FAQs - Health insurance
How it works
Health insurance covers vision, dental, and medical expenses you may incur. Canadian residents have access to coverage for basic medical services through their Provincial Health Plan. Supplemental health insurance plans cover expenses your provincial plan may not. For example, Ontario Health Insurance Plan (OHIP) does not cover eyeglasses but Flexcare, one of Manulife’s supplemental health and dental plan does (subject to plan maximums).
Copay (short for copayment) is generally standard to most health insurance plans. A copay is a flat fee paid by the insured on some health care services such as doctors’ visits. For example, the insured pays a flat $10 on prescriptions and insurance covers the remaining balance up to plan and annual maximums (maximum amount to be paid out by insurance provider in a year). Manulife Individual Health and Dental plans do not apply a copay, but do apply a co-insurance. Co-insurance is also an amount paid by the insured on health and dental claims expressed as a percentage not a flat fee.
You can have a group benefit plan (a plan provided to a group of members most commonly by your employer) and an individual health insurance plan however, you cannot have multiple Manulife individual health insurance plans.
Yes, health insurance plans have plan maximums (maximum amount to be paid out by insurance provider for a specific plan). Maximums vary depending on plan and specific services or items being covered. These plan maximums can be annual maximums (maximum amount to be paid out by insurance provider in a year) and/or lifetime maximums (maximum amount to be paid out by insurance provider during the lifetime of your policy and/or benefit). Once your health insurance plan is maxed out the insurer will not reimburse future claims.
To get health insurance, you must meet the following requirements:
- be a resident of Canada,
- have coverage under your government health insurance plan,
- be at least 18 years of age on the date of application for the policy, except for children of an insured person.
- Quebec residents must also be registered under the RAMQ Prescription Drug Insurance Plan or have equivalent coverage under a group plan, and
Note: If the plan is medically necessary or requires a medical questionnaire, you must disclose any medical condition, injury or illness that occurred or existed on or before the date of your application, regardless of whether you went to see a doctor about the condition or were given a diagnosis, or whether or not you believe that it is important.
An annual premium is the amount you pay for your health insurance. Cost of insurance varies based on factors such as age, type of coverage etc. The first premium payment is due before the effective date of the policy.
Yes, you can get treated without health insurance as most Canadians have coverage under their provincial plan. For non-Canadian residents who aren’t covered under provincial plans, medical expenses can be costly. It is recommended that non-Canadian residents look at health insurance options such as a Manulife CoverMe Visitor to Canada plan as provincial plans such as OHIP will only be in affect after 3 months.
You have 12 months from the date you were charged for a health and dental service to submit your claim for reimbursement.
If your claim form is complete and accurate, you will generally receive payment within six business days. When information is missing, we may have to return the claim form to you. This delays processing and payment.
First, check to see if your provider has already submitted your claim. Often, you don't have to submit a claim because many hospitals, pharmacies and dentists can submit your claim directly to us. If it’s submitted for you, there's no online form or paperwork needed , and you only pay the amount your plan doesn't cover.
If your provider hasn't already submitted your claim, you can submit your claim online or on paper by mail.
Submit your claim online:
- Within 12 months of the date you were charged
- After you've paid more than any deductible in your plan
- Specify the currency if your claim is for services outside Canada
- Hold onto original receipts and applicable supporting documentation for 12 months
Submit your claim on paper by mail:
- Within 12 months of the date you were charged
- After you've paid more than any deductible in your plan
- Specify the currency if your claim is for services outside Canada
- Include original receipts and applicable supporting documentation
- Make sure you've signed your claim form
- Extended health claim form – for all covered expenses except dental expenses
- Dental benefit claim form – must be completed by your dentist or dental specialist
Submit your claim online:
- Within 12 months of the date you were charged
- Hold onto original receipts and applicable supporting documentation for 12 months
- Include original receipts and applicable supporting documentation
Submit your claim on paper by mail:
- Within 12 months of the date you were charged
- Include original receipts and applicable supporting documentation
- Make sure you've signed your claim form
- Extended health claim form – for all covered expenses except dental expenses
For FlexCare Customers
If you're in Canada or the United States, call our Assistance Centre at 1-800-805-1008. Outside of Canada or the United States, call collect at 1-519-251-7298.
For Follow Me Customers
If you're in Canada or the United States, call our Assistance Centre at 1-855-857-5919. Outside of Canada or the United States, call collect at 1-519-251-1570.
For Guaranteed Issue Enhanced Customers
If you're in Canada or the United States, call our Assistance Centre at 1-800-805-1008. Outside of Canada or the United States, call collect at 1-519-251-7298.
