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 information about Accidental Death & Dismemberment claims, please see Guiding you Through Life Events.

Life Insurance Claims

For information about Life insurance claims, please see Guiding you Through Life Events.

Extended Disability Claims

For information about Extended Disability claims, please see Guiding you Through Life Events.

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 Out-of-Country 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.

Please ensure submitted receipts contain the following information:

• First and last name of the patient who received the treatment, service or product
• Service date or date the product was purchased
• Provider's name, address and, if applicable, their credentials/registration number
• Total cost and amount paid
• Detailed description with cost breakdown

Spending Account Receipts

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

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. Photos or scans of receipts are accepted as long as the date of purchase, details of the item purchased, amount paid and details about who sold the item are visible and legible. As you would with your tax documents, you should keep all receipts for at least seven years.

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.

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.

Learn more about the type of appeals ASEBP allows below and check out this infographic to help guide you through the appeals 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 believe you meet the definition of Total Disability.

If you have new medical information regarding your situation, please submit this to your claims facilitator for their review and decision. This information cannot be submitted as part of an existing appeal. Once it's reviewed by your claims facilitator and their decision on your file remains unchanged, your appeal can continue.

For more information about this appeals process, contact your claims facilitator. 

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
  • 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)
  • 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 e.g., hospitalization, natural disasters, etc.