Administration des prestations de maladie

Le département de l’assurance maladie s’efforce d’offrir les meilleures prestations de soins de santé possibles aux employés de l’Église adventiste du septième jour au Canada et à leur famille.

Les réclamations sont traitées par ClaimSecure.

Pour toute question concernant les réclamations, veuillez contacter ClaimSecure par courriel à l’adresse moc.erucesmialcnull@ecivres ou par téléphone au 1 888 513-4464.

Pour toute question générale concernant les avantages sociaux, veuillez écrire à ac.tsitnevdanull@stifenebhtlaeh.

Nous avons pour mission de proposer un programme d’avantages clairement défini afin de répondre aux besoins de nos employés en matière de santé et de revenu. Ces avantages comprennent donc :

• Une assurance maladie complémentaire et une assurance dentaire
• Une assurance invalidité
• Une assurance vie
• Une assurance individuelle contre les accidents

Nous sommes liés à des principes d’intégrité et de professionnalisme. De plus, nous cherchons à offrir à nos employés un service de haute qualité et une couverture exceptionnelle.

Ressources Départementales Disponibles

• eProfile Claims Submission
• eProfile ClaimSecure Account
• Preferred Pharmacy Network
• Prior Approval for Major Dental Work
• Administrative Forms
• Claim Forms
• Claiming Wellness Benefits for Active Employees
• For Employer Use Only
• GoodLife Fitness / Fitness Benefit
• Optional Life, Optional Critical Illness & AD&D
• Out Of Country - CANADA LIFE
• Prior Authorization Forms
• Short Term Disability
• Tax Reporting

• Login

eProfile Claims Submission:

• eProfile Online Claims Submission
  Once you've created your eProfile ClaimSecure account, you will be able to submit your Extended Health, Dental, Vision and Paramedical claims online, access your claims history, change direct deposit banking information, etc. (External Link)

eProfile ClaimSecure Account:

• Plan Member eProfile
  eProfile Information
• eProfile Online Registration
  ClaimSecure eProfile Account Registration Instructions

Preferred Pharmacy Network:

• Preferred Pharmacy Network Information
  The future of your employee wellness plan begins with the TELUS Health Virtual Pharmacy app — the easiest way to connect with a pharmacist and order, track and manage medications for you and your loved ones with free next business day delivery. (External Link)
• Renseignements sur le Réseau de Pharmacies Préférées
  Le futur de votre régime de mieux-être à l’intention des employés commence par l’application Pharmacie Virtuelle TELUS Santé : il s’agit de la façon la plus facile de communiquer avec un pharmacien et de commander, de faire le suivi et de gérer des médicaments prescrits pour vous et vos proches, en profitant d’une livraison gratuite le jour ouvrable suivant. (External Link)

Prior Approval for Major Dental Work:

• We recommend prior approval for Major Dental Work. Please ask your dental office to submit your Pre-Determination accompanied with a radiograph directly to ClaimSecure (you must provide your dental office your ClaimSecure card information).

Administrative Forms:

• Benefit Change Request (Employee)
  For Employee use when reporting any family update or address change.
• Overage Dependent Form (21yrs old and up)
  Complete only if your child(ren) is over age 21 and a full-time student.
• Dependent Form Application (20yrs old and under)
  Complete only if you have any child(ren) under age 21 who are attending school full-time outside of Canada.

Claim Forms:

• Active Member and Regular Retiree --- DRUG CLAIM Form
  This DRUG CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. (External Link)
• Active Member and Regular Retiree --- HEALTH CLAIM Form (english)
  This HEALTH CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. This form is also used for Vision claims.
• Active Member and Regular Retiree --- HEALTH CLAIM Form (french)
  This HEALTH CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. This form is also used for Vision claims.
• Active Member --- WSA CLAIM Form
  This WSA CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure.
• Active Member and Regular Retiree --- DENTAL CLAIM Form (english)
  This DENTAL CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure.
• Health Care Spending Account Retiree --- HSSA Form
  This HCSA (aka HSSA) CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure.
• Standard Dental Claim Form is available from your Dentist.

Claiming Wellness Benefits for Active Employees:

• Wellness Spending Account (english) (WSA)
  General WSA Questions
• Wellness Spending Account (french) (WSA)
  General WSA Questions

For Employer Use Only:

• New Employee Enrollment Form
  For employers to enroll new employees into the Health Benefits Plan.
• New Employee / Transfer Notice Form
  For employers to notify HBA of new employees
• Employee Termination of Benefits Form
  For employers to complete when terminating employee benefits
• Employee on Leave of Absence Waiver of Coverage
  

GoodLife Fitness / Fitness Benefit:

• Frequently Asked Questions (English and French)
  
• GoodLife Fitness Corporate Program (English)
  
• Programme corporatif Goodlife Fitness (French)
  

Optional Life, Optional Critical Illness & AD&D:

• Accidental Death & Dismemberment Rates (English)
  
• Insurance Beneficiary Form
  Active Members to fill out this form if they want to modify their beneficiary information and / or to increase their optional insurances.
• Optional Life & Optional Critical Illness Rates (English)
  
• SUNLIFE Health Statement Form - Member & Spouse
  Please fill out this SUNLIFE Health Statement Form if you are requesting for Optional Life and / or Optional Critical Illness for YOU and YOUR SPOUSE only
• SUNLIFE Health Statement Form - Member, Spouse & Child(ren)
  Please fill out this SUNLIFE Health Statement Form if you are requesting for Optional Life and / or Optional Critical Illness for YOU and YOUR SPOUSE and YOUR CHILD(REN)

Out Of Country - CANADA LIFE:

• Out Of Country Insurance - CANADA LIFE - booklet English Effective February 01, 2025
  
• Out Of Country Insurance - CANADA LIFE - booklet French Effective February 01, 2025
  

Prior Authorization Forms:

• Prior Authorization Forms for Medication
  For Prior Authorization Forms, please visit https://www.claimsecure.com/forms/
  click on "Members" / click on "Special Authorization Forms" (External Link)

Short Term Disability:

• Claim forms available from your employer or Health Benefits Administration.

Tax Reporting:

• If you wish to claim your medical expenses please save the Explanation of Benefits from ClaimSecure, it will provide the detailed information you require, or keep a copy of the receipt.
  
  For tax purposes you may report the portion not reimbursed to you if it meets the minimum medical expense deduction for Canada Revenue Agency.
  
  ALSO NOTE, your extended health and dental benefits are paid by your employer, therefore, you may not claim those premiums as an additional medical expense to include in the Canada Revenue Agency medical deduction.