I'm having difficulty logging on to the member portal. What can I do?
To use Coughlin's plan member portal for the first time, you must first register.
To register you will need three items:
- your personal identification number;
- the plan number; and
- the temporary password.
This information can be found on any of your claim statements dated April 2007 and later.
If you do not have a temporary password, please contact Coughlin and we will send one to you. When you receive it, please follow the "Haven't registered yet?" link, if you are registering for the first time.
Please note that temporary passwords are case-sensitive. What may appear as a "1" may be a lower case "L". Please be sure to enter the characters exactly as they appear on your statement. Once the temporary password has been accepted, you may then proceed to enter your personal and plan information and create your account. If you do not have your personal identification or plan number, please advise our office. We will be happy to give these numbers to you.
I am set up for direct deposit. Why don't I receive the statements showing what was paid anymore?
If you submitted a void cheque and filled out a direct deposit form authorizing Coughlin to deposit money directly into your bank account, and listed your email address on the form, you will only receive an email advising that money has been deposited into your account.
To view your statement, you must log onto the member portal at www.coughlin.ca under "Login area". You can print the explanations of benefits from that site.
How do I find out if my claim has been processed?
Inquire about the status of your medical or dental claim by calling our Ottawa or Winnipeg claims departments directly. Click here for our local and toll-free direct lines.
Alternatively, you may log into our Plan member portal online and view information about your claim in process, claims history and maximum accumulations for selected benefits.
How long do I have to submit claims for medical or dental expenses?
Claims should be submitted within six months of the date on which the expense was incurred. However, a claim can be processed up to 24 months from the expense date in our Ottawa office and up to 15 months in our Winnipeg office, provided there have not been any significant changes to the plan's underwriting arrangements. Any claims received after those respective time limits have expired and will not be considered.
In cases where a plan’s underwriting arrangements have changed, such as a plan termination, the allowable submission period will generally be shorter than those mentioned above. If you have questions regarding your plan’s submission deadlines, contact the Coughlin claims office.
How do I submit a dental claim?
Dental claims are accepted by mail, online through the Member portal or electronic data interchange (EDI).
When submitting by mail, online through the Member portal or walk-in service, a standard dental claim form (available from all dental offices) must be submitted for each patient. The form must be completed by the dental office and signed by the plan member. Note: a blank Coughlin form is not sufficient. The claim form must be completed by your dental office using either the Coughlin claim form or the dental office's standard dental claim forms.
When submitting electronically, advise your dental office that Coughlin & Associates Ltd. is your claims administrator and present them with the following security codes:
- the Coughlin & Associates Ltd. carrier identification number (also known as the BIN number) which is 610105 on the Emergis network;
- your unique employee identification number; and
- the 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 number.
An important note: If your claim is submitted electronically, your reimbursement will be mailed to you within two to four business days. The Coughlin walk-in claim reimbursement service is not linked to the EDI service.
My dental office has given me an estimate for future dental treatment. Can you tell me over the phone how much will be covered?
Unfortunately, approvals cannot be made over the phone. All dental estimates must be completed by your dental office and submitted either in writing on a form approved for use by the Canadian Dental Association or electronically through our EDI service.
Once Coughlin reviews the information, a written response will be sent to both the plan member and the dentist who prepared the estimate. The evaluation time can range from a few days to several weeks, depending on the type of treatment to be performed.
How do I submit a medical claim?
You can download, print and return by mail your completed and signed claim form, along with all receipts. Or you can submit your claims online through the Member portal.
Please retain all original receipts for a period of 12 months for auditing purposes.
My group plan provides a drug card. What do I do if I’m having a problem with my drug card?
When a pharmacist tries to enter a claim using a drug card, he or she is informed of the nature of the problem. If the message refers to terminated coverage, a dependant not on your file, or incorrectly entered information, please contact our administration department. If the nature of the problem stems from a prescription not being paid according to your plan specifications, please contact our claims department.
