How Canada Life processes health and dental claims

Key takeaways

If you use your health and dental coverage, you’ll want to make a claim for expenses.
You may submit a form to make your claim.
There is an appeal process if your claim isn’t approved.

How to submit a health and dental claim

Paper - Complete and submit the appropriate health and dental claim form.
Online via Canada Life – Sign into My Canada Life at WorkOpens a new website in a new window to complete a claim.
Online by your health care provider – Your pharmacist, dental office, optical location or paramedical provider can submit a claim on your behalf.

What are the submission timelines?

You must submit the claim within 15 months from the date the service was incurred.

My form is complete. Now what?

Once all information for your claim is received, we’ll assess your claim.

If there’s any missing information required to assess your claim, we’ll contact you through My Canada Life at Work or by mail.

You can respond to any missing details for your claims online by signing in to My Canada Life at WorkOpens a new website in a new window and going to the contact us section.

How long does it take to process my claim?

A decision will be made 7 calendar days from the date we receive all necessary information.

Please note: This timeline is intended for standard plans only. Actual timelines might vary based on plan design and claim complexity. Missing information or incomplete applications for benefits may impact processing timelines. We may need to extend the timeline if additional review is needed.

How will I find out if my claim has been accepted?

We’ll provide you a response either electronically or by mail, depending on your communication preferences.

Appeal details for out-of-country claims

Appeal level 1

Details – You can appeal by either calling our customer relationship specialists at our call centre or by resubmitting the claim and indicating it is an appeal. Please tell us why you disagree with our assessment.
Timeline – Canada Life aims to process all appeals within 7 calendar days of receipt.
Communication – If the appeal is accepted, we will provide you a response either electronically or by mail, depending on your communication preferences. If the appeal decision is maintained, we will respond by sending a detailed letter with an explanation for the decision.

Appeal level 2

Details – If you aren’t satisfied with the first appeal decision you may send us in writing all claims details with any additional information we may not already have for review.
Timeline – Appeals will be reviewed within 10 calendar days.
Communication – We will respond by sending a detailed letter with an explanation for the decision.

Complaints

After Appeal level 2, you can ask to have your concerns escalated further. This would flow into our customer complaint process.

What’s next?

Get the health and dental claims forms you need.

This information is general in nature and is intended for informational purposes only. For specific situations you should consult the appropriate legal, accounting or tax advisor.