{"id":994,"date":"2012-07-18T14:12:08","date_gmt":"2012-07-18T18:12:08","guid":{"rendered":"http:\/\/www.adventist.ca\/?page_id=994"},"modified":"2025-08-05T08:58:26","modified_gmt":"2025-08-05T12:58:26","slug":"administration-des-prestations-de-maladie","status":"publish","type":"page","link":"https:\/\/www.adventist.ca\/fr\/services\/administration-des-prestations-de-maladie\/","title":{"rendered":"Administration des prestations de maladie"},"content":{"rendered":"<p><b>Les r\u00e9clamations sont trait\u00e9es par ClaimSecure.<\/b><\/p>\n<p>Pour toute question concernant les r\u00e9clamations, veuillez contacter ClaimSecure par courriel \u00e0 l\u2019adresse <a href=\"mailto:service@claimsecure.com\">service@claimsecure.com<\/a> ou par t\u00e9l\u00e9phone au 1\u00a0888\u00a0513-4464.<\/p>\n<p>Pour toute question g\u00e9n\u00e9rale concernant les avantages sociaux, veuillez \u00e9crire \u00e0 <a href=\"mailto:healthbenefits@adventist.ca\">healthbenefits@adventist.ca<\/a>.<\/p>\n<hr \/>\n<p>Nous avons pour mission de proposer un programme d\u2019avantages clairement d\u00e9fini afin de r\u00e9pondre aux besoins de nos employ\u00e9s en mati\u00e8re de sant\u00e9 et de revenu. Ces avantages comprennent donc\u00a0:<\/p>\n<ul>\n<li>Une assurance maladie compl\u00e9mentaire et une assurance dentaire<\/li>\n<li>Une assurance invalidit\u00e9<\/li>\n<li>Une assurance vie<\/li>\n<li>Une assurance individuelle contre les accidents<\/li>\n<\/ul>\n<p>Nous sommes li\u00e9s \u00e0 des principes d\u2019int\u00e9grit\u00e9 et de professionnalisme. De plus, nous cherchons \u00e0 offrir \u00e0 nos employ\u00e9s un service de haute qualit\u00e9 et une couverture exceptionnelle.<\/p>\n<hr \/>\n<div class='EmpList text'><div class='EmpNoPicture'>&nbsp;<\/div><h4>Directeur<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class='Employee'>Jeremy O&#039;Dell<br\/>Poste 2076<br\/><a href='mailto:odell.jeremy@adventist.ca'>odell.jeremy@adventist.ca<\/a><\/div><\/div>\n<div class='EmpList text'><div class='EmpNoPicture'>&nbsp;<\/div><h4>Renseignements g&eacute;n&eacute;raux \/ Soumission de r&eacute;clamation<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class='Employee'>(905) 433-3964<br\/>(800) 263-7868<br\/><a href='mailto:healthbenefits@adventist.ca'>healthbenefits@adventist.ca<\/a><\/div><\/div>\n<div style='clear:both'><\/div><div class='EmpList text'><div class='EmpNoPicture'>&nbsp;<\/div><h4>Sp&eacute;cialiste des avantages sociaux<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class='Employee'>Jesther Migrino<br\/>Poste 3552<br\/><a href='mailto:migrino.jesther@adventist.ca'>migrino.jesther@adventist.ca<\/a><\/div><\/div>\n<div class='EmpList text'><div class='EmpNoPicture'>&nbsp;<\/div><h4>Sp&eacute;cialiste des avantages sociaux<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class='Employee'>KJ Jacinto<br\/>Poste 3552<br\/><a href='mailto:jacinto.karen@adventist.ca'>jacinto.karen@adventist.ca<\/a><\/div><\/div>\n<div style='clear:both; height:1px; padding:0px; margin:0px'><\/div>\n\n<hr \/>\n<h4>Ressources D\u00e9partementales Disponibles<\/h4><ul class='Info'><li><a href='#category82'>eProfile Claims Submission<\/a><\/li><li><a href='#category52'>eProfile ClaimSecure Account<\/a><\/li><li><a href='#category91'>Preferred Pharmacy Network<\/a><\/li><li><a href='#category78'>Prior Approval for Major Dental Work<\/a><\/li><li><a href='#category12'>Administrative Forms<\/a><\/li><li><a href='#category9'>Claim Forms<\/a><\/li><li><a href='#category25'>Claiming Wellness Benefits for Active Employees<\/a><\/li><li><a href='#category77'>For Employer Use Only<\/a><\/li><li><a href='#category84'>GoodLife Fitness \/ Fitness Benefit<\/a><\/li><li><a href='#category13'>Optional Life, Optional Critical Illness &amp; AD&amp;D<\/a><\/li><li><a href='#category86'>Out Of Country - CANADA LIFE<\/a><\/li><li><a href='#category10'>Prior Authorization Forms<\/a><\/li><li><a href='#category14'>Short Term Disability<\/a><\/li><li><a href='#category15'>Tax Reporting<\/a><\/li><\/ul>\n<hr \/>\n<h4 id='category82'>eProfile Claims Submission:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/eprofile.claimsecure.com\/login'>eProfile Online Claims Submission<\/a><br\/>Once you&#039;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. