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Health, Travel and Dental Claims

You have two main options for submitting most of your health, travel and dental claims - online and paper claim form.

Deadline for Submitting Claims

You must submit your claim and receipts within the following deadlines or they will not be reimbursed:

Online claims Within 6 months after incurring the expense.
Paper claims Within 12 months after incurring the expense.

Online Claims

If you register for Great-West Life's GroupNet for Plan Members online secure site and for direct deposit, you will be able to submit a number of health and dental claims online and receive your reimbursement faster. To register, go to www.greatwestlife.com and click on GroupNet for Plan Members. Then follow the links to register.

Once your access has been set up, complete the online form with the details of the service or expense; you don't need to send your receipts. Great-West Life assesses your claim and deposits your payment to your bank account and sends you an email notifying you of the payment. You are responsible for keeping your original receipts for 12 months following the date you submitted your claim online, in case Great-West Life later requests them as part of an audit.

Get your claims reimbursed faster when you submit your claims online and enrol for direct deposit. Be sure to sign up for Great-West Life’s Group Net for Plan Members.

Paper Claims

To submit a paper claim, complete the appropriate form:

You can access the forms online or request paper copies of the form from Johnson Inc.

To avoid any delays in processing your health or dental claim, be sure that all sections of your claim form are complete and that your receipts are attached.

Remember, always provide your group policy number (56530) and your identification number, which can be found on your pay-direct drug card.

It is important to indicate if you have benefits under another plan, such as your spouse’s plan. If this information is not included, your claim cannot be processed.

Staple receipts and any other required documentation to your claim form before mailing. For drugs, be sure to include the pharmacy receipt. Don’t forget to keep a copy for your records.

Direct Deposit

You can have Great-West Life deposit your claim reimbursements directly into your bank account. It’s a fast and convenient way to receive your health and dental reimbursements.

To sign up for direct deposit, go to www.greatwestlife.com, click on GroupNet for Plan Members and follow the steps online. Alternatively, you can contact Great-West Life directly and a representative will talk you through the steps for signing up. Great-West Life will not take banking information over the telephone. You will need to submit this information by mail.

The initial set-up takes one to two weeks. Afterward, deposits should take only one to two days.

Helpful Tips for Submitting Claims

The steps for making a claim will depend on the eligible expense you are claiming. See the expense below for specific instructions.

If you have a question about a health claim, contact Great-West Life at 1 800 957-9777.

Prescription drugs

Paying with Your Pay-Direct Drug Card

  • Give your pay-direct drug card to the pharmacist.
  • The pharmacist will enter the data on your card and your prescription into their system.
  • Within seconds, this data is electronically processed, and the system will indicate your portion of the cost.
  • You pay for only your portion of the cost.
  • Your claim is submitted automatically, which means you do not need to submit a claim form to Great-West Life.
  • If you also have coverage under your spouse’s plan, you may use your drug card for that plan too.

If You Don’t Have Your Pay-Direct Drug Card

  • Pay the total cost up-front and ask for a receipt.
  • Complete an online claim or submit a paper claim form to Great-West Life.

Note: Your receipt must show the prescription number and the name of the drug or the Drug Identification Number (DIN).

Paramedical practitioners

Vision care

Out-patient services and supplies

Ambulance services

  • Pay the total cost up-front and ask for a receipt.

  • Complete an online claim or submit a paper claim form to Great-West Life.

Hospital accommodations

  • You have no claim form to complete. Simply provide the plan’s policy number and your certificate number, which you can obtain from your pay-direct drug card or from Johnson Inc.
  • The hospital will invoice Great-West Life directly.
  • If you have chosen a private room, the hospital will bill you directly for the portion of your expenses not covered by the plan.

Private-duty nursing

  • Obtain written confirmation from your doctor that the service is medically necessary.
  • Obtain approval from Great-West Life prior to receiving any private nursing care.
  • Once you are receiving nursing care, you must obtain a claim form from Great-West Life specifically for this purpose.
  • Complete the claim form and submit it to Great-West Life.

Medical equipment and supplies

  • Where applicable, before you incur an expense, ask Great-West Life to approve the expense.
  • Pay the total cost up-front and ask for a receipt.
  • Complete an online claim or submit a paper claim form to Great-West Life.

Note: For diabetic supplies, you can simply use your pay-direct drug card.

Accidental dental treatment

  • Submit a treatment plan within 180 days of the impact for treatments scheduled to occur more than 180 days following the impact.
  • Pay the total cost up-front and ask for a receipt.
  • Complete a claim form. Indicate on the form that the expense is the result of an accident. Great-West Life will require details of the accident and possibly X-rays.
  • Submit the claim form and your receipt to Great-West Life.

Travel

  • When you travel, be sure to carry your travel assistance card at all times.
  • If you become ill or injured, you or your representative should immediately call the number on the card.
  • If a medical provider or hospital bills you directly, send the bill along with your claim form to:

    Assistance Centre - Claims Department

    P.O. Box 97, Station A
    Mississauga, ON L5A 2Y9

  • You must submit your claim form within 12 months after incurring the expense.
  • If you have any claim questions or require an out-of-country claim form, please call the Great-West Life Customer Care Centre toll free at 1 800 957-9777.

Claims for Referrals

Before you incur eligible expenses, you must provide Great-West Life with:

  • Full details from the physician regarding the treatment, and
  • A statement from the provincial health plan that describes what it will cover.

After you have incurred an eligible expense and the provincial plan has already paid its portion, complete an online claim or submit a paper claim form for the unpaid portion to Great-West Life.

Dental

  • Ask your dentist if they can bill Great-West Life directly.
  • If your dentist bills Great-West Life directly:
    • Pay only your portion of the cost. You have no claim form to submit.
  • If your dentist does NOT bill Great-West Life directly:
    • Pay the total cost up-front and ask for a receipt.
    • Complete an online claim or submit a paper claim form to Great-West Life.
  • For orthodontic treatments, obtain a treatment plan from your dentist and submit it to Great-West Life. The plan will pay 50% of the eligible expense up to the maximum, as follows: 30% of the cost at the beginning of the treatment, excluding the diagnostic fee, and the rest on a monthly or quarterly basis depending on how the dentist bills for the services or how you submit receipts. No advance payments will be made.

Coordination of Benefits

If you and your spouse both have family coverage, you may submit your claims to both plans and get reimbursed for up to 100% of your covered expenses.

The steps to follow will depend on who incurred the expenses:

Your expenses

The PSGIP is the first payer.

Your spouse’s expenses

Your spouse’s plan is the first payer.

Your children’s expenses

Submit a claim to the plan of the parent whose birthday falls first in the calendar year.

For example, if your birthday is March 11 and your spouse’s birthday is July 8, submit claims for your children’s expenses to the PSGIP first, and then to your spouse’s plan. Be sure to keep copies of your receipts.

Coordination of Benefits with Pay-Direct Drug Cards

If you and your spouse both have family coverage and your spouse has a drug card under their plan, the pharmacist can use your PSGIP drug card to electronically process claims under both your plan and your spouse’s plan, right on the spot.