Call 1-800-268-3763 and we will tell you what documentation we need. You can also write to us:
Manulife Affinity Markets, Life and Living Benefits Claims Unit
PO Box 670, Stn. Waterloo, Waterloo ON N2J 4C6
Call 1-800-268-3763 to speak to a customer service professional. You must complete nursing approval forms before starting homecare and nursing services.
Prescription drug receipts must be original receipts (not statements) and show:
- Name of drug
- Drug identification number (DIN)
- Date of service
- Prescription number
- Prescription strength and quantity
- Drug cost
- Dispensing fee (if applicable)
All other receipts must be original receipts on the printed letterhead of the person or company providing the service and show:
- Name of patient
- Date(s) of service
- Description of service
- Cost of each service
- Proof of payment
You need a prescription for drugs and you may need a doctor’s note for some health care services.
When a proposed course of treatment is expected to cost more than $500. Get an estimate by sending us the Dental benefit claim form for assessment before the procedure is done. Ask your dentist to outline the proposed treatment plan and to include x-rays if available. We will let you know how much your plan will cover.
Before you arrange for any prosthetic appliances, homecare, nursing, medical equipment and supplies , hearing aids, orthotics or surgical stockings, complete the prior authorization form and send it to us. We will let you know how much your plan will cover. We would ask you not to register for or purchase from an authorized medical supplier until you hear about whether your request has been approved or declined. Keep in mind that most government health insurance plans also contribute towards these costs, if there is coverage through the government plan, you will need to send your claim to that plan first.
When you submit your claim, you must include:
- Original receipt
- Copy of government health insurance plan contribution statement (including the portion paid)
- Written prescription/functional assessment from a certified plan authorizer
Costs submitted after 12 months
To consider a health and dental claim, we must receive all the information we need within 12 months of the date you paid for the expenses you're claiming.
Costs that aren't medically necessary
Health claims must be deemed medically necessary under the terms of your plan Preventative dental services aren’t usually medically necessary, however, they are allowable if your plan covers them.
Costs associated with excluded conditions
Some plans require the completion of a medical questionnaire and therefore specific health conditions could be excluded. There is no coverage for any treatments – including but not limited to medications – that relate to an excluded condition under such plans. Your health care provider must explain if a treatment that can be used for an excluded condition is being used to treat an unrelated condition. Include this explanation when you submit your claim.
If we approve your claim, we will pay it and you will receive a cheque or, if you have registered for it, direct deposit and an electronic claims statement. If your claim form is complete and accurate, you will generally receive payment within six business days. You can check the status of a claim at any time online.
Log in online anytime to see:
- Status of submitted claims
- Claims activity in last 12 months
- Benefit details including dollar maximums
Every province and territory has a different health insurance plan – check your health ministry's website for details.
All our plans have a 30-day money-back guarantee. If you are not completely satisfied, return your package with the policy by mail to Manulife within 30 days of the issue date. We will cancel your coverage and refund any premiums you paid.
Without health and dental coverage, routine and unexpected health and dental expenses can be very costly. If you have a serious illness or injury, you can be especially vulnerable because government health insurance plans offer limited coverage for expenses. Health and dental coverage is an affordable way to protect your savings.
We’ve made things easy for you and have the premium receipts available on the same portal that you can use to submit your claims electronically. If you have not registered for our site, you can register now and do not have to wait. Your tax receipt is available on the secure portal.
To access your receipt at that time:
- Sign in using the link above to Secure Service. If you haven’t visited our Secure Service portal yet, please register to access your information
- Navigate through the easy-to-use online portal
- Find your receipt under the payments section
For our health and dental policies that include Emergency Travel benefits our Assistance Centre is contacted because an insured is being treated for a medical emergency, a confirmation that the patient purchased insurance coverage is sent to the medical provider.
The Assistance Centre has existing relationships with medical providers in many vacation destinations, as well as contacts all over the world, to ensure emergency situations are handled as smoothly as possible.
There may be some medical providers who will require a small deposit or assurance that they will be paid. In almost all cases, once the Assistance Centre is contacted and actively managing the case, the providers will directly bill Manulife, and in almost all case you will not see a bill.
In the unusual event that a foreign hospital requires the patient to make a deposit or, in rare situations, pay the hospital directly, Manulife will promptly reimburse these expenses to the insured once we ensure that the terms and conditions of the policy have been met and all the claim documentation is received.
It is so important to call our Assistance Centre at 1-855-857-5919 or 1-519-251-1570 before you get emergency medical treatment.