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<\/ul><h4 id='category52'>eProfile ClaimSecure Account:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=989&amp;lang=fr'>Plan Member eProfile<\/A><br\/>eProfile Information<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=244&amp;lang=fr'>eProfile Online Registration<\/A><br\/>ClaimSecure eProfile Account Registration Instructions<\/li>\n<\/ul><h4 id='category91'>Preferred Pharmacy Network:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.telus.com\/en\/health\/organizations\/group-health-benefits\/employers\/virtual-pharmacy\/seventh-day-adventist'>Preferred Pharmacy Network Information<\/a><br\/>The future of your employee wellness plan begins with the TELUS Health Virtual Pharmacy app &mdash; 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. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.telus.com\/fr\/health\/organizations\/group-health-benefits\/employers\/virtual-pharmacy\/seventh-day-adventist'>Renseignements sur le R&eacute;seau de Pharmacies Pr&eacute;f&eacute;r&eacute;es<\/a><br\/>Le futur de votre r&eacute;gime de mieux-&ecirc;tre &agrave; l&rsquo;intention des employ&eacute;s commence par l&rsquo;application Pharmacie Virtuelle TELUS Sant&eacute; : il s&rsquo;agit de la fa&ccedil;on la plus facile de communiquer avec un pharmacien et de commander, de faire le suivi et de g&eacute;rer des m&eacute;dicaments prescrits pour vous et vos proches, en profitant d&rsquo;une livraison gratuite le jour ouvrable suivant. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<\/ul><h4 id='category78'>Prior Approval for Major Dental Work:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li>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).<\/li>\n<\/ul><h4 id='category12'>Administrative Forms:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=24&amp;lang=fr'>Benefit Change Request (Employee)<\/A><br\/>For Employee use when reporting any family update or address change.<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=25&amp;lang=fr'>Overage Dependent Form (21yrs old and up)<\/A><br\/>Complete only if your child(ren) is over age 21 and a full-time student.<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=991&amp;lang=fr'>Dependent Form Application (20yrs old and under)<\/A><br\/>Complete only if you have any child(ren) under age 21 who are attending school full-time outside of Canada.<\/li>\n<\/ul><h4 id='category9'>Claim Forms:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_drug-2002000-015A-CL-64.pdf'>Active Member and Regular Retiree --- DRUG CLAIM Form (english and french)<\/a><br\/>This DRUG CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_ehc_en-2002000-013A-CL-64.pdf?v=1738342184'>Active Member and Regular Retiree --- HEALTH CLAIM Form (english)<\/a><br\/>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. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=996&amp;lang=fr'>Active Member and Regular Retiree --- HEALTH CLAIM Form (french)<\/A><br\/>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.