The Insurance and Claims Procedures
Who do I call when having a medical emergency?
If you are experiencing a medical emergency, you should first contact your local emergency services. Please remember that it remains a responsibility to report your emergency to Ontime Care as soon as possible. You or someone on your behalf should call 1-888-988-3268.
What is an Emergency?
Emergency means that you require immediate medical treatment for the relief of acute pain or suffering resulting from an unexpected and unforeseen sickness or injury occurring during the coverage period and that such medical treatment cannot be delayed until your return to your country of origin.
What is a pre-approval and what is the purpose of it?
It is a policy requirement to have certain procedures pre-approved. This means you will need to submit medical records and a referral letter in advance before undergoing surgery/invasive procedure/diagnostic services. The purpose is to ensure the procedure is medically necessary, appropriate for your situation and to confirm that it cannot be postponed until you return to your home country.
How do I submit my claim?
There are two ways to submit your claim:
1. You can mail your completed claim form, complete medical records (including referrals and test results), original invoices and receipts to us.
2. You can submit your claim online at eclaim.jfgroup.ca if the total claim expenses are under $1000. Please upload pdf or readable copies of your medical records, invoices and receipts in your submission.
How can I be reimbursed for my expenses?
There are two ways you can be reimbursed for your expenses:
1. By cheque
Please make sure to include your full mailing address and the payee name on the claim form.
2. By e-mail transfer
The total claim reimbursement amount must be $1000 or under for you to select email transfer as a method of reimbursement.
You must also have email transfer set up with your Canadian financial institution in order to receive reimbursement by email transfer.
How can I get my paramedical services (Chiropractor, Physiotherapy, and so on) reimbursed?
Paramedical services are only covered when referred by a physician and pre approved by Ontime Care (1 888 988 3268). Please call Ontime Care before you go for treatment. When you submit your claim, please include the referral letter, medical records from the physician together with the paramedical service receipts. If you had a paramedical service of your own choice, without a referral, it is not going to be covered.
How can I get reimbursed for my new eyeglasses? (for Student Policy Holder only)
You were injured first, and you must visit a physician. Your physician advised your eyeglasses have to be replaced as the result of an unexpected accident and injury. If the medical expenses are eligible for reimbursing, you could submit another claim for your eyeglasses. Please include the accident report, medical records from the physician together with the eyeglass receipt. But if you just replaced it by your own choice, it is not going to be covered. Please refer to the policy benefits section for details.
What if I do not have any medical notes?
You will not be given a medical record unless you ask your doctor, they are not automatically given to you. Please provide full details when you describe your sickness or injury. Mention the exact diagnosis and symptoms, NOT what you did, such as ‘I did blood work’, ‘I did CT scan’, or a vague description such as ‘I have many problems.’ If your description is not clear enough, we have no choice but to ask you for the medical note.
What is a medical record and why do I need to submit it?
A medical record is a detailed record of your visit with a treating physician that should include information regarding your symptoms and when they appeared, past medical history, procedures done, plan of treatment etc. It is important documentation for our claim examiners to have in order to substantiate illness or accident related claims.
Can the provider directly invoice Ontime Care?
For in-patient service, please let the finance department know all bills can be mailed to us. If possible, please include medical records . For out-patient services, we normally work on a reimbursement basis, meaning you will have to pay out of pocket then submit your claim. However, if you are unable to pay and your treating physician is willing to invoice you, you may submit the invoice with your other claim documents.
How can I check my claim status?
You can check your claim status online by logging into https://eclaim.jfgroup.ca with your policy number and birthday. Once logged in, go to Check Claim Status.
How many E-claims can I submit?
You can submit multiple new claims but please make sure one claim is submitted per medical issue. Duplicate claims will be rejected or combined.
Can I update an E-claim that I submitted online?
To update an existing claim please contact our Claims department at firstname.lastname@example.org or 905-707-3335
Is there a limit on the amount of E-claim I can submit?
For submitting a medical claim the limit is $1000 for the total claim amount. If the claim amount exceeds $1000, please mail in your claim.
What does the status mean on my E-claim?
- Waiting for process – Eclaim submitted
- Processing – Eclaim being processed
- Processed – Claim decision made
- Refused – The E-claim cannot be processed as a new claim, or it is a duplication of an existing claim, or your E-claim was submitted under an incorrect policy #.
What if I have multiple invoices for one claim?
Avoiding submitting each expense separately is a good start. If you still have pending procedures, it is recommended to wait until you finish all procedures and treatments. If your total expenses are over $1,000 or if you were hospitalized, you could mail all claim documents to our office. An assigned claim examiner will reach out to you for further information if required.
How can I make sure my E-claim was submitted successfully?
Once you have the RFR#, it means we acknowledge receipt of your e claim. We greatly appreciate your patience. We will try our best to process your claim as fast as possible.
How can I get my reimbursement faster?
If you want to be reimbursed quickly, we recommend that you select e transfer as your payment method. E transfer is quicker than issuing a cheque, as the cheque delivery is out of our company’s control. Under the e claim portal’s payee information, please fill in your name and email address which are linked to your bank account.
How come my claim status shows “Refused” right after my E-claim submission?
We understand an additional invoice might suddenly pop up in your mailbox. It happens and you choose to submit it by E claim portal. You probably will receive an email after E claim submission, explaining we cannot make a new claim because one claim is assigned to each condition. But it’s not a refusal of your claim. We will add the newly submitted expense to the existing claim. So do not worry, just give us some time to process it.