Submitting a Claim

Download from the App Store or Google Play. On the app, you can submit claims for:

• Drugs (Extended Health Care)
• Other Medical Services & Supplies (Extended Health Care)
• Vision Care
• Dental Care
• Spending Accounts

Submitting a claim on the app is quick and easy:

• Log in to the My ASEBP Mobile App
• Tap the + icon to submit a claim
• Select the type of claim you would like to submit
• Add a receipt or any other applicable documents (like an Explanation of Benefits statement) for all but Spending Account claims
• You can either take a photo of your receipt/document with the app or upload a file from your phone.
• Submit, and you’re done!

You can also transfer unpaid claim amounts to your Health Spending Account (HSA) with the tap of a button from the Claims screen.

Reminders:

• If you coordinate benefits with another plan, please ensure the amount you are transferring to your HSA is your true out-of-pocket expense to avoid overpayments.
• There are submission deadlines for both HSA and Wellness Spending Account expenses. Please keep your receipts as you may be required to produce them.

On My ASEBP, you can submit claims for:

• Drugs (Extended Health Care)
• Other Medical Services & Supplies (Extended Health Care)
• Vision Care
• Dental Care
• Spending Accounts

To submit your Drugs, Other Medical Services & Supplies, Vision, Dental and Spending Account claims:

• Create a My ASEBP account using your personal (not work) email address
• Log in
• Click Submit a Claim at the top of the page
• Enter your claim details
• Indicate if you have coverage through another benefit plan
• Upload receipts or any other applicable documents (like an Explanation of Benefits statement) for all but Spending Account claims
• Submit, and you’re done!

You can also transfer unpaid claim amounts to your Health Spending Account (HSA) from the Claims page.

Reminders:

• If you coordinate benefits with another plan, please ensure the amount you are transferring to your HSA is your true out-of-pocket expense to avoid overpayments.
• There are submission deadlines for both HSA and Wellness Spending Account expenses. Please keep your receipts as you may be required to produce them.

Paper claim forms can be submitted for:

• Drugs (Extended Health Care)
• Other Medical Services & Supplies (Extended Health Care)
• Vision Care
• Dental Care
• Spending Accounts —only through exceptions

Submitting a claim through the My ASEBP Mobile App or My ASEBP may not always be possible, so going the more traditional route of completing a paper claim form is still an option. Simply download the claim form you’re looking for, fill it out, attach your receipts and any other applicable documents and mail it to us.

As a reminder, there are submission deadlines for both Health Spending Account and Wellness Spending Account expenses. Please keep your receipts, as you may be required to produce them.

Accidental Death & Dismemberment Claims

For more information, please see Accidental Death & Dismemberment.

Life Insurance Claims

For more information, please see Life Insurance.

Extended Disability Claims

For more information, please see Extended Disability Benefits.

Travel Emergency Claims

All your Travel Emergency claims must first be reviewed by Alberta Health Services (AHS) to determine if they can cover any eligible expenses. To make the process easier for you, ASEBP coordinates the entire claims process on your behalf, so there’s no need for you to contact AHS on your own.

To ensure your claim is processed properly, please complete both the ASEBP and AHS sections of the Emergency Travel Claim form. When completing the AHS section, note that:

• The From Date should be the date your trip began
• The To Date should be 18 months from the date your trip began

AHS can take several months to assess these claims and forward their final payment and statement of account. Ensuring the information on your forms and any other documentation provided is accurate and complete and mailed to us as a package will help prevent delays.

If you submit your claims online through your My ASEBP account or the mobile app, you can upload images of receipts, plus the Explanation of Benefits (EOB), if you coordinate benefits. To avoid a delay in receiving your claim reimbursement, you will want to ensure the following information is clearly visible in the image:

• First and last name of the patient who received the treatment, service or product
• Service or treatment date or date the product was purchased
• Provider’s name, address, and, if applicable, their credentials/registration number. Please note that products and services must be provided or purchased from a licensed provider or authorized medical supply store, when applicable. For specific requirements, please contact a benefit specialist.
• Detailed description of the service, treatment or product
• Total cost and amount paid (including what another provider paid in the EOB, if applicable)

If any of the above information is missing, cut-off or too blurry, your claim may be denied, which will delay your reimbursement. If that happens, you will have the opportunity to resubmit your claim with a new image.

Spending Account Receipts

Submission Deadlines

As a reminder, there are submission deadlines for both HSA and WSA expenses. Please keep your receipts, as you may be required to produce them.

