Frequently Asked Questions

Every province and territory have a different health plan. However, the following are usually not covered by government health insurance plans:

• Prescription drugs*
• Dental check-ups and treatment
• Hospital stays
• Specialized care, including speech therapists or pathologists, physical therapists, chiropractors, and many more
• Homecare and nursing
• Medical supplies and equipment
• Emergency medical health treatment for travellers
• Personal emergency response
• Hearing aids
• Accidental death and dismemberment
• Catastrophic coverage

Your province may outline coverage on their website.

* For Quebec residents, the prescription drug coverage available under this plan is limited to costs not covered by the RAMQ Prescription Drug Insurance Plan. It is not intended to be a replacement for the RAMQ Plan. In order to be eligible for coverage under this plan, you must have a provincial health card and be registered under the RAMQ Prescription Drug Insurance Plan or have equivalent coverage under a group plan.

No one likes to think about the possibility of having serious health issues. Unfortunately, if an accident or illness were to happen to you or a member of your family, the cost of medication, treatment and other expenses could add up to a considerable amount. Even treatment for common illnesses, like medication for back pain or therapy for a sprain, can be costly. Supplemental health insurance can help cover medical costs that may not be covered by your provincial health plan.

While critical illnesses such as cancer¹, stroke and heart attacks² are the serious causes of death in Canada, there are many common illnesses such as back problems, diabetes, epilepsy or high cholesterol that may also have significant financial consequences.

¹ http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance

² Heart & Stroke Foundation, 2014 report on the health of Canadians, page 3

Every year, you could pay thousands of dollars in unexpected medical and dental expenses if you don't have a health plan. You could also be especially financially vulnerable in the event you suffer a serious illness or injury. Or you could end up having to use up your savings on private care, because your government health insurance plan, unfortunately, may only offer limited coverage for home nursing care and in-home assistance.

From just dollars a day, you can have comprehensive coverage that you and your family simply shouldn't be without. And, if you're self-employed or are an employee of your own business, health and dental premiums may be a non-taxable benefit and a tax-deductible expense. For others, the premiums may qualify as a medical expense and create a tax credit.

Government health insurance plans may have limits on the reimbursement of the emergency medical expenses incurred while in another province or territory. For example, air and ground ambulance costs, emergency dental treatment and prescription drugs might not be covered outside your province or territory of residence. For maximum protection, you can purchase additional medical coverage even while travelling within Canada.

Although the dental, drug and vision components of a health plan are typically the most used benefits, the long-term value lies in the comfort of knowing that you have supplemental health insurance that may help beyond what the government health system provides.

Wisdom teeth removal falls under oral surgery (extensive services). Procedures related to oral surgery require x-rays and a treatment plan to be submitted to Manulife for assessment by your dentist before any work or treatment begins. You will then be advised of the eligibility of the treatment.

Five of the eight plans require no medical questionnaire at the time of application. These plans include the Base Health and Dental Plan and the four Dental (with basic health) Plans. When you apply, your acceptance is guaranteed provided that you meet the eligibility criteria.

First, check to see if your provider has already submitted your claim. Often, you don't have to submit a claim because many hospitals, pharmacies and dentists can submit your claim directly to us. There's no online form or paperwork for you, and you only pay the amount your plan doesn't cover.

If your provider hasn't already submitted your claim, you can submit your claim on paper by mail.

You have 12 months from the date you were charged for a health and dental service to submit your claim for reimbursement.

If your claim form is complete and accurate, you will generally receive payment within six business days. When information is missing, we may have to return the claim form to you. This delays processing and payment.

You can claim on paper by mail:

• Specify the currency if your claim is for services outside Canada
• Include original receipts and applicable supporting documentation
• Make sure you've signed your claim form
• Use the extended health claim form for all covered expenses except dental expenses
• Use the dental benefit claim form – must be completed by your dentist or dental specialist

Call to speak to a customer service professional. You must complete nursing approval forms before starting homecare and nursing services.

Prescription drug receipts must be original receipts (not statements) and show:

• Name of drug
• Drug identification number (DIN)
• Date of service
• Prescription number
• Prescription strength and quantity
• Drug cost
• Dispensing fee (if applicable)

All other receipts must be original receipts on the printed letterhead of the person or company providing the service and show:

• Name of patient
• Date(s) of service
• Description of service
• Cost of each service

You must submit a prior authorization request and a written recommendation from a physician or nurse practitioner for the following items: hearing aids, orthotics, prosthetic appliances, medical equipment and supplies. 

