Claim appeal process

Your plan provides comprehensive coverage, but sometimes claims are denied (partially or fully). If a health or dental claim is denied, and you disagree with the reason(s) provided:

• You (and your covered dependants) have the right to appeal Manitoba Blue Cross’ interpretation of plan terms and benefit determinations.
• You must start the process within 90 days of the claim decline date.
• You can only appeal a claim settlement decision once.

Steps to appeal a claim

1. Appeal any Manitoba Blue Cross (MBC) decision directly. You need to mail or email a written explanation to MBC of why there should be an exception to the rules for your claim.
   Email to:
   appeals@mb.bluecross.ca

   Mail to:
   Manitoba Blue Cross
   P.O. Box 1046 STN Main, Winnipeg, MB R3C 2X7
2. If you receive a letter from MBC denying your appeal, then you can appeal to the Trustees. Start by completing a CWBR Trust Claim Appeal Form and send it to AGA Benefit Solutions.
3. Appeals Committee reviews and makes recommendation to Trustees, or advises you if the Claim Adjudicator decision will stand.
4. Trustees make a decision, if necessary, and notify you of their decision in writing.

The Trustees’ authority

For health and dental benefits

Trustees are able to change plan terms and plan documents, and have ultimate authority over the plan interpretation and appeals process because our benefits are self-insured.

Life and travel insurance

Trustees are not able to overrule adjudication decisions for insured benefits, but may have discussions with the insurer on your behalf.