Equity's Accident and Sickness Insurance Plan, underwritten by Chubb Life Insurance Company of Canada.
Medical / Paramedical Claim Forms
Use this form to claim reimbursement for dental expenses incurred when treatment is required as a result of an accident. If the accident occurs while on contract, the reimbursement is no more than 80% per cent to a maximum of $2,500. If you are eligible for off-contract coverage, the reimbursement rate is 50% per cent. Note that this form must accompany a standard dental claim form completed by your dentist.
Health and Wellness
This form is applicable to a variety of miscellaneous services and expenses as described on Page 2 of the form. There is an annual allowance of $100 for all members, whether you are on or off contract.
Medical / Paramedical Claimant Statement
Use this claim form for expenses related to physical therapies, medical expenses and alternative medicine. Note that maximums for physical therapies are different for all members: either $600 or $1,200 per treatment depending on your contract. Also, medical expenses have a collective maximum of $5,000 and alternative medicines have a collective maximum of $750. Supporting documentation may be required.
This form may be required depending on your claim situation and should accompany your Medical/Paramedical Claim Form.
Reasonable and Customary Fee Guide
Reasonable and Customary Charges for Paramedical Services.
Income Replacement Benefit Claim Forms
Attending Physician Statement
This form needs to accompany your Income Replacement Benefits Claim Form. It must be completed by your physician.
Use this form to apply for income replacement if you need to drop out of a current or upcoming contract due to illness or injury. If you are working, you are insured for 60% per cent of your contractual weekly fee to a maximum of $1,500 per week for up to 52 weeks. Additional supporting documentation is required.