Complete the Prior authorization for homecare, hearing aids, nursing, orthotics, prosthetic appliances, medical equipment, and medical supplies, CM5006, in full and attach all requested information. We will not accept or process estimates or requests for third party assignment of benefits that are attached to an claim form. Do not register for, purchase, or submit claims for these devices and/or supplies that cost more than $300 until you receive information from us about whether your request has been approved or declined. Make sure you attach a copy of the prior approval decision from Manulife when you submit your claim to us for reimbursement. We will not pay claims for hearing aids, orthotics, prosthetic appliances, medical equipment, and medical supplies over $300 that did not receive prior authorization. 

For Homecare and Nursing, you may call us and speak to our team. Our customer service representatives can give you information about completing a nursing questionnaire or referring you to our preferred provider before nursing or homecare services begin.

Costs submitted after 12 months

To consider a Health and Dental claim, we must receive all the information we need within 12 months of the date you paid the costs you're claiming.

Costs that aren't medically necessary

Health claims must be deemed medically necessary under the terms of your policy. Dental claims for preventative services are allowable if your policy covers them.

Costs associated with excluded conditions

Sometimes, we make counter-offer agreements that exclude specific health conditions. We won't pay for any treatments – including but not limited to medications – that relate to an excluded condition. Your health care provider must explain if a treatment that can be used for an excluded condition is being used to treat an unrelated condition. Include this explanation when you submit your claim.

If we approve your claim, we will pay it and you will receive a cheque or, if you have registered for it, direct deposit and an electronic claims statement. If your claim form is complete and accurate, you will generally receive payment within six business days.

Our program is the only one in the industry to offer:

• member referral to specially trained pharmacists at the Shoppers Drug Mart Cannabis Care Centre
• coverage guidance based on the approved formulary
• help with the coordination of medical marijuana distribution
• case management, which includes patient oversight and outreach for follow-up
• a support line that is available for continuous guidance throughout the process

The Critical Illness Insurance plan was designed for healthy individuals between the ages of 18 and 65 who want a basic amount of affordable critical illness coverage that can be obtained quickly, easily and without completing a medical questionnaire.

Life-threatening cancer: A tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue as confirmed by histological examination of tissue samples.

Heart attack (myocardial infarction): The death of a portion of the heart muscle due to atherosclerotic heart disease. The diagnosis must be based on all of the following criteria occurring at the same time:

• New episode of typical chest pain or equivalent symptoms; and resulting from the blockage of one or more coronary arteries; and
• New electrocardiographic changes indicative of myocardial infarction; and
• Biochemical evidence of myocardial necrosis including elevated cardiac enzymes and/or troponin.

Stroke: A cerebrovascular incident causing infarction of your brain tissue, due to intracranial hemorrhage, thrombosis or embolism, producing a new measurable permanent clinical neurological deficit persisting for at least thirty (30) days following the occurrence of the stroke.

Coronary artery bypass surgery: You have undergone heart surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts.

Kidney failure: End stage renal disease, due to whatever cause or causes, as a result of which you are undergoing peritoneal dialysis or haemodialysis on a regular basis or have received a transplanted human kidney.

Major organ transplant: You have received a transplant of a human heart, liver, lung or human bone marrow, due to irreversible failure of such organ.

In the Critical Illness Insurance Health Declaration, "signs and/or symptoms" means any indication that a named condition may exist – for example:

• Presence of an undiagnosed breast lump
• Chronic cough
• Blood in urine
• Unexplained weight loss
• Chest pain
• Shortness of breath
• Difficulty speaking
• Numbness
• Paralysis
• Severe headache
• Sudden onset of blurred vision

If you have had any unusual signs or symptoms that have not yet been diagnosed by a doctor or if you have been diagnosed with a condition named in the Health Declaration, you are not eligible for Critical Illness Insurance coverage.

In the Critical Illness Insurance Health Declaration, "signs and/or symptoms" of heart disease means any indication that heart disease may exist – for example:

• Chest pain
• Chest discomfort possibly radiating to arms, neck or jaw
• Irregular heart rate
• Shortness of breath
• Cold sweats
• Nausea
• Light-headedness

However, these signs or symptoms could be caused by conditions other than heart disease.

A pre-existing condition is an illness or condition for which an individual showed indications of “signs or symptoms,” was prescribed or took medication, or was diagnosed, treated or hospitalized during the 24 months immediately prior to the policy’s coverage effective date.