Health Claims
Prescription Drugs
Most transactions will occur at the point of sale (i.e., pharmacy).
Prescription drug claims that are purchased at the point-of-sale using the Plan Member’s pay-direct drug card (if applicable to your plan) are submitted directly to the insurance company and the Plan Member is not required to pay out-of-pocket. Any portion of the claim not reimbursed because of plan limitations (e.g., coinsurance amounts, deductibles, etc.) is the responsibility of the claimant.
If, for any reason, the Plan Member’s pay-direct drug card was not used at the point of sale, simply have the Plan Member complete the insurer’s drug claim form and attach the original receipt(s). Plan Member may submit claims directly to the insurer.
Other Health Claims (e.g., vision care, health professional services, prostheses, etc.)
Have the Plan Member complete the appropriate claim form and attach the original receipt(s). Plan Member may submit claims directly to the insurer.
Authorization from a physician is required for certain paramedical practitioners - please refer to the master contract for additional details.
Dental Claims
Most Dental claims are submitted at the point-of-sale and are submitted directly to the insurance company by the Dental Office. Any portion of the claim not reimbursed because of plan limitations (e.g. coinsurance amounts, deductibles, maximums, etc.) is the responsibility of the claimant). Your insurer also provides a claim form for any claims not submitted directly by the dentist.
For any extensive course of treatment involving crowns, bridgework, etc., which may exceed $300, we recommend the Plan Member ask his/her dentist to complete a cost estimate before the work is completed. Send the estimate to the insurer’s claim department to determine how the expenses will be reimbursed.
Before incurring any large dental expenses, or beginning any orthodontic treatment, the dental service provider should complete a treatment plan and submit it to the insurer. The insurer will calculate the benefits payable for the proposed treatment, so the Plan Member will know in advance the approximate portion of the cost they will have to pay.
Online Claim Submission
Register for GreenShield Plan Member Online Services: You may also submit certain claims online or through GreenShield’s mobile app.
Registration is quick and easy. Visit http://greenshield.ca/register. You’ll just need your GSC ID number (from your ID card) and a registration key.
Disability Claims
Short Term Disability
There are three forms that need to be completed for a Short Term Disability claim:
- Employee Statement and Consent Form.
- Attending Physician Statement.
- Employer’s Statement.
Long Term Disability
There are three forms that need to be completed for a Long Term Disability claim:
- Employee’s Statement and Consent Form.
- Attending Physician’s Statement
- Employer’s Statement
To submit claims online, click here. You have the option of submitting paper or electronic claims. Please follow the instructions on the Canada Life site. There is a guide available for paper submissions on the site.
It’s best to submit online, but you have options if you can’t.
You can mail or fax your forms to your local Disability Management Services Office – If you have questions about submitting online, call us at 1-855-755-6729.
Note the following:
- Claims must be submitted six to eight weeks before the end of the elimination period (for long term disability) and as soon as possible after the date of disability for short term disability claims. Please refer to your benefit summary for the applicable elimination periods for both long and short term disability benefits.
- When a disabled Plan Member returns to work (whether the claim was for short or long term disability), please advise HUB International as soon as possible.
- If the Plan Member is Eligible for Worker's Compensation (WSIB) Benefits, he/she will receive a Worker's Compensation claim form from their employer.
Life and Dependent Life Claims
- The beneficiary must complete the Group Life Claimant Statement
- The plan sponsor must complete the applicable sections of the Group Life Employer Statement
- The attending physician will need to complete the Attending Physician’s Certificate of Death
- Once all forms are completed by the appropriate individuals, they should be forwarded to Canada Life head office or emailed to [email protected] along with the Plan Member's original enrolment Form
Accidental Death & Dismemberment Claim
Please contact HUB International for assistance with an Accidental Death or Accidental Dismemberment claim.