When submitting a claim, your primary attachment (the first one we ask for) should almost always be the original benefits receipt your provider gave you. If you already submitted your service to another insurer, they will have provided you with an "EOB" (Explanation of Benefits) afterward. You should upload that EOB as your primary attachment any time you would like to claim the rest of your service. Also make sure to upload the original benefits receipt as a secondary attachment to ensure your claim can be approved faster.
Simply Benefits follows the Canadian Life and Health Insurance Associations recommendations for claims receipts. This helps ensure receipts are consistently formatted by your health providers, and provides us with enough information to settle your claim.
According to the CLHIA, receipts should include:
- Receipt Date (typically formatted YYYY/MM/DD)
- Date of Service/ Supply
- Amount paid by any other party (reason must be given)
- Provider name
- Clinic name
- Provider address (if treatment provided at a diff address i.e customer home – both addresses to be provided)
- Provider phone number
- Provider identification number, designation or credentials
- Patient name
- Type of service/supply provided (clearly identified if initial or subsequent visit). If medical supply, then make and model number (if applicable) are to be provided, and the description should also indicate if the equipment is initial or replacement
- Quantity provided
- Length of treatment if applicable (must indicate 45/60/90 mins etc)
- Charge amount (clearly show ($) immediately before charge amount)
Services and treatments can only be considered for reimbursement if they have been paid; Additional proof of payment is sometimes required depending on the receipt provided. Unfortunately claims for advanced treatment plans cannot be considered.
Claims for gift vouchers, shipping and handling or portions of claims including gratuity are also not eligible for reimbursement.
These recommendations are widely enforced by Simply Benefits. We will reach out to you if there are any concerns or gaps with a provided receipt, and work with you to quickly get the claim settled.
Please note that all reimbursements are in CAD. If a claim is submitted in any other currency, Simply Benefits will use the exchange rate at the time of adjudication.