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Plan Admin Forms and Resources

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As a plan administrator you have many day-to-day tasks that require extra documentation. Please go through the sections below to find any forms relevant to your situation.

Enrollment

When employees become eligible for insurance, access the forms here to enroll them.

Applications

Add additional coverage or dependents to an employee’s plan.

Health Questionnaires

Gather personal health information on an applicant in order to determine eligibility.

Change Forms

When an employee experiences life changes, they may need to modify their coverage.

Frequently asked questions

What is prior authorization?
An approval process for Plan Members who need certain high-cost drugs. This process ensures patient safety and appropriate drug use by requiring specific medical criteria to be satisfied before expenses are considered eligible for reimbursement under the plan. For example, patients are required to try initial drug therapies before moving on to more expensive treatments, ensuring less expensive alternatives are used first.
What requires prior authorization?
Certain high-cost drug, biologics (specialty drugs) and drugs with a potential to be used inappropriately. To check if a drug needs prior authorization, the member can use the Drug (Prescription) lookup tool in the Wawanesa app or plan member portal, or call the Health & Dental Claims Call Centre at 1-800-665-7076, option 1.
What if the member already received an approval from a previous insurance carrier?

If the member is already taking a drug that requires prior authorization, Wawanesa may honor the approval from the member's previous insurance carrier for up to six months from the Wawanesa approval date, if:

  • The previous carrier approved the drug or medical supply within six months of the members enrollment in the Wawanesa Life Group plan;
  • They can provide a claim statement with an explanation of benefits (EOB) or a pharmacy receipt showing the drug was covered under the previous group plan; and
  • The drug or medical supply is covered under the Wawanesa group plan.