Health Spending Account (HSA) Receipts

Note that while you don’t have to submit a receipt for HSA expenses, we may randomly review expense submissions both before and after you have been reimbursed. By submitting expenses online, you agree to provide us, if requested, the receipts and/or Explanation of Benefits statements which support your expenses. As you would with your tax documents, you should keep all receipts and Explanation of Benefits statements for at least seven years.

Wellness Spending Account (WSA) Receipts

Note: order confirmation or summary statements are not proof of payment and will not be accepted in place of a receipt. See below for receipt information requirements.

You may need to submit a receipt for WSA expenses—you’ll be prompted during the submission process on My ASEBP if it’s required. As you would with your tax documents, you should keep all receipts for at least seven years.

Required Receipt Information: ASEBP is obligated to follow standards for documentation as stipulated in Spending Account agreements with employers. As such, photo, scanned, or hard copy receipts must clearly indicate:

• details of the item(s) purchased,
• date payment was processed,
• amount paid, including taxes
• payment method (i.e., credit card, debit card, etc.)
• details about who sold the item

Typical online claims (submitted through My ASEBP) take five to seven business days to process. Paper claims are generally processed in 10 – 14 business days. We issue all of our claim payments electronically, so it’s important that we have your most current banking information on file. You can add or update your banking details quickly online through My ASEBP by clicking the profile icon and then My Profile.

This is a service your health care practitioner can sign up for that allows them to submit your claims (e.g. massage therapy, prescriptions, dental checkups, etc.) directly to ASEBP. With direct billing you’ll only be required to pay the outstanding amount not covered by your plan at the point of sale or service. Remember, any outstanding amounts can be submitted to your Health Spending Account, if you have one.

When direct billing isn’t available with a health care practitioner, assignment billing allows you to authorize them to make a claim on your behalf by completing the Assignment of Benefits section on our Extended Health Care and Vision Care Claim form. With assignment billing you’ll only be required to pay the outstanding amount not covered by your plan at the point of sale or service. This service is only available for three benefits: ambulances, hospital rooms and oxygen, along with supplies related to its use.

Overview

ASEBP’s Trustees have established an appeals structure that reflects their belief that health is a shared responsibility.

View ASEBP’s Appeal Process.

Total Disability Appeals

These appeals are about whether you meet the definition of Total Disability under the Extended Disability Benefits (EDB) plan. Most often, this involves a disagreement about the interpretation of medical information. You can appeal a claim decision in either of the following two cases:

• if your application is declined
• if your claim is terminated

The outcome of your appeal will be based on a review of your claim file, a copy of which will be shared with you. You are also invited to present in person, and with a representative, if you choose, to demonstrate how you meet the definition of Total Disability based on medical information in your claim file.

If you wish to proceed with an appeal, please complete a Total Disability Appeal Request.

You must submit your Total Disability Appeal Request form within 60 calendar days of when you were notified of the decision. ASEBP may grant an extension when there are extenuating circumstances, such as hospitalization, natural disasters, etc.

If you have additional medical information regarding your situation, please submit it to your ASEBP adjudicator or case manager for their review and decision. This information cannot be submitted as part of an existing appeal. Once the information is reviewed by your adjudicator or case manager, and if their decision on your file remains unchanged, your appeal will continue.

All appeal decisions are final. Once a decision is made, ASEBP’s appeals facilitator will email you the appeal decision within three to five business days.

Please note: ASEBP’s appeal body does not provide rationale for their decisions and the appeals facilitator is unable to advise why your appeal may have been denied.

Policy Appeals

Policy Appeals are about coverage and claims (excluding Total Disability). Only covered members can appeal, even if the decision relates to one of your dependants.

Generally, you can appeal in the following two cases:

• When there is a disagreement about the evidence used to make a decision:
  • interpretation of medical information; or
  • the assessment of whether relevant factors are present (e.g., are you a resident of Canada, does the EDB pre-existing condition clause apply as stated).
• When you can demonstrate medical necessity and extenuating circumstances:
  • medical necessity: current documented support from a recognized health care professional (usually a physician or nurse practitioner)
  • extenuating circumstances: established when the group plan design results in hardship to an individual (e.g., purchasing a life-sustaining drug that isn’t on the ASEBP Drug Benefit List, there are no other sources of funding and paying for it yourself will cause financial hardship).

As individual circumstances vary, you are encouraged to complete a Policy Appeal Request. By providing summary information, ASEBP can determine whether your situation qualifies as a Policy Appeal and what information is required for your appeal file.

You must submit your Policy Appeal Request within 60 calendar days of when you were notified of the decision. ASEBP may grant an extension when there are extenuating circumstances such as hospitalization, natural disasters, etc.