Maximum

Step-by-Step Guide to Filing Claims with Maximum (My-Benefits Portal)

1. Log In or Register

• New Users:
  • Visit the My-Benefits Portal and click “Register” using your policy number and personal details (provided by your employer or benefits administrator).
  • Verify your identity via email or SMS to activate your account
• Existing Users:
  • Sign in with your credentials.

2. Select Claim Type

Maximum supports claims for:

• Health/Dental Services: Paramededical (e.g., massage therapy, physiotherapy), prescriptions, dental procedures.
• Travel Insurance: Emergencies abroad (if included in your plan).
• Specialized Services: Coverage for psychologists, social workers, and occupational therapists (subject to policy limits)

3. Prepare Required Documentation

• Original Receipts: Must include:
  • Provider name, license number, and address.
  • Service date, description, and total cost (e.g., $120 for a 60-minute massage session).
• Completed Claim Form: Download from the portal or employer’s HR portal
• Medical Reports: For disability or critical illness claims (e.g., physician’s statement)

4. Submit Your Claim

1. Online Submission:
   • Navigate to “Submit a Claim” → Select Health, Dental, or Travel Insurance.
   • Upload scanned receipts and forms (JPEG/PDF/PNG).
   • Ensure CPT/ICD-10 codes match the service (e.g., CPT 97110 for physiotherapy) to avoid rejections
2. Direct Billing:
   • Confirm if your provider (e.g., dentist, physiotherapist) uses TELUS Health eClaims. Present your Maximum ID card to avoid upfront payments
3. Mail Submission:
   • Send original receipts and forms to:
     Maximum Claims Department
     [Address listed on your policy documents]

5. Track and Receive Payment

• Processing Time:
  • Online: 3–5 business days for acknowledgment; payments via direct deposit within 1–2 weeks
  • Mail: Allow 7–14 business days plus mailing time.
• Check Status: Use the “Claims History” tab for real-time updates

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FAQ: Maximum (My-Benefits)

1. What is the deadline to submit claims?

Claims must be filed within 12 months of the service date. Travel insurance claims require submission within 90 days of returning home

2. Does Maximum cover massage therapy?

Yes, most plans include coverage (e.g., $400/year). Check your policy’s “Paramedical Benefits” section for limits

3. How do I handle a denied claim?

Common reasons include missing receipts or exceeded coverage limits. Resubmit with corrections or appeal via the portal. For CO 119 (“Maximum Benefit Met”), transfer the claim to secondary insurance or bill the patient

4. Can I use direct billing for dental services?

Yes, if your dentist participates in Maximum’s network. Provide your Maximum ID card at the appointment

5. How do I check my remaining coverage?

Log in to the My-Benefits Portal → Navigate to “Coverage Details”

6. What if I have secondary insurance?

Submit to the primary insurer first, then to Maximum with the primary insurer’s Explanation of Benefits (EOB). Do not alter the payer sequence

7. Are pre-authorizations required for surgeries?

Yes, for procedures over $500 (e.g., MRI scans). Submit a Letter of Medical Necessity from your physician

8. How do I enroll in direct deposit?

Update banking details under “Payment Settings” in the portal. Payments are issued twice monthly (5th and 20th)

9. What is the timely filing limit for appeals?

Appeals must be submitted within 180 days of the denial date. Include supporting documents (e.g., corrected receipts)

10. Does Maximum cover mental health services?

Yes, psychologists and social workers are typically covered (e.g., $1,000/year). Confirm limits in your policy’s “Mental Health” section