The preparation includes reviewing all documents submitted as well as information from Canada Life, the employer, or the pension office. The PSHCP Administration Authority will prepare your file for hearing by the Appeals Committee. The Appeals process generally takes about four months to complete.
The PSHCP Administration Authority will send you a letter confirming that the appeal request has been received. Please note that appeals cannot be submitted by fax or e-mail. Letters of appeal and relevant documents must be sent to the following address: Include any other documentation or information relevant to your appeal. If your appeal is in relation to coverage, you should describe circumstances leading to your appeal as well as your justification for a possible adjustment.
A copy of the Claimant’s explanation of benefits issued by Canada Life. A copy of the claim and related receipts. The reason you feel the claim should be appealed. Dates and details of conversations, if any, with Canada Life representatives. A description of the service or product for which the claim was submitted, and dates of purchase or service. If your appeal is in relation to a claim, your letter should also include the following: (Note: It is the responsibility of the POA to understand the provisions of the Plan.) Appeals may also be submitted by a Power of Attorney (POA) or Executor. You must submit a letter requesting a review of your file to the Federal Public Service Health Care Plan Administration Authority. Stage 2 – Appeal submission Submit a letter of appeal to the PSHCP Administration Authority Records (with dates) of related phone calls, e-mails, or letters, if possible. Printed copies of forms submitted through Compensation Web Applications. Copies of application forms submitted to the designated officers of your employer or pension office. If your appeal is in relation to coverage issues, such documentation may include: Copies of any relevant correspondence with Canada Life. Copies of your Claimant’s explanation of benefits. 
Copies of questionnaires or claim forms submitted to Canada Life. Documentation submitted with your appeal may include: If your appeal is in relation to a claim, the appeal must be submitted within 12 months of the expenses being denied. Review sections of the Plan Document relevant to your appeal, such as the provisions of the Plan in relation to your claim, general exclusions and limitations, or terms related to coverage levels and eligibility. To prepare the appeal, you should: Review the Plan Document Prior to submitting an appeal, you should make every effort to resolve the issue with Canada Life.
0 kommentar(er)
