Claims Submission

Claims Submissions

All claims must be submitted within 12 months of the date the expense was incurred, but not more than 12 months after the date your coverage terminates, or the Benefit is discontinued.

All bills must be paid in full before reimbursement can be made.

Should the contract terminate with NexgenRx, you have 90 days from the termination date to submit any claims incurred during the period you were covered under the plan.

Coordination of Benefits with Your Spouse’s Plan

Co-ordination with your spouse’s plan is one of the advantages of group coverage. It may allow you to receive up to 100% of Health Care costs. First, you must have family coverage that includes Health Care coverage and has an eligible spouse and/or children. Second, your spouse must have the same type of coverage.

Claiming Your Spouse’s Expenses

If you are claiming your spouse’s expenses, a claim must be sent to your spouse’s plan first. Your spouse’s plan will pay for the portion of the claim that is covered by them and send your spouse an explanation of payment. You can then send a copy of the explanation and a copy of the receipts, along with a completed claim form for the unpaid portion, to NexgenRx Inc.

Claiming Your Child’s Expenses

If you are claiming expenses for your child, you must first claim from the plan of the parent with the earliest birthday (month and day) in the calendar year. For example, if your birthday is May 19th and your spouse’s birthday is June 11th, your child will claim under your plan first. Then, the claim for the unpaid portion should be sent to your spouse’s plan along with a copy of the explanation of payment and a copy of the receipts.

Claiming Your Expenses

If you are claiming your expenses, the claim must be sent to NexgenRx Inc. first. NexgenRx Inc. will pay for the portion of the claim that is covered by your plan and send you an explanation of payment. Your spouse can then send a copy of the explanation and a copy of the receipts, along with a claim form for the unpaid portion, to his/her group carrier.

  • If you are separated or divorced, claims for your child’s benefit must be coordinated based on the standard industry guidelines. Please refer to CLHIA – Coordination of Benefits Guide at https://www.clhia.ca/

Submitting Your Claims

Web Submissions

Members have the option to submit claims on our secure website. Please note when using the web claims submission, you must be set up on our system for Direct Deposit for your claims reimbursement. You must also keep the original copies of your receipts for 18 months from the time you submit your claim online for audit purposes.

As a plan member, NexgenRx Inc. provides you with access to our claims processing website to look up the status of your claims anytime you wish. In order to access our secure, online administration and information website please follow these instructions:

  1. Go to memberweb.nexgenrx.com
  2. Select your language of preference
  3. Enter your username and temporary password and click Login
  4. Then click NEXT
  5. Create a new password
  6. Enter your email address
  7. Next, create a security question and answer for security purposes
  8. Click NEXT
  9. Review the Conditions of Use and click on Accept to complete the activation
  10. A message will confirm that your account has been activated
  11. The next time you log in, enter your username and your new password to access your account on NexgenRx Benefits Member Web

NexMobile App Submissions

NexMobile App is designed to increase convenience for Plan Members. You can submit a claim by taking a picture of your claim receipt on your handheld device with the NexMobile submission feature. It’s the easiest and fastest way to submit a claim. In fact, it’s as “quick as a selfie!”

Download the free NexMobile App from the Google Play or the App Store for your device!

Still need help? Contact us for assistance:

Paper Claim Submissions

Complete the claim form that is available from the NexgenRx Inc.’s website: www.nexgenrx.com

Make sure your receipts include:

  • the name of the person who received the service or supply (referred to as “the patient”)
  • the date the service or supply was received
  • the type of service or supply received and
  • the total cost paid

Submit your claim by mail to:

Local 493 Benefit Services
584 Clinton Avenue
Sudbury, ON
P3B 2T2

Submit your claim by fax to:  1-705-674-6728

Submit your claim by email to:  benefits493@liunalocal493.ca