FAQs
You have questions
We have solutions
Plan Member FAQs
How do I register for online services?
Active plan members can register for online services by visiting RWAM Plan Member Services Sign In webpage. Log in using your RWAM group number and certificate number provided to you with your welcome package.
If you have forgotten your User ID or password, click "Forgot your user ID" or "Forgot your password" and follow the instructions to recover your security credentials.
What is a RWAM OneCard and where do I find it?
Your RWAM OneCard contains your group and certificate numbers and can be used at the pharmacy, hospital, dentist, and many paramedical practitioners.
Emergency Travel Assist telephone numbers are listed on your RWAM OneCard, if applicable to your group plan, for assistance while travelling outside your province of residence or Canada.
Your RWAM OneCard is available on the RWAM Plan Member Services website, or on the RWAM Mobile app.
How do I submit a claim?
Claims can be submitted to RWAM online through the RWAM Plan Member Services website, on the go via the RWAM Mobile app, or by completing a paper claim form and submitting to RWAM via email, fax or mail.
When submitting claims to RWAM, you will be required to attach copies of all relevant receipts for services received.
Note: Online submissions will allow 5 files to be attached under 1 submission.
Is there an annual deadline for submitting claims?
Most extended health, dental, and drug claims can be submitted up to 12 months from the date of service, regardless of calendar year-end.
Plan members with a Health Spending Account should refer to their policy for submission guidelines as they differ by plan.
Can my provider submit claims on my behalf?
Yes! Healthcare providers can submit claims directly to RWAM using the TELUS Health eClaims portal, allowing for immediate adjudication and payment assignment directly to the provider or to the plan member.
My RWAM OneCard shows a GreenShield logo, what is this for?
RWAM partners with GreenShield as a pharmacy benefit manager on some plans. The GreenShield logo will alert your pharmacy to submit all prescription claims via Green Shield for adjudication.
How do I coordinate benefits between two or more group benefit plans?
Please visit RWAM’s COB webpage to understand how to maximize your coverage if you are covered under more than one benefit plan.
How do I know what coverage I have?
Your RWAM Employee Benefit Booklet provides full details of your coverage and is available on the RWAM Plan Member Services website, or on the RWAM Mobile App.
Paramedical and vision coverage balances are available on the "Balance Summary" tab of the RWAM Plan Member Services website.
For all other benefit balances, please contact:
RWAM Claims at 1-877-888-7926.
How do I change or update my personal information?
You can update your banking information, mailing address, and email address directly on the RWAM Plan Member Services website under the “Personal” tab.
Other changes such as life events (marital status, children, name changes, etc.) and beneficiary changes must be done via your plan administrator.
Where do I find proof of claim expenses for tax purposes?
You can access a Claim Summary from the RWAM Plan Member Services website. Once you log in select "View Claims" from the left menu.
From there you can select the date range, claim type and plan member you wish to summarize.
Individual Explanation of Benefits documents are available by clicking on the claim paid date from your Claim Summary.
How do I report benefits fraud?
To report benefits fraud, email details directly to RWAM at special.investigations@rwam.com
You can also report fraud to insurers via the Canadian Life and Health Insurance Association website.
Disability FAQs
Is my spouse covered for disability?
No. Disability coverage, if included in your plan design, is only available to the employee/plan member.
Who can sign my Attending Physician Statement?
The Attending Physician Statement should be completed by your Family Physician or treating Specialist, but can be completed by any physician who has treated you, including an urgent care or emergency room physician.
RWAM cannot review a disability claim without a complete Attending Physician Statement (APS).
If you have questions about other practitioners’ ability to sign the APS, contact RWAM Disability Management at csr-disability@rwam.com.
Can my claim be reviewed without having an Attending Physician Statement completed?
No. A completed Attending Physician Statement (APS) must accompany the application.
RWAM cannot review a disability claim without a complete Attending Physician Statement.
If you have questions about other practitioners’ ability to sign the APS, contact RWAM Disability Management at csr-disability@rwam.com.
If I don’t apply for disability benefits, what will happen to my group benefits if I am absent from work for medical reasons
To remain eligible for all coverage(s) under your group benefits, you need to be actively working or on an approved absence from work. Therefore, if you are absent from work for medical reasons, it is important that you apply for disability benefits. If you do not apply, your eligibility for group benefits may be impacted. Please refer to the Termination of Coverage section in your Employee Group Benefits booklet.
How long do I have to apply for disability benefits?
Please refer to your Employee Benefits Booklet to ensure you meet the claim deadline for disability benefits. Late filing could result in an ineligible claim.
Can I access my disability claim status online rather than speaking to my case manager?
No. Disability claims are not accessible online.
Plan Administrator FAQs
Where do I find my Taxable Benefit Summary?
RWAM will send the Taxable Benefit Summary in December, and you can access the up to date Taxable Benefit Report at any time on the RWAM Plan Administrator Services website.
Where do I find the Plan Administrator Manual and other resources?
You can find plan administrator training resources located on the RWAM Plan Administrator Services website.
There you will find the Plan Administrator Manual, Quick Reference Guide, video tutorials and other training resources. Just click on the blue resource booklet in the top right corner.
Log in to RWAM Plan Administrator Services here.
Provider FAQs
Can the Health Care Provider determine the patient's eligibility for coverage?
No, RWAM's Provider Claims Services website does not allow the health care provider to determine a patient's eligibility for coverage. Plan members should refer to their group benefits booklet for details of paramedical coverage included in their plan. If there are any questions regarding coverage plan members should speak with their plan administrator, or contact RWAM directly.
What information will a plan member receive regarding claims submitted on their behalf by the Health Care Provider?
Plan members will receive an Explanation of Benefits (EOB) for all claims submitted by a health care provider. The EOC details the patient's name, service description, submitted claim amount, and information regarding the benefit eligibility / amount paid, along with any comments / explanations pertaining to the adjudication of the benefit.
Who receives the approved claim payment when the Health Care Provider submits a claim?
Claim payments can be assigned directly to the health care provider, as long as the insured's group benefit plan allows for assignment. Or, the provider may choose to have any approved claim payment paid to the insured plan member. The provider indicates who is to receive payment on the claim submission screen.
How long will it take to receive payment for claims submitted directly by the Provider?
Claims submitted directly by the health care provider using the RWAM Provider Claims Services website are adjudicated in real-time. Providers will receive confirmation of the disposition of the claim immediately upon submitting the claim.
For claim payments assigned directly to the provider, once the claim has been adjudicated and approved a cheque is mailed out within 2 business days. An Explanation of Benefits will be sent to the provider and also to the plan member.
For claims being paid to the plan member, if the plan member has enrolled for direct deposit, the approved claim payment will be deposited to the Plan Member's bank account within the next few business days*, and an Explanation of Benefits will be sent to the Plan Member. For Plan Members not participating in direct deposit, the claim cheque and Explanation of Benefits are usually mailed out within 2 business days after the claim has been approved.
*Exact timing of the bank account deposit is dependent in part on the financial institution.
Can assigned payments be deposited directly to the Health Care Provider's bank account?
No, RWAM does not deposit assigned payments directly to the health care provider's bank account.
Can clinic staff submit claims on behalf of multiple Health Care Providers?
Yes. All participating health care providers must register individually on RWAM's Provider Claims Services website and obtain a unique Provider ID. Next, the clinic staff member registers on RWAM's Provider Claims Services website and enters the unique Provider IDs for those providers.
How do Health Care Providers submit claims?
Providers must register on RWAM's Provider Claims Services website. Once registration is complete claims can be submitted via the website.