Making a Claim
Pay–Direct and Your Pay–Direct Number
Electronic submission of Prescription Drug Care and Dental Care expenses will be possible in many situations. Within one month of your enrollment into the Plan, you will receive a welcome letter that has your certificate and group number on it, that you and your eligible dependants will use when claiming benefits at the dentist or pharmacy.
It is important that your pharmacist and dentist have this new information. Without it, they will not be able to process an eligible claim electronically.
Extended Health Care Claims
An Extended Health Care claim form is available on the Writers’ Coalition Program website under the directory "Forms". You need to complete, sign and date this form and return it to AFBS.
Extended Health Care claim forms must be completed, signed and submitted to AFBS.
To claim expenses when AFBS is the first or only insurance company provider, send your original receipts along with your completed claim form directly to AFBS. Photocopies cannot be accepted. When submitting original receipts, please block any confidential information such as a credit card number
If AFBS is the second payor, please include the receipt of claim settlement information, often called an Explanation of Benefits (EOB), from the other insurance company along with your completed Extended Health Care claim form and copies of your receipts.
Some Dental Expenses Require Pre-authorization
If your dentist recommends dental work that will cost more than $500 or includes procedures such as crowns, bridgework, veneers, implants, onlays or inlays, you must have your expense pre-authorized by AFBS. Your dentist must provide AFBS with specific information, including x-rays, study moulds or casts.
Pre-authorization is not required if treatment is the result of an emergency. If the emergency treatment is for a crown or bridge, you must submit x-rays with your claim. Pre-authorization is not necessary for a crown if a root canal has been performed on the tooth. The dentist needs to indicate this on the claim form.
Through the pre-authorization process, you will have confirmation of the amount eligible for reimbursement through the Program before treatment starts.