A "pre-existing condition" means any condition that existed prior to your effective date.
Pre-Existing Condition means any disease or physical condition, whether diagnosed or not, for which symptoms occurred or medical treatment was sought, recommended, required, or obtained, from or by a Physician (medical treatment including any medical advice, consultation, care, diagnosis, treatment or service provided by a Physician), or for which drugs were prescribed by a Physician or taken by an Insured Person, during the 24-month period immediately preceding the Effective Date of Coverage.
Our health and dental plans that offer guaranteed acceptance, including the Flexcare® ComboPlusᵀᴹ Starter Plan, Guaranteed Issue Enhanced Plan, and all four FollowMeᵀᴹ plans for people whose group benefits are ending, cover eligible pre-existing conditions and eligible current medications. Our other health and dental plans only cover new medications. Refer to your policy for more details.
Your coverage generally starts on the 1st of the following month for health and dental plans that offer guaranteed acceptance, and the 1st of the month after your plan is approved for health and dental plans that require a medical questionnaire. However, if you buy a Flexcare plan or Guaranteed Issue Enhanced plan within the first 7 days of the month or a FollowMe plan within the first 15 days of the month, you can choose to start your coverage on the 1st of the current month. As soon as your coverage starts, you have access to most of the benefits in your plan, with the exception of some benefits that have a waiting period. Refer to your policy for more details.
We ask you to pay your first two months of premiums when you buy your policy. After that, your premiums are due on the first business day of the month.
Call 1-877-268-3763 to speak to Manulfe’s Customer Service.
Your application is approved right away if you applied for a health and dental plan that offers guaranteed acceptance and we received your initial two months premium. For health and dental plans that require a medical questionnaire, the approval process may take a few weeks.
Two of our Flexcare® plans – ComboPlusᵀᴹ Enhanced and DrugPlusᵀᴹ Enhanced – cover birth control drugs, subject to pre-existing condition exclusions. Birth control drugs are also covered on our Guaranteed Issue Enhanced plan.
Our health and dental plans require that you be covered by a government health insurance plan. If you aren't covered by one yet, our travel insurance plans for visitors to Canada can help protect you until you are eligible to apply for health and dental coverage.
Two of our Flexcare® plans – ComboPlusᵀᴹ Enhanced and DrugPlusᵀᴹ Enhanced – cover brand-name medications. For all other Flexcare health and dental plans, we will cover brand name up to the cost of a generic equivalent. Coverage and eligibility will be subject to exclusions and limitations.
We cover Diabetic supplies such as test strips, lancets, and syringes. We do not cover glucometers, insulin pumps, and any related equipment, supplies, treatment or procedures.
Your plan number is 5 to 6 characters long and can contain both numbers and letters. You can find your plan number on your Manulife wallet card.
Your identification number is a 7 to 10 digit number. You can find your identification number on your Manulife wallet card.
We can help with that!
For health and dental online claims, how can I change my password?
We can help with that!
For health and dental online claims, what do I do if I'm locked out of my account?
We can help with that!
For health and dental online claims, I reset my password but haven't received your email. What do I do next?
Check your trash or junk folders to see if your email went in one of those by mistake.
If it's not there, click Reset password, follow the steps and we'll send you another email.
If you still do not a receive an email, give us a call: 1-800-268-3763
Monday to Friday, 8am to 8pm, Eastern Time
For health and dental online claims, how do I register?
It's easy. Simply click Register and follow the steps.
Our medical marijuana program is available under Flexcare plans and the Guaranteed Issue Enhanced plan, as a part of drug benefits (plan limitations apply, refer to schedule of benefits).
Patients will need to submit a Prior Authorization form to Manulife for assessment. Members will need to select “Medical Marijuana” from the drop down menu and have their doctor fill out the medical information. Please follow the instructions on the form carefully. If approved, the patient will receive a welcome call from the Shoppers Drug Mart Cannabis Care Centre. The pharmacist will review the patient’s needs, advising them on the different strains of medical marijuana and the different ways to take it. Based on this support, patients can choose the treatment that best meets their needs and is covered under their plan.
Our program offers:
- Member referral to specially trained pharmacists at the Shoppers Drug Mart Cannabis Care Centre
- Coverage guidance based on the approved formulary
- Help with the coordination of medical marijuana distribution
- Case management, which includes patient oversight and outreach for follow-up
- A support line that is available for continuous guidance throughout the process
Dependents and Co-applicants Questions
No, child support does not have to include health insurance. This is a personal decision as child support is not required to include a health insurance plan.
