Frequently Asked Questions

Click on the benefit booklet or call the western CLAC Benefit Administration office at 780–454–6181 or 1–888–600–2522 (toll free).

All claims must have a completed claim form and can be sent directly to the Sun Life office. You should inform your dentist that he or she can use electronic data interchange (EDI) to send your claims to Sun Life. The Sun Life address should be on the back of the claim form or on your certificate of insurance.

• your union steward
• downloading it from this website at Forms
• nearest CLAC office
• your employer
• call the western CLAC Benefit Administration office at 1–888–600–2522 (toll free)

Once every nine months. Any work you require, however, such as a filling or extraction, can be done any time without limits.

When you visit your dentist, take along your benefit booklet. Your dentist is a professional who can soon tell which procedures are covered and if there are any predetermination (prior approval) requirements.

Yes it is. In Alberta, there was a problem in the late 1990s. Alberta dentists were unwilling to establish a dental fee guide. However, the industry has developed a 2000 Reimbursement Guide effective January 1, 2000, which is used to pay claims by all insurance companies, and it is updated annually.

No. You must purchase your eyewear and submit the claim to the western CLAC Benefit Administration office.

You must contact the western CLAC Benefit Administration office for the proper claim form. This form must be completed by you, your doctor, and your employer. The form must then be sent to the western CLAC Benefit Administration office for processing.

There are no limits to the amount you can claim at a particular time. It is recommended that you have more than $25 in receipts per claim, but this is a guideline only. All claims must be submitted no later than 90 days after coverage terminates or by the end of the year.

Present your Assure card to the pharmacist when purchasing a prescription. The pharmacist keys in the necessary information and submits it to Assure Health electronically. Your claim is then adjudicated and a message is sent back to the pharmacy indicating what amount will be paid by your plan and any amount you owe.

The Assure card can be used at most drug stores in Canada. Over 99 percent of pharmacies in Canada are connected to Assure Health for processing drug claims. In Alberta, 100 percent of pharmacies are on the Assure network.

If you do not have your Assure card to present to the pharmacist, you will need to pay for the prescription yourself and then submit a paper claim and your original receipt for reimbursement.

No. You cannot use your Assure card at pharmacies in the United States.

No. Your Assure card can only be used for prescription drug claims.

No. The only information on the magnetic strip at the back of the card is the information on the front of the card. All the information on who and what is covered by the plan is stored in Assure Health's central computer system. The pharmacist dials in to this system to have your claim adjudicated.

In order to determine what problem has occurred with a claim, it is helpful to provide your plan administrator or insurance company representative with as much information as possible. The following information is helpful:

• your plan number;
• the name of your employer;
• your name and employee identification number;
• the name of the patient receiving the prescription (you, your spouse, your child) and that person's date of birth;
• the date of the claim in question;
• the name of the drug involved if you know it;
• the name and address of the pharmacy; and
• a general explanation of what happened at the pharmacy.

The more complete information you can supply, the easier it will be to quickly resolve your problem.

Pharmacies can transmit their customer's drug claim online to both the primary plan and the secondary plan when both plans have a drug card. If the pharamcist is aware there is a secondary plan, he or she will be able to transmit a claim under the secondary plan indicating what amount was allowed under the primary plan. In most cases, this will permit a total of 100 percent reimbursement to the pharmacist.