Enrolment form
Please use this form to enrol in the benefit plan and to change your beneficiary.
Claim forms
HOW TO MAKE A CLAIM
All completed claim forms must be forwarded to Coughlin & Associates Ltd.
It is only reasonable for you to expect prompt payment of claims when they arise. The administrator wants to provide prompt service but needs your help. Make sure that all the information is complete and that all questions have been answered. It is important that you identify that you are a member of the CMSG Western Branch benefit plan.
Following are the claims procedures for the various benefits:
Life insurance
If you or one of your dependants dies, a claim form should be completed as soon as reasonably possible. Contact the administrator for the necessary forms.
If you become totally disabled, a claim for waiver of premium from the trust fund must be made not later than 12 months after you stopped being “actively at work” and not earlier than six months.
Accidental death and dismemberment
In the event of a claim, notice of claim must be given to Chubb Life Insurance within 30 days from the date of accident and subsequent proof-of-claim within 90 days from the date of the accident. Contact the administrator for the necessary forms.
Weekly indemnity
If you become totally disabled, a claim must be made immediately and not later than 60 days after the commencement of your total disability. It is important that you promptly report to your employer any disability which may result in a weekly indemnity claim in order that the appropriate form can be completed.
Any fees charged by the attending physician for the completion of forms will be covered by the benefit plan.
Long-term disability
If you become totally disabled, notify Manulife Financial of your condition at least 30 days before the end of your elimination period. A formal claim must be made not later than 90 days after you complete the 52-week elimination period
While you are receiving the short-term disability benefit (WI) leading up to the long-term disability benefit, the insurer, Manulife Financial, will forward the necessary forms to be completed long enough in advance so that no interruption in payment results.
Extended health care
When you or any of your registered dependants have accumulated eligible expenses in excess of the required deductible, obtain a claim form from your employer, the Guild or the administrator.
Please submit the original bills and/or receipts no later than 24 months after the date the expense was incurred to substantiate the claim. Be sure that the receipts are itemized on the claim form, i.e. sufficient information should be included to identify the insured person, the date each expense was incurred and the type of service provided.
A completed claim form, together with all the bills and/or receipts, should be sent to the administrator.
Out-of-country coverage
Should a claim arise, written notice of any loss, damage, injury, expenses or payments shall be given to the company within 30 days. The insured must provide proof of loss within 90 days.
All claims and enquiries should be directed to the plan administrator, Coughlin & Associates Ltd.
Dental care
When you or a member of your family receive a bill for eligible dental services, ask your dentist to provide a completed claim form with sufficient details so that the claim can be processed for payment. A separate claim must be completed for each eligible dependant who has received dental care services.
Mail or fax the completed claim form to the administrator. Be sure to include the name of the dentist, the name of the person receiving the dental care, the date of birth, the group policy number, your personal identification number and your home address.
Alternatively, at the member’s request, assignment of benefits to the dentist can be made.
Note:
Claims should be submitted as soon as possible after the dental treatment has been completed. No action may be brought against the plan for any claim unless presented to the plan administrator within 60 days of treatment completion date. Our EDI service
Coughlin & Associates Ltd. can process your dental claim using our electronic data interchange (EDI) claims processing service.
With EDI, your dental claim can be sent directly from your dental office to our claims department for adjudication.
Our EDI service uses the secure data networks of Telus, the dedicated claims processing network sponsored by the Canadian Dental Association. With Telus, you can be assured that the information contained in your dental claim will be transmitted to Coughlin & Associates Ltd. quickly, safely and confidentially right from your dentist’s office.
To take advantage of Coughlin’s EDI service, just tell your dentist that Coughlin & Associates Ltd. is your claims administrator and present him/her with the following security codes:
- the Coughlin & Associates Ltd. Telust carrier identification number (also known as the BIN number), which is 610105 on the Telus network;
- your unique employee identification; and
- the policy number of your group benefit plan.
Your human resources department or plan administrator will be able to provide you with your employee identification and group benefit plan policy numbers.
Pre-Authorized Deposit (PAD)
You can have your claim reimbursements deposited directly to your bank account.
With Coughlin’s Pre-Authorized Deposit (PAD) reimbursement program, you can receive your reimbursement within two to five days following the approval of your medical or dental claims. You will not have to wait for the arrival of a cheque and a trip to the bank before depositing your reimbursement. The deposit of the reimbursement will be confirmed by email.
To enrol in Coughlin’s PAD program, just log on to the Coughlin website at www.coughlin.ca or contact your plan administrator.
Coughlin Member Portal
You can log in to the Coughlin Member Portal at www.coughlin.ca and view your personal benefits and claims account. You can:
- Manage your profile, including updating your mailing address, telephone number, email address, updating your language of preference and viewing your dependant information.
- View your claims history and the status of claims, print explanation of benefits statements, view your benefit accumulations/ maximums and view your booklet (where applicable).
- Download and print claim submission and administrative forms.
Should a claim arise, written notice of any loss, damage, injury, expenses or payments shall be given to the company within 30 days. The insured must provide proof of loss within 90 days.
All claims and enquiries should be directed to the plan administrator, Coughlin & Associates Ltd.
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