you are changing your family status (e.g. from single to couple or couple to family), please complete a Health and Dental Change form.

Please contact OTIP benefits services to update your address. An OTIP benefits services representative will ask you for your plan and identification number to verify that you are the plan member and your address will be updated within one business day.

To replace a lost or stolen benefits card, contact OTIP benefits services as soon as possible. We will issue you a new card.

Your pharmacy should have your benefits card information on its system so you can continue to make claims while you wait for your new card to arrive. For non-prescription claims or if your pharmacy does not have your card information on file, please submit an Extended Health Benefit Claim form with receipts.

If you or your dependants 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. Here's how:

• The plan that covers you as a plan member pays first. Then, the plan that covers you as a dependant pays any remaining eligible balance. Your spouse's claims should go to his or her plan first, and then any remaining balance should be sent to your plan.
• Dependant children are covered first by the plan of the parent whose birthday falls earlier in the calendar year. In other words, if your birthday falls in January and your spouse's birthday is in March, you should submit your children's claims to your plan first.

Your first benefit plan will send you an explanation of how much of your claim has been covered. You will need to send that explanation, along with copies of your expense receipts, to the second benefit plan in order to claim any remaining balance that is eligible.

OTIP Health and/or Dental Claims (based on the nature of your claim)
125 Northfield Drive West
PO Box 218
Waterloo ON N2J 3Z9