Claim Submission Guidelines

Health and Dental Claims

How to Submit Claims...

 Are you covered by more than one benefit plan?

Coordinate between multiple plans to maximize your coverage.  Review the Coordination of Benefits page and receive up to 100% coverage for eligible expenses. 

Drug Claim Submission Requirements

Submitting Your Prescription Claim With RWAM Is Easy!
To submit your claim, you will need to scan or take a picture of your official prescription receipt ensuring all information is clearly visible and there are no shadows, markings or obstructions. Use the RWAM Plan Member Services website or RWAM Mobile App to submit your claim, attach the photo or scanned copy of the official prescription receipt, and click “Submit”. It’s that easy!

For prescription drug claim submissions, RWAM will require an official prescription receipt - often you will find it attached or inside your prescription takeaway package you receive from the pharmacy.

Receipt MUST Include:
Patient Name - The name of the patient that was prescribed and will use the medication must be clearly visible.
Drug Name and/or DIN - The name of the prescribed drug and/or the Drug Information Number (DIN) must be clearly visible.
Amount Charged - The total cost including drug cost, fees, and if applicable the amount covered by your drug plan must be clearly visible.

Download the Informational PDF "Drug Claim Submission Requirements"

Did you know?

For most extended health, dental and drug claims, active plan members can submit their claim up to 12 months from the date of occurrence, regardless of year end of calendar date. Download the Informational PDF "Claim Submission Deadlines" to learn more!  

All Other Claims

Have questions about submitting your Claim?

• Read the fact sheet "Extended Health Care Benefits - What's covered?" to learn how to determine whether your Group Health Benefits Plan includes coverage for a particular provider.
• Review the "Understanding Your Group Insurance Benefits" fact sheet to learn how certain rules, limits, and maximums which govern how much of your claim is eligible for reimbursement are applied to each and every claim.
• Check out the Claims FAQs for Plan Members for answers to common claim questions.
• Need more information? Please Contact Us.

Patient Choice Cards

In cases where your group plan doesn't cover the full cost, Patient Choice Cards may allow you to access your preferred brand name medications with a minimum of out-of-pocket expense .

Registration is FREE, and you can register for multiple programs in order to access the brand name product(s) you wish to receive. To learn more about either program and to view a current list of the medications covered by each, please visit the www.RxHelpONE.com and www.innovicares.ca websites.

Note the content of these programs may change, and coverage for specific brands can be discontinued at any time. RWAM provides this information on the free RxHelp ONE^TMand innoviCares patient choice card programs as an option for Plan Members. This is not an endorsement.