Yes, marriage is a qualifying event (or a life event) for health insurance. Qualifying events include major events that makes you eligible to change their plan outside of the period where you can sign up for or change your health insurance plan. A qualifying event also allows you to add or remove dependents from your policy.
No, coverage for health insurance only applies to immediate family in your household. A grandchild can be added as a dependent if you have legal guardianship and they reside with you.
Stepchildren can be covered under health insurance however it is supplemental (an accessory). Biological and adoptive children are covered as long you have legal guardianship. Family coverage (insurance policy that covers family members as well as the primary insured) does not cover members of your household if they are stepchildren.
This is a personal decision and may be beneficial to cover for expenses your provincial plan may not. While it is a personal choice, newborns can be added to the policy within the first 30 days without medical underwriting (is when medical or health information is used to evaluate to evaluate coverage).
Health insurance coverage can help cover expenses that are not covered by individual health insurance plans (insurance plans purchased on your own) and or provincial plans. Health insurance is crucial to cover unexpected medical expenses. Financial impacts from these unexpected impacts can be devastating. For example, OHIP does not cover drugs administered outside of a hospital setting whereas supplemental health insurance may.
Plans vary depending on your coverage. Flexcare and FollowMe customers can stay on their plan up to the age of 21. Most group plans (plans provided to a group of members most commonly by your employer) cover children to the age of 21 if they are not in school, or up to age 25 if they are enrolled in post-secondary program.
Yes, however underwriting may occur. Adding or removing a spouse can occur at any time in the cycle of the policy and the difference will be billed or refunded depending on the case.
It can. Separated partners can choose to keep each other on their health insurance policy, however usually when people legally separate, they find separate insurance plans.
If you have your own insurance plan (through an employer for example) this is your primary health insurance and would come before a supplemental plan (a plan that covers costs above your provincial plan) or a plan in which you are a dependent. Your plan is the primary plan and any additional plans are supplementary (additional).
Life events are major events (getting married, having a child, losing group benefits etc.) that makes you eligible to change your plan outside of the regular period in which you can sign up for or change your health insurance plan including adding or removing dependents.
FlexCare Questions
Yes, you can cancel your individual health insurance at any time. There is a 24-month waiting period to get new coverage (at Manulife).
The choice of having private health insurance (also known as supplemental health insurance) is a personal one. Supplemental health insurance helps cover unforeseen expenses (e.g. supplemental (added) costs of surgeries, medical consultations, dental and vision appointments, prescription drugs etc.) which are not covered by a government health insurance plan. For example, a supplemental health insurance plan like Flexcare can cover eye exams and other vision costs that may have previously been paid out of pocket.
Individual health insurance coverage is insurance coverage that you purchase on your own to cover yourself or immediate family members. Individual health insurance is not provided through a group or employer. Additionally, it covers medical treatments and supplies not in your provincial plan.
Comprehensive plans cover a wide variety of expenses. While not all insurance plans are comprehensive, they are supplemental. Supplemental health insurance can cover prescription drugs, dental cleaning and orthodontics, hospital room coverage, vision care and paramedical services etc. Supplemental health insurance covers medical treatments and supplies not in your provincial plan.
In order to purchase supplemental health insurance (covers costs above your provincial plan), you must be over age of 18, have an active government health insurance plan (GHIP), and be a resident of your home province/territory.
Part-time employees are eligible for insurance plans. It is up to the discretion of the employer if there are group plans (plans provided to a group of members most commonly by your employer) available. Part time employees can purchase supplemental health insurance (covers costs above your provincial plan) as a top up to their group plan.
Contractors do not often receive health insurance from their employer. However, supplemental health insurance (a plan that covers costs above your provincial plan) plans are available.
All core Flexcare plans include vision. Dental coverage varies depending on plan type.
Provided the health insurance policy meets the definition of “Private Health Services Plan”, a defined term under the Income Tax Act (the “Act” herein), section 20.01 of the Act permits a self-employed individual deduct amounts payable under an insured PHSP health insurance plan (e.g. not a cost-plus or health spending account) for a benefit of the individual, his or her spouse or common-law partner, or any member of the individual’s household, provided certain thresholds are met.
- As per CRA Interpretation Letter (2015-0581431E5), "Where a sole proprietor has no employees, paragraph 20.01(2)(c) of the Act limits the premium deductible for each full year of coverage by a dollar maximum. This limit is equal to $1,500 for each of the individual, the individual's spouse and members of the individual's household who are 18 years of age or over, and $750 for members of the individual's household who are under the age of 18, pro-rated based on the number of days in the period which are in the year. The dollar limit includes any applicable provincial sales tax and goods and services tax." Refer to Refer to CRA Interpretation Letter 2015-0581431E5 for additional information.