<\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_wellness_en-2002000-017A-CL-64.pdf?v=1738341136'>Active Member --- WSA CLAIM Form (english)<\/a><br\/>This WSA CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_wellness_fr-2002000-017A-CL-64.pdf?v=1738341191'>Active Member --- WSA CLAIM Form (french)<\/a><br\/>This WSA CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_dental_en-2002000-014A-CL-64.pdf?v=1738344269'>Active Member and Regular Retiree --- DENTAL CLAIM Form (english)<\/a><br\/>This DENTAL CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_dental_fr-2002000-014A-CL_64.pdf?v=1738344298'>Active Member and Regular Retiree --- DENTAL CLAIM Form (french)<\/a><br\/>This DENTAL CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_hssa_en-2002000-016A-CL-64.pdf?v=1738341640'>Health Care Spending Account Retiree --- HSSA Form (english)<\/a><br\/>This HCSA (aka HSSA) CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2022\/12\/form_claim_hssa_fr-2002000-016A-CL-64.pdf?v=1738341690'>Health Care Spending Account Retiree --- HSSA Form (french)<\/a><br\/>This HCSA (aka HSSA) CLAIM form is only needed to be filled out if you are mailing in your claims to ClaimSecure. <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li>Standard Dental Claim Form is available from your Dentist.<\/li>\n<\/ul><h4 id='category25'>Claiming Wellness Benefits for Active Employees:<\/h4><div class='sdacc_CatDesc'>Guidelines for the Wellness Benefits Account<\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=886&amp;lang=fr'>Wellness Spending Account (english) (WSA)<\/A><br\/>General WSA Questions<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=994&amp;lang=fr'>Wellness Spending Account (french) (WSA)<\/A><br\/>General WSA Questions<\/li>\n<\/ul><h4 id='category77'>For Employer Use Only:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=594&amp;lang=fr'>New Employee Enrollment Form (english)<\/A><br\/>For employers to enroll new employees into the Health Benefits Plan.<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=810&amp;lang=fr'>New Employee \/ Transfer Notice Form (english)<\/A><br\/>For employers to notify HBA of new employees<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=811&amp;lang=fr'>Employee Termination of Benefits Form (english)<\/A><br\/>For employers to complete when terminating employee benefits<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=604&amp;lang=fr'>Employee on Leave of Absence Waiver of Coverage (english)<\/A><br\/><\/li>\n<\/ul><h4 id='category84'>GoodLife Fitness \/ Fitness Benefit:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=649&amp;lang=fr'>Frequently Asked Questions (english and french)<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=997&amp;lang=fr'>GoodLife Fitness Corporate Program (english)<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=708&amp;lang=fr'>Programme corporatif Goodlife Fitness (french)<\/A><br\/><\/li>\n<\/ul><h4 id='category13'>Optional Life, Optional Critical Illness &amp; AD&amp;D:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=298&amp;lang=fr'>Accidental Death &amp; Dismemberment Rates (english)<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=1021&amp;lang=fr'>Accidental Death &amp; Dismemberment Rates (french)<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=845&amp;lang=fr'>Insurance Beneficiary Form (english)<\/A><br\/>Active Members to fill out this form if they want to modify their beneficiary information and \/ or to increase their optional insurances.<\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=885&amp;lang=fr'>Optional Life &amp; Optional Critical Illness Rates (english)<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=1022&amp;lang=fr'>Optional Life &amp; Optional Critical Illness Rates (french)<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=809&amp;lang=fr'>SUNLIFE Health Statement Form - Member &amp; Spouse<\/A><br\/>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<\/li>\n<li><a href='https:\/\/www.sunnet.sunlife.com\/public\/slfformdataintegrate\/req\/public\/displayForm?formId=3484-Opt-CI-MS-F&amp;lang=fr_CA&amp;formAppPath=\/Application_GB_GMU_Forms_1\/1.0'>SUNLIFE Health Statement Form - Member &amp; Spouse French<\/a><br\/> <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=990&amp;lang=fr'>SUNLIFE