Frequently Asked Questions

What is Canopy?

Canopy Insurance Company Ltd is a newly registered group health and life insurance company in Jamaica. The company is backed by a partnership of GraceKennedy and the Musson Group, two of the Caribbean’s largest most trusted corporate entities. The company’s mission is to remove the hassle associated with group health and life insurance administration through the deployment of world class technology and a team of dedicated employees passionate about customer care.

Canopy’s goal is to remove the hassle of health and life insurance administration. We have designed the company to reduce the administrative burden to employers, members as well as medical practitioners. Here are a few of the advantages to providers who decide to join the Canopy family:

  • Access to a growing membership (client) base
  • No new hardware or software required. We integrate AIS swipe card technology
  • Reliable & speedy reimbursements (5 to 7 days) – backed by names you can trust (Grace Kennedy and the Musson Group)
  • Convenient online submission of paper claims (new to Jamaica)
  • Easy to use web portal to track claims and explanations of benefits

Why should I join Canopy’s provider network?

Canopy’s goal is to remove the hassle of health and life insurance administration. We have designed the company to reduce the administrative burden to employers, members as well as medical practitioners. Here are a few of the advantages to providers who decide to join the Canopy family:

  • Access to a growing membership (client) base
  • No new hardware or software required. We integrate AIS swipe card technology
  • Reliable & speedy reimbursements (5 to 7 days) – backed by names you can trust (Grace Kennedy and the Musson Group)
  • Convenient online submission of paper claims (new to Jamaica)
  • Easy to use web portal to track claims and explanations of benefits

What’s special about the Canopy Provider portal?

In keeping with our mission to remove the hassle associated with health insurance administration, Canopy has developed a world-class provider portal. This portal will allow you to:

  1. Track claims and explanations of benefits
  2. Download paper claim forms
  3. Upload paper claim forms
  4. Submit preauthorization requests
  5. Chat in real-time with customer service representatives

Personalized credentials to the Canopy Provider Portal will be shared with you during your onboarding process.

How can I become a Canopy Provider?

In the spirit of efficiency, we have created 3 easy ways to apply to our network.

  1. Fill our online application at www.canopy-insurance.com
  2. Download, complete and mail/drop-off an application along with required documents to our 58 Half-Way Tree offices
  3. Register online for expedited sign-up meetings from April to June 2019

For more information on the application process to become a Canopy provider please email us at providers@canopy-insurance.com or call us at 876-654-8381 or 876-654-7205.

What are the requirements needed for my application?

Please see below for information needed when submitting your application.1

  1. Banking Information
  2. Government issued identification
  3. Tax Registration Number for Authorized Officer completing application (if driver’s license is not provided)
  4. Certified copies of:

Additionally, we request that you present the following documents within 180 days of submitting your application: 2

  • Verification documents for entity. **
  • Current Practicing Certificate from relevant registration body3 ***
  • Tax Registration Number for Business

**Entity Verification:

Entity Type Document Needed
Sole Proprietor Business Registration Certificate issued by the Companies Office of Jamaica
Partnership Business Registration Certificate issued by the Companies Office of Jamaica and partnership agreement.
Limited Liability Company Certificate of Incorporation and Articles of Incorporation issued by the Companies Office of Jamaica
Individual (operating without a trade name) Your TRN inclusive of the branch code issued by the Tax Administration of Jamaica and proof of residency for persons not born in Jamaica (e.g. work permit or naturalization certificate)

***Relevant registration body based on provider type:

Provider Type Registration Body
Medical Doctor/Specialist/Consultant/ Ophthalmologist Medical Council of Jamaica
Dentist Dental Council of Jamaica
Optometrist Registrar General’s Department
Radiographer/Medical Lab Technologist, Physiotherapist Council of Professions Supplementary to Medicine
Pharmacy, Pharmacist Pharmacy Council of Jamaica
Laboratory/Diagnostics Standards & Regulations Division – Ministry of Health

Will I have to sign a provider contract to be on the Canopy provider network?

Yes, you will have to sign a provider agreement to become a part of Canopy provider network. Once your application with required documents is received and reviewed, we will send you a copy of our agreement.

How long will it take for my provider application to be processed?

Once we receive your application, we will be in touch with you within 48 hrs3. If your application is accepted, we will email you instructions for how to download, sign and submit a Canopy Provider Agreement.

What health care benefits are covered by Canopy?

Canopy covers standard health benefits, such as Medical, Dental, Vision Care, Diagnostic Services, Prescription Drug, Surgeries, Maternity, Hospitalization and Preventative Care as well as other specialized benefits. However, specific benefits and plans may differ based on exclusions and limitations of each employer contract.

How will Canopy members know that I am a Canopy provider?

Once you are accepted into the Canopy Provider network you will be given a Provider Welcome Kit which will include stickers to identify you as a Canopy provider. Also, you will be listed on the Canopy website and included in documentation provided to our members.

How will I identify a Canopy member?

