Claim details
My claims
| Name | Benefit |
Service date |
Amount submitted |
Amount eligible |
Percent paid |
Deductible |
Benefit paid |
|---|---|---|---|---|---|---|---|
|
DOE,JOHN |
Health |
01 Oct 2016 |
$300.00 |
$126.29 |
100 |
$7.00 |
$119.29 |
|
TOTAL |
|
|
$300.00 |
$126.29 |
|
$7.00 |
$119.29 |
The total amount reimbursed by the primary carrier is $14.36.
Who received payment for this claim?
- Your claim was assigned to a third party so payment was made directly to them instead of you.
What does my plan cover?
How we calculated your benefit payments
Name
DOE,JOHN
Benefit
Drugs
The total amount submitted on your claim form for all services and/or patients.
$300.00
The maximum amount that could be paid for this service based on the published provincial or association fee structures for that service.
$126.29
The amount reimbursed to you after all plan maximums, restrictions, deductions, and coordination of benefits (if applicable) have been applied.
$119.29