Health Statement Form - Member, Spouse &amp; Child(ren)<\/A><br\/>Please fill out this SUNLIFE Health Statement Form if you are requesting for Optional Life and \/ or Optional Critical Illness for YOU, YOUR SPOUSE and YOUR CHILD(REN)<\/li>\n<li><a href='https:\/\/www.sunnet.sunlife.com\/public\/slfformdataintegrate\/req\/public\/displayForm?formId=3484-Basic-Opt-CI-MSD-F&amp;lang=fr_CA&amp;formAppPath=\/Application_GB_GMU_Forms_1\/1.0'>SUNLIFE Health Statement Form - Member, Spouse &amp; Child(ren) French<\/a><br\/> <span class='Disclaimer'>(External Link)<\/span><\/li>\n<\/ul><h4 id='category86'>Out Of Country - CANADA LIFE:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=672&amp;lang=fr'>Out Of Country Insurance - CANADA LIFE - booklet English Effective February 01, 2025<\/A><br\/><\/li>\n<li><a href='https:\/\/www.adventist.ca\/wp-content\/plugins\/sdacc_functions\/forms\/deptforms.php?id=673&amp;lang=fr'>Out Of Country Insurance - CANADA LIFE - booklet French Effective February 01, 2025<\/A><br\/><\/li>\n<\/ul><h4 id='category10'>Prior Authorization Forms:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li><a href='https:\/\/www.claimsecure.com\/forms\/'>Prior Authorization Forms for Medication (english)<\/a><br\/>For Prior Authorization Forms, please visit https:\/\/www.claimsecure.com\/forms\/\r<br\/>click on &quot;Members&quot; \/ click on &quot;Special Authorization Forms&quot; <span class='Disclaimer'>(External Link)<\/span><\/li>\n<li><a href='https:\/\/www.claimsecure.com\/wp-content\/uploads\/2024\/11\/Standard-SpecAuthForm_French-.pdf?v=1731441451'>Prior Authorization Forms for Medication (french)<\/a><br\/> <span class='Disclaimer'>(External Link)<\/span><\/li>\n<\/ul><h4 id='category14'>Short Term Disability:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li>Claim forms available from your employer or Health Benefits Administration.<\/li>\n<\/ul><h4 id='category15'>Tax Reporting:<\/h4><div class='sdacc_CatDesc'><\/div><ul><li>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.\r<br\/>\r<br\/>For tax purposes you may report the portion not reimbursed to you if it meets the minimum medical expense deduction for Canada Revenue Agency.\r<br\/>\r<br\/>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.<\/li>\n<\/ul>\n\n","protected":false},"excerpt":{"rendered":"<p>Les r\u00e9clamations sont trait\u00e9es par ClaimSecure. Pour toute question concernant les r\u00e9clamations, veuillez contacter ClaimSecure par courriel \u00e0 l\u2019adresse service@claimsecure.com ou par t\u00e9l\u00e9phone au 1\u00a0888\u00a0513-4464. Pour toute question g\u00e9n\u00e9rale concernant les avantages sociaux, veuillez \u00e9crire \u00e0 healthbenefits@adventist.ca. Nous avons pour mission de proposer un programme d\u2019avantages clairement d\u00e9fini afin de r\u00e9pondre aux besoins de nos &hellip; <a href=\"https:\/\/www.adventist.ca\/fr\/services\/administration-des-prestations-de-maladie\/\">Continued<\/a><\/p>\n","protected":false},"author":14,"featured_media":0,"parent":94,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"template-simplewide.php","meta":[],"class_list":["post-994","page","type-page","status-publish","hentry","odd"],"_links":{"self":[{"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/pages\/994","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/comments?post=994"}],"version-history":[{"count":13,"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/pages\/994\/revisions"}],"predecessor-version":[{"id":19778,"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/pages\/994\/revisions\/19778"}],"up":[{"embeddable":true,"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/pages\/94"}],"wp:attachment":[{"href":"https:\/\/www.adventist.ca\/fr\/wp-json\/wp\/v2\/media?parent=994"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}