By submitting an estimate or pre-determination for the expensive medical equipment or services you require, you will know how much is covered under your benefits plan and how much you may be responsible for paying out of your pocket. This will help you to plan and will also minimize surprises and disappointment if your claim is not eligible for full or partial reimbursement.

Here is a list of items we recommend you submit an estimate or pre-determination for:

• Medical equipment and services that cost more than $300 (e.g. orthopaedic shoes, compression stockings, knee braces, orthotics, glasses, contact lenses, etc.)
• Drugs that need pre-approval (Drug Prior Authorization Form)
• Expensive dental work
  • Your dentist knows the information insurers need. Most dentists can submit an estimate for you, or you can submit it yourself if you wish.

How to submit an estimate

The process is very similar to submitting a claim. You can do it online in My Claims or complete the appropriate health and dental claim form. When you submit an estimate using the form, make sure you clearly label it as an estimate.

Supporting documentation may be required for:

• Drug prescriptions, include:

  • Drug name
  • Drug Identification Number (DIN)
  • Method for taking the drug
  • Dose of the drug
  • Where the drug is being given (if applicable)
  • Drug Prior Authorization Form (if applicable) 

• Medical equipment, includes:

  • Diagnosis necessitating the equipment
  • Prescription for the equipment if applicable (e.g. orthotics, compression stockings)
  • Anticipated duration the equipment will be required
  • Description of what activities the equipment will be primarily worn for (daily living, sports, etc.)
  • Verification if this is an initial purchase, or provide a reason for a replacement
  • Confirmation from the supplier (if applicable) whether the item is eligible for funding through a government provincial health plan (e.g. OHIP); if so, include a copy of the government provincial health plan's statement of payment
  • Item being rented or purchased, include a written quote from the supplier indicating the purchase price of the equipment

Related links:
Submitting your claim 101
Submitting a claim for orthopaedic shoes
Be informed when buying your custom-made orthotics