Electronic Real-Time Claims
Your ClaimSecure benefit card allows your pharmacist and your dentist to submit claims electronically for instant adjudication of all your prescription drug and dental claims.
Online eClaims Submission
This feature allows you easy online submission and prompt payment (maximum 5 business days) of your Extended Health Care and Vision Care claims, as well as any Prescription Drugs and/or Dental claims that were not submitted electronically by your pharmacist or dentist. Please retain all original receipts after your submission for 12 months.
Note: in order to submit claims online, you must first register for an eProfile account and then enrol in the direct-deposit payment service, which will instantly activate your Member eClaims service. Please follow the steps outlined in the eProfile™ section below to register.
Once this is done, choose ‘My Claims’ and then ‘Submit Claims’ and follow the easy step-by step instructions.
eProfile™
This is an online tool for members to submit claims online, as well as a tool to access information on your healthcare and dental plan. To register for your eProfile™ account, logon to www.claimsecure.com. Click either the eProfile™ Services tab on the top menu bar, select Login and then click on the Register Now tab OR scroll down the home page to eProfile™ Login and click on the Register Now tab and follow the instructions. You will need your group number (251005) and your 10-digit certificate number (as shown on your ClaimSecure benefits card) to get started.
Enrolment takes only a few minutes and then you’re ready to go – it’s that easy and it’s free.
This is a list of some of the services available through your eProfile TM account:
- Real-time adjudication of most healthcare and dental claims, including instant messaging of claims eligibility
- Online submission of claim receipts (if required)
- Claim reversal feature in the event of an error
- Automated email notification of successful payment
- Query your healthcare and dental plan coverage from the convenience of any computer, any time, any place
- Instantly find out whether your plan covers a specific drug, dental procedure or extended health care service or appliance
- Identify if there are any applicable co-payment requirements and/or frequency or benefit maximums for any eligible benefit
- View your claims history as well as the status of recently submitted claims
Manual Reimbursement Claims
All manual reimbursement claims for Prescription Drug, Extended Health Care, Vision Care and Dental claims must be submitted to ClaimSecure, together with the original receipt(s) and on a properly completed claim form that is dated and signed by the Member (employee) or Claimant, and must clearly indicate the following:
- the name of the Plan, which is the “USW Local 1005 ELHT”
- the Member’s name, address, date of birth, telephone number, group number and certificate number
- if the claim is for a spouse or dependent, the claimant’s full name, date of birth, gender and relationship to the Insured Member
- the date(s) the service was rendered, or the purchase was made.
In addition, each prescription drug receipt must show:
- the patient’s full name
- name of the medication or Drug Identification Number (DIN).
- the quantity dispensed
Your eligible expenses should be listed separately, by insured individual, on the appropriate claim form. Claim forms are available from the ClaimSecure website at www.claimsecure.com.
When submitting a claim for prescription lenses and frames, the original receipt should show the charge for the lenses and the charge for the frames as separate items. It should also show the full name of the patient.
Note: Failure to fully complete claim forms may delay your payment.
Please mail all manual reimbursement claims for Prescription Drugs, Extended Health Care, Vision and Dental to:
ClaimSecure
P.O. Box 6500
Sudbury, Ontario P3A 5N5
Toll Free Phone 1-888-513-4464