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Plan Member Forms and Resources

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As a plan member, you may be asked to provide additional documentation when you submit your claim. Please go through the sections below to find any forms relevant to your situation.

Change Forms

When life changes happen, you may need to modify your policy.

Life Insurance Claims

When you or someone on your plan dies.

Critical Illness

When you or someone on your plan is diagnosed with a life altering illness, you may be eligible for a Critical Illness benefit payment.

Disability

Whether long or short term, when you experience a disability, you may need additional medical information.

Health and Dental

Forms for when you have dental or health claims not covered by provincial insurance.

Spending Accounts

If you have a Personal Spending Account or a Health Care Spending Account.

Have a claim?

Have a claim?

Most claims can be submitted online. For others, visit

Group Insurance Claims

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 your drug needs prior authorization, 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 I already received an approval from my previous insurance carrier?

If you are currently taking a drug that requires prior authorization, Wawanesa may honor the approval from your 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 your enrollment in the Wawanesa Life Group plan;
  • You 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 your Wawanesa group plan.

Out of country medical emergency

What should I do if I need emergency medical assistance while out of the country?

If you require emergency medical assistance while out of the country, contact CanAssistance immediately.

Calling CanAssistance promptly allows them to notify the medical center of your arrival and arrange for direct billing. If you don’t contact CanAssistance before receiving medical attention, you 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 you or your dependents to call CanAssistance in an emergency. CanAssistance will guide you on where to receive medical attention and confirm your eligibility. Here are the phone numbers for Travel Assistance:

If you visit a provider for outpatient care without calling CanAssistance first, you may be charged directly. You’ll then need to submit a claim for reimbursement. To avoid this, always contact CanAssistance before any medical visits.

Will CanAssistance send the medical center insurance forms to complete?

No, CanAssistance collects all necessary information directly from you or your dependents to open a new file. You will receive an email with a link to the CanAssistance website, where you can complete an online claim form.

Will I need to pay out of pocket and seek reimbursement later?

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

What if I can’t provide my insurance information due to the severity of my condition?

If you are unable to provide your insurance information due to the severity of your condition, the medical center will typically try to locate your 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, you may need to pay out of pocket and submit a claim for reimbursement.