Below you will find links to your group benefit forms and a series of frequently asked member questions. Click on the form titles marked with a plus (+) to get a list of form links.
ProBenefits Inc. claims can be emailed to firstname.lastname@example.org. Please ensure that a signed claim form, as well as quality scanned copies of your receipts are included.
Note: Claim Submission Deadline for 2020 claims is March 31, 2021.
ProBenefits Inc. Mobile app (Symbility Health Mobile Claims)
Plan Member FAQs
1. How do I submit and check on the status of my claims?
- Dental claims can be submitted electronically by your dental provider, should they participate in electronic submission. If you are submit ting your dental expense, please have your dental office complete a standard dental claim outlining the procedures completed and forward to our office via email or mail. You can also submit it on-line.
- Healthcare and visioncare expense receipts MUST be attached to the healthcare/visioncare claim form if submitted via email or mail. Claims forms are found above the FAQs. A claim form is not required if submitting on-line.
- The status of your claim can be checked by signing up for online access at the link above under Member Logins.
2. Can I submit claims electronically?
- Yes, claims can be submitted electronically. Online access can be found at the link above under Member Logins. Please click here for additional step by step instructions for online claims submission.
3. Can I sign up for Direct Deposit?
- Yes, in order to setup this feature please see the above direct deposit form. Make sure all requirements are completed and submit as requested. Your Online access will not allow you to add or change banking information, it must be sent to ProBenefits Inc. with a copy of a VOID cheque or Pre-Authorized debit agreement.
4. Is direct billing allowed?
- Each provider has their own policy in place regarding payment options. If the provider allows you to assign your benefit payable to their office please have the healthcare or visioncare provider email, fax, or mail the AOB, health/vision claim form, and their invoice. You will find an Assignment of Benefits (AOB) form under the Additional Forms above the FAQ’s. Claim forms are found in the Claim Forms column.
5. What does my plan cover?
- You would have received an Employee Benefit Booklet outlining the benefit coverage you have in place. If you have not received a booklet, you can find a copy through the online access (link found under Member Logins above) or contact your plan administrator for a copy.
6. How long do I have to submit a claim?
- Your Employee Benefit Booklet will have the details. Submit as soon as possible with ProBenefits but no later than 3 months into the new calendar year after the treatment is provided.
7. Where do I find my group and certificate numbers?
- This information is located on your benefit id card, which you would have received from your plan administration at the time you became effective on the program. Your benefit card can also be found if you click on the person icon on-line.
8. My plan is supposed to pay 100% for basic dental services, yet I still have to pay out of pocket for some of these services, why?
- Each province has its own official dental fee guide for the current year, your dentist may charge more than what the suggested fee guide is; thus you will have to pay the difference.
9. When are children no longer eligible to be on my benefit policy?
- For most policies, dependent children are those under age 21, and over age 21 to age 25 for those that a re attending full time studies at a recognized post- secondary institute. If you have a disabled dependent over age 25, please contact our office to discuss further. Please review your benefit booklet to confirm dependent eligible age.
10. When should I get a pre-authorization on health and dental treatment?
- For dental services, have your dentist submit a pre-authorization when your treatment is expected to be a large sum or for services you may not be certain are covered under your program.
- Certain health expenses may require pre-authorization. Contact our office for details.
11. I submitted a till receipt for my purchase/service, but it was declined, why?
- A till receipt is declined for coverage as it does not identify what the purchase/service was, does not include the drug identification number (required for prescriptions only), is missing the claimants name, and the date of service. Please ensure you are submitting official receipts for assessment.