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Plan Admin Forms and Resources

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As a plan administrator you have many day-to-day tasks that require extra documentation. Please go through the sections below to find any forms relevant to your situation.

Enrollment

When employees become eligible for insurance, access the forms here to enroll them.

Applications

Add additional coverage or dependents to an employee’s plan.

Health Questionnaires

Gather personal health information on an applicant in order to determine eligibility.

Change Forms

When an employee experiences life changes, they may need to modify their coverage.

Frequently asked questions

Drug authorization

What is prior authorization?
An approval process for Plan Members who need certain high-cost drugs. This process ensures patient safety and appropriate drug use by requiring specific medical criteria to be satisfied before expenses are considered eligible for reimbursement under the plan. For example, patients are required to try initial drug therapies before moving on to more expensive treatments, ensuring less expensive alternatives are used first.
What requires prior authorization?
Certain high-cost drug, biologics (specialty drugs) and drugs with a potential to be used inappropriately. To check if a drug needs prior authorization, the member can use the Drug (Prescription) lookup tool in the Wawanesa app or plan member portal, or call the Health & Dental Claims Call Centre at 1-800-665-7076, option 1.
What if the member already received an approval from a previous insurance carrier?

If the member is already taking a drug that requires prior authorization, Wawanesa may honor the approval from the member's previous insurance carrier for up to six months from the Wawanesa approval date, if:

  • The previous carrier approved the drug or medical supply within six months of the members enrollment in the Wawanesa Life Group plan;
  • They can provide a claim statement with an explanation of benefits (EOB) or a pharmacy receipt showing the drug was covered under the previous group plan; and
  • The drug or medical supply is covered under the Wawanesa group plan.

Out of country medical emergency

What should the plan member do if they need emergency medical assistance while out of the country?

If they need emergency medical assistance while out of the country, contact CanAssistance immediately.

When the plan member promptly calls CanAssistance, it allows them to notify the medical center of their arrival and arrange for direct billing. If they do not contact CanAssistance before receiving medical attention, they may have to pay out of pocket and submit a claim for reimbursement later.

Do emergency medical providers contact CanAssistance to confirm coverage?

No, emergency medical providers do not contact CanAssistance to confirm coverage. It is crucial for plan members or their dependents to call CanAssistance in an emergency. CanAssistance will guide them on where to receive medical attention and confirm their eligibility. Here are the phone numbers for Travel Assistance:

If they visit a provider for outpatient care without calling CanAssistance first, they may be charged directly, and will need to submit a claim for reimbursement. To avoid this, they should contact CanAssistance before any medical visits.

Will CanAssistance send the medical center insurance forms to complete?

No, CanAssistance collects all necessary information directly from the plan member or their dependents to open a new file. They will receive an email with a link to the CanAssistance website, where they can complete an online claim form.

Will the plan member need to pay out of pocket and seek reimbursement later?

No, if they contact CanAssistance before receiving care, they can arrange for the medical center to bill them directly. This means they won’t need to pay out of pocket and seek reimbursement later.

What if the plan member can’t provide their insurance information due to the severity of their condition?

If they are unable to provide their insurance information due to the severity of their condition, the medical center will typically try to locate their insurance details and contact CanAssistance to open a file. CanAssistance will then attempt to contact a relative for any additional information needed. If they cannot obtain the required information, they will try to arrange billing directly with the medical centre. However, in some cases, they may need to pay out of pocket and submit a claim for reimbursement.