- Pursuant to paragraphs 20.01(2)(b) and (d) of the Act, there are also limitations on deductibility of PHSP premiums if the sole-proprietor has employees including arm's length employees. For more information, refer to section 20.01 of the Act and consult with your tax advisor.
If you are self-employed, you are most likely not eligible for group plans and benefits. Self-employed individuals can find coverage in government plans (provincial plans) and supplemental health insurance plans (plans that cover costs above your provincial plan).
No, you do not need to take health insurance from your employer. Supplemental health insurance plans (plans that covers costs above your provincial plan) are also available for you to purchase on your own. The only way in which you would have to take the employer plan is if it pays 100% of the premiums or if you agree to take it as part of a union agreement.
Business owners can get supplemental health insurance coverage (a plan that covers costs above your provincial plan). The amount of insurance needed is a personal choice and research can be conducted into different plan types and options.
Most provinces have provincial coverage. You also may be able to seek coverage through a spouse’s group plan. Additionally, supplementary health insurance plans (plans that cover costs above your provincial plan) are available (for example FollowMe) for opt-in if first premium (first payment made towards insurance policy) is paid within 90 days of your employee benefits ending.
Yes, laser eye surgery forms part of the Flexcare vision benefit. Laser eye surgery is covered up to the annual benefit maximum of your plan.
Critical Illness Questions
The CoverMe® Critical Illness Insurance plan was designed for healthy individuals between the ages of 18 and 65, who want a basic amount of affordable critical illness coverage that can be obtained quickly, easily and without completing a medical questionnaire.
In the Critical Illness Insurance Health Declaration, "signs and/or symptoms" means any indication that a named condition may exist – for example:
- Presence of an undiagnosed breast lump
- Chronic cough
- Blood in urine
- Unexplained weight loss
- Chest pain
- Shortness of breath
- Difficulty speaking
- Numbness
- Paralysis
- Severe headache
- Sudden onset of blurred vision
If you have had any unusual signs or symptoms that have not yet been diagnosed by a doctor or if you have been diagnosed with a condition named in the Health Declaration, you are not eligible for Critical Illness Insurance coverage.
In the Critical Illness Insurance Health Declaration, "signs and/or symptoms" of heart disease means any indication that heart disease may exist – for example:
- Chest pain
- Chest discomfort possibly radiating to arms, neck or jaw
- Irregular heart rate
- Shortness of breath
- Cold sweats
- Nausea
- Lightheadedness
However, these signs or symptoms could be caused by conditions other than heart disease.
In the Critical Illness Insurance Health Declaration, "medical consultations" means visits to a doctor or medical practitioner prompted by signs or symptoms related to the conditions named in the Health Declaration. Medical consultations do not include routine check-ups that were not prompted by these signs or symptoms.
In the Critical Illness Insurance Health Declaration, "abnormal tests" means tests that have a "positive" result or require further testing, investigation or consultation – for example:
- Positive ECG
- Positive stress test
- Positive chest x-ray
- Elevated PSA test
- Positive mammogram
- Elevated blood sugar test
- Positive colonoscopy
They do not include tests with "negative" or normal results that do not require further investigation, run for either diagnostic or routine purposes.
You may still be eligible. However, you are not eligible if you have had an abnormal ECG or been diagnosed with or experienced symptoms of coronary artery disease, heart attack, stroke, TIA or heart surgery.
You may still be eligible. However, you are not eligible if you have had an abnormal ECG or been diagnosed with or experienced symptoms of coronary artery disease, heart attack, stroke, TIA or heart surgery.
“Signs or symptoms” means any indication that a serious illness or underlying condition may exist. Once you have had any “signs or symptoms” related to the named disorders even if these “signs or symptoms” have not yet been diagnosed by a doctor, or if you have a condition stated in the health declaration, you are not eligible for Critical Illness Insurance.
A pre-existing condition is an illness or condition for which an individual showed indications of “signs or symptoms,” was prescribed or took medication, was diagnosed, treated, or hospitalized, during the 24 months immediately prior to the policy’s coverage effective date.
No, Critical Illness Insurance provides coverage for life-threatening cancer only.
No, to be considered a non-smoker and qualify for lower rates, you must be able to declare that within the last 12 months, you have not used any tobacco, tobacco cessation products or marijuana.
You can write to Manulife and request a cancellation at any time. If you request cancellation within 30 days of receiving the policy, a full refund will be provided.