Canopy members will be issued swipe and benefit cards which will clearly indicate the cardholder name and number. The swipe card will have a magnetic strip on the back which is used to submit claims electronically and the benefit card will outline the basic plan benefits for the cardholder. Please remember to check the personal ID (e.g. Driver’s License or National ID) of the patient against the Canopy card provided to validate credentials such as name and date of birth (DOB).

How can I submit my claims for reimbursement?

Claims4 can be submitted to Canopy in three ways:

  1. Online upload of paper claims – for the first time ever in Jamaica, our paper claims can be downloaded, completed and uploaded via our web portal. We will share sign-on instructions to our portal via email to accepted providers.
  2. Paper claim submission – fill out paper claim form and mail or drop off to our 58 Half-Way Tree road office location
  3. Electronic claims submission (swipe card) – providers contracted to AIS can use the PAS system to submit Canopy claims using member swipe cards.  However, AIS’ transaction fee will apply as per your contract with AIS.   For specific questions regarding the use of the PAS system, please contact AIS’s customer service at 876-929-6462.

I am a Pharmacy provider and I don’t use PAS, I use a third-party pharmacy software to submit claims. Will I be able to submit Canopy claims?

Yes, you will be able to submit Canopy Claims once your software provider has gone through the AIS approval process and added your Canopy provider number to your software application.

Will I be able to get pre-authorization for my surgery or other major medical claims?

Yes, Canopy makes pre-authorization as efficient as possible. You can email, fax or mail your pre-authorization requests to Canopy. You can also submit the preauthorization request online through our easy to use provider portal.

Is there a transaction fee for submitting claims?

Canopy does not charge you for submitting paper claims whether hardcopy or uploaded to our website. However, for electronic claims (swipe card) there is a transaction fee payable to Advanced Integrated Systems (AIS) for submitting claims through PAS. This is deducted from the amount that we will reimburse to you for the claims as per your agreement with AIS. As part of your required documentation for Canopy, we request a payment authorization form.

How long after submitting my Canopy claim will I get paid by Canopy?

Payment(s) for claims will be made within 5 to 7 working days after being received and approved by Canopy. This means electronic claims will be processed at a faster rate than claims submitted by paper form.

How will I get paid? Will I get a physical cheque?

Our standard payment method will be electronic funds transfers. Banking information will be requested during your application process to facilitate more convenient and direct payments to your account. Paper cheques will only be sent upon special request submitted through the provider portal, or by calling our operations line at 876-654-8381/ 876-654-7205.

How will I know when my claims are paid?

Once payment has been processed an Explanation of Benefits (EOB) will be emailed to you with payment details. You can also log into our portal with the user credentials, assigned to you upon joining the network, in order to view your claims’ payment status.

Will you make the reconciliation process easy?

Yes, we will. The statements will be easy to understand and the transactions will be outlined in the same order as they have submitted by you.

What do I do if I find a discrepancy in my statement when I am doing my reconciliation?

You can call our Operations Department at 876-654-8381 or 876-654-7205 or email us at providers@canopy-insurance.com and a Canopy representative will assist you with your reconciliation concerns. You can also log a complaint in our online portal, credentials for which you will receive upon successful registration.

Does Canopy require any specific standards be maintained at my practice?

Canopy requires all providers to maintain basic site standards as outlined in the Canopy Provider Manual which will be provided to you during your onboarding process. If you have further questions about these standards or wish to review the provider manual prior to joining, please call our Operations Department at 876-654-8381 or 876-654-7205 or email us at providers@canopy-insurance.com

Will Canopy conduct visits to my site location?

Canopy reserves the right to conduct a site visit at the time of a provider’s initial application for participation or at any time throughout the provider’s contractual relationship with Canopy. In addition, we may ask certain Provider types to arrange an inspection by the following independent/regulatory body and have a copy of the report submitted to us:

  1. Diagnostic Facilities utilizing radiation or magnetic resonance imaging should have their facility inspected annually by a Medical Physicist.
  2. Surgery Centres should have their Operating Theatres inspected and reviewed by the Ministry of Health’s Standard and Regulations Division.
  3. Testing Laboratories are to be inspected and reviewed by the Ministry of Health’s Standard and Regulations Division.

1 This list does not provide all information to be listed on the application, the application will require additional basic information such as name, address etc. Please supply a certified English translation for any foreign language documentation.

2 Canopy reserves the right to immediately terminate or suspend this Agreement if you fail to provide the requisite certification and verification within the time period specified herein

3 Optical centers should have confirmed coverage from a licensed Optometrists/Ophthalmologist for at least 12 hours per week at each location. Confirmation of this schedule should be presented within 60 days after onboarding.

4 Canopy reserves the right to require additional documents or to conduct a site visit which may delay the onboarding process. Canopy also reserves the right to deny providers access to its network if it so chooses at its own discretion.

5 All paper claim forms should be submitted within 90 days of the date of service. Please note that pharmacy claims will only be processed electronically.