A helpline is also available for pharmacists to call if they require help or guidance. This number should be indicated on your drug card.
My doctor has recommended that I purchase some medical equipment. Does that mean it will automatically be eligible for reimbursement?
Only those expenses identified as a benefit in your group contract will be considered for reimbursement. Certain limitations may apply.
It is strongly recommended that a cost estimate, along with supporting medical information, be submitted prior to incurring any expenses.
Note: A claim for medical equipment cannot be approved over the phone. All estimates must be submitted in writing along with a physician's referral where necessary.
I would like to keep my original receipts for my records. Will you accept photocopies with my claim?
With the exception of co-ordination of benefits claims for which we are the second carrier (see the following question), original receipts must be submitted in all cases. We recommend you make copies of all documentation for your records prior to submission.
Please note that original receipts will not be returned.
My spouse also has a group medical and/or dental plan. Does it matter which one we use first?
Yes. If a person is covered by two different plans, reimbursements may be co-ordinated so that each plan covers part of the costs. This is called co-ordination of benefits (COB).
The COB clause in your benefit plan is used to define how your claimed expenses will be divided between insurance companies when both you and your spouse are covered by different benefit plans.
The Canadian insurance industry follows these rules when more than one insurance plan is involved in claims payment:
- The insured employee's claims must be first submitted to his/her own plan, then to the spouse's plan.
- Children's claims go first to the plan of the parent who has the earliest birth date in the year, meaning earlier month of birth and day in the calendar year (the year of birth is not a factor).
In cases of divorce or separation, alternate guidelines may apply for children's claims. Contact the Coughlin & Associates Ltd. claims office for more information.
When making a claim, you are required to submit a completed claim form and original supporting documentation to the first plan. When submitting to the second plan, include a completed claim form, photocopies of all supporting documentation (i.e. receipts) and the original Explanation of benefits (EOB) statement from the first plan indicating the reimbursement.
When both spouses are covered through group plans administered by Coughlin & Associates Ltd., only one claim form has to be submitted. However, the claim form must bear the signatures of both plan members.
If I have reached my maximum for a particular benefit, can I hold on to my receipts and submit them later when I am eligible again? Or, can I transfer my maximum from one year to another if I don’t use it all one year?
Claims are assessed based on the date on which an expense was incurred. If the expense is not eligible for reimbursement on the date the expense was incurred, it cannot be submitted for consideration at a later date. For equipment purchases, such as eyeglasses, the incurred date is the date on which the item was paid for in full. For services such as physiotherapy, it is the date on which the service was performed.
If you have not used all of your available coverage for a certain benefit, the balance cannot be carried to another period.
My plan has an annual maximum for certain types of expenses. Are those maximums for my entire family combined, or for each person? If I don't need to use the benefit, can my maximum be used by one of my family members?
In general, most plan benefits are administered on a "per person" basis. This means that each covered family member can claim up to the maximum stated in your plan.
Note: your group benefit plan may be based on a prescription drug maximum per family. Be sure to refer to your employee information booklet to confirm your coverage maximums.
The maximums cannot be transferred among family members; nor can they be combined to provide additional coverage for one family member when another member has not submitted a claim for them.
I have extended family members living with me. If I have a family plan, are their expenses eligible for reimbursement?
While the definition of an eligible family member depends on the specific wording of your group plan, family plans generally provide coverage for one spouse and any dependant children of the insured individual.
A spouse is usually defined as either the employee's legal or common-law spouse that has been publicly represented as such for a minimum of one year. A dependant child is frequently defined as an unmarried natural, adopted, or stepchild of the employee, or the insured spouse, who is under the maximum age specified by the plan.
In general, other family members such as grandparents, aunts, uncles or cousins are not considered eligible dependants under group plans.
Click here for information on obtaining personal health insurance plans for individuals and small business.
Contact either your human resources department or the Coughlin & Associates Ltd. claims department for more information on the specific provisions of your group plan or to add a dependant to your file.
