You should be using the “Claim to OMA-OPIP then to Western Form" when submitting claims that would be eligible under the OMA-OPIP plan. Sunlife will adjudicate the claim based upon the two plans and provide reimbursement for eligible expenses. This will ensure that expenses are being applied against your annual deductible with the OMA-OPIP plan. Use this form for the following expenses: Prescription Drugs, Hospital Services, Medical Services, Supplies and Equipment, Private Duty Nursing, Hearing Aids, Ambulance and Paramedical Services.
You should be using the “Direct to Health Care Spending Account at Western" for expenses not covered under OMA-OPIP or a Spousal Benefit Plan. Expenses that may not be covered OMA-OPIP include: Visioncare and Dental expenses. You should also utilize this form to submit for reimbursement when you receive an explanation of benefits without full reimbursement.