Claim Procedures

Current Underwriter (2020) - Desjardins Financial Security
Policy Number: 140834

Health Claims

The member may submit claims to the Plan Administrator, Johnson Inc., at any time up to the end of the calendar year following the year in which the expense was incurred. All claims are paid based on the date the expense was incurred. For all Health claim benefits, when the member’s insurance terminates for any reason, written proof of claim must be submitted to the Plan Administrator, Johnson Inc., within 90 days of the date of termination of insurance.

Direct Pay Drugs

A drug card is issued by the Plan Administrator, Johnson Inc., to all new members, and to any member, upon request. For drug claims incurred in Newfoundland and Labrador, an eligible member may upon presentation of the drug card, obtain drugs from a pharmacy by paying only the pharmacy dispensing fee and markup. The pharmacist will bill the Plan Administrator, Johnson Inc., for 100% of the ingredient cost of the eligible prescribed drug. If a drug claim is not payable in the above manner, an eligible member must pay the entire purchase cost to the pharmacy and submit proof of claim to the Plan Administrator, Johnson Inc., for reimbursement of eligible expenses.

Hospital

An expense will be incurred if the member requests semi-private or private accommodation while in hospital. Upon presentation of the drug card to the hospital, the hospital will bill the Plan Administrator, Johnson Inc., for the eligible expenses covered under the Hospital Benefit. The member will be required to pay the hospital the remaining expenses not covered by the Plan. Many other expenses such as physiotherapy, chiropractor, and vision can be reimbursed by using your prescription drug card.

Other Expenses

Many other expenses such as physiotherapy, chiropractor, and vision can be reimbursed by using your Prescription Drug Card. For all other expenses not payable in the above manner, you are initially required to pay the full cost. A claim form should be completed and returned to the Plan Administrator, Johnson Inc., along with the original paid in full receipt, for reimbursement of eligible expenses. Eligible expenses shall not include expenses incurred for any services, treatments and supplies which are not specifically listed in the Eligible Expenses Clause of the Master Policy.