Concerns and Complaints

Concern and resolution process

Alberta Blue Cross^® is part of the Canadian Life and Health Insurance Association (CLHIA), a voluntary trade association which represents the collective interests of its member life and health insurers. All member organizations have undertaken to adhere to the Consumer Code of Ethics as a condition of membership.

This Code focuses on fair treatment of consumers through:

• A competitive marketplace
• Clear and straightforward advertising
• Competent sales and services
• Respecting the privacy of consumers

When plan members have questions or concerns about the products and services Alberta Blue Cross^® provides, we do our best to provide an explanation of the decision processes used within the rules established by the relevant plan or policy guidelines and rules.

Government programs

If you have a concern regarding a decision or service related to a government program administered by Alberta Blue Cross^®, please contact Customer Services to be referred to the appropriate area for assistance.

For more efficient service, please have your group/policy number and ID number available.

Telephone:

Edmonton and area 780-498-8000

Toll-free 1-800-661-6995

Office hours Monday to Friday 6 a.m. to 6 p.m. Mountain Time

Mail:

Alberta Blue Cross^® Attn: Customer Services

Blue Cross^® Place

10009 108 Street

Edmonton, AB T5J 3C5

Email:

Please note that regular email is not a secure method of communication or transmission of personal information. To send us a secure message, please use this form.

Individual health plans or employer group sponsored benefit plans

If you have a concern regarding a decision or service related to your Alberta Blue Cross^® individual health plan or employer group sponsored benefit plan, you may have the situation reviewed by following the steps listed below:

Step 1 – Bring it to our attention

Step 2 – Contact the Alberta Blue Cross^® Complaints Officer

If you are unable to resolve your concern through the assistance of the applicable department, you can escalate your request to the Alberta Blue Cross^® Complaints Officer.

The Complaints Officer will not review complaints that have not been through Step 1. When contacting the Complaints Officer, you will need to provide the details of how your concern was dealt with in Step 1 and why you disagree with the outcome.

In the course of our investigation, the Complaints Officer may:

• Contact you to clarify information you have already provided
• Contact you to request additional information in writing
• Share your complaint and supporting documentation with the relevant internal parties related to the initial concern and subsequent interactions
• Request additional information from other parties involved
• Provide you with updates throughout the complaint handling process
• Advise you of any action we will be taking

After the Complaints Officer review, you will receive a written response, on the resolution of your complaint, no later than 30 business days of receiving the formal request and the receipt of all supporting information. If this deadline cannot be met, you will be contacted to let you know the status of the review and what is being done.

Mail:

Complaints Officer, Alberta Blue Cross^®

10009 108 Street

Edmonton, AB, T5J 3C5

Fax:

780-425-4627 Attn: Complaint Officer

Email:

Please note that regular email is not a secure method of communication or transmission of personal information. To send us a secure message, please use the form below. All fields are required.

Concern type Select Dental claim Government sponsored plan Health claim Life or disablity claim Personal plan (individuals and families) Privacy Service provider Travel claim Other

Please select an concern type.

Have you completed Step 1 of the concerns and complaints process listed above?

Yes

No

Please choose an option.

Name

Enter your first name.

Name

Enter your last name.

Alberta Blue Cross^® ID number

Enter your Alberta Blue Cross^® ID number.

Address

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City

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Province*

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Postal code*

Enter your postal code.

Email

Enter a valid email, for example example@email.com.

Details about your concern and why you disagree with the outcome

Give us specific details about your concern.

Please outline the steps taken prior to reaching out to the Complaints Officer

Tell us the steps you have already taken.

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