FAQ (That's short for frequently asked questions…and we'll give you the answers too)

Your benefit booklet provides a summary of your benefit plan and what is covered. For detailed information regarding eligibility for a specific item or service, Get in Touch.

If the cost of any proposed treatment is expected to exceed $300, you should submit to GSC a detailed treatment plan from your provider before your treatment begins. If a description of the procedures to be performed and an estimate of the charges are not submitted in advance, GSC reserves the right to make a determination of benefits payable, taking into account alternate procedures, services, or course of treatment, based on acceptable standards of medical/dental practice. For more information on pre-authorized requirements, please call our Customer Service Centre at 1.888.711.119.

Yes. Your health service provider can bill GSC directly and payment will be made directly to the provider. This benefits you, as the plan member, because you do not have to fill out any claim forms, nor in some cases will you have to pay anything out-of-pocket (other than pay for you portion of the benefit). Be sure to talk to your provider today so that they can bill us directly.

Here are GSC’s mailing addresses for claims and other general correspondence (when in doubt, just send your claim to the General Mail address):

Green Shield Canada
Out-of-Province, HCSA, General Mail
P.O. Box 1606
Windsor, Ontario N9A 6W1

Green Shield Canada
Drug Claims
P.O. Box 1652
Windsor, Ontario N9A 7G5

Green Shield Canada
Dental Claims
P.O. Box 1608
Windsor, Ontario N9A 7G1

Green Shield Canada
Hospital, Nursing Home, Vision Claims
P.O. Box 1615
Windsor, Ontario N9A 7J3

Green Shield Canada
Medical Items
P.O. Box 1623
Windsor, Ontario N9A 7B3

Green Shield Canada
Professional Services
P.O. Box 1699
Windsor, Ontario N9A 7G6

To avoid additional postage costs, please submit multiple claims in one envelope to any of the addresses listed in the response above.

We process health and dental claims on average within four business days from the date we receive the claim at our Head Office in Windsor, Ontario. If information is missing, we may have to return the claim to you and this will delay payment. Please be sure to:

• Complete the claim form in full and sign in the appropriate spot. Remember to include your GSC ID number (found on the front of your ID card). If the claim is for a dependent, include the dependent’s ID number (found on the back of your ID card).
• Be sure to include your original receipts and remember to take a photocopy for your records.
• Double check that you have provided your full mailing address.
• Send the form to the GSC address indicated on the form. It must be received within 12 months from the service date (unless otherwise stated in your benefit plan documentation).

For the fastest claim payment, register for Plan Member Online Services and sign up for Direct Deposit. You will receive an e-mail indicating that your claim has been processed and paid. Otherwise, we aim to have a cheque in the mail to you in one to two day(s) after processing.

We also suggest you ask your health service provider to bill us directly. This will eliminate the time you spend waiting for a reimbursement cheque, and eliminate the need to fill out a messy claim form!

All claim forms require at a minimum:

• plan member name
• patient name
• GSC ID Number, including the dependent code
• plan member signature

For more detailed instructions, please click here.

You need to send a receipt showing confirmation of payment with your claim form. The accompanying receipt from the health service provider must show the following:

• date of service
• service performed
• cost of the service
• signature of the provider or the provider's official stamp (on the receipt)

In addition to the above, a receipt accompanying a drug claim must also show:

• prescriber's name
• drug identification number (DIN)
• name of the drug
• strength of the drug
• quantity provided
• prescription number

Sometimes cash isn’t an acceptable form of payment – from time to time, when processing claims, valid traceable and identifiable confirmation of payment is required. What does that mean? It means that you need to submit a copy of your payment transaction with your claim to confirm the claim was paid in full. For certain claims, we may require additional confirmation of payment so we recommend you keep a copy of some other identifiable confirmation of payment, such as a cancelled cheque (copy is acceptable if both sides of the cheque are provided), an authorized electronic credit card receipt and/or credit card statement, direct payment /debit receipt or bank statements.

Please note: Any information on a credit card or a bank statement that does not pertain to the claim awaiting payment may be omitted.

All claims must be received by GSC within 12 months following the date of service (unless otherwise stated in your benefit plan documentation).

No, GSC requires the original receipts and a signed claim form to process your claim. We cannot accept photocopied, faxed or scanned receipts.

Instead of returning your receipt to you, GSC produces an Explanation of Benefits (EOB) statement. This statement provides information that may be required for tax purposes (like the information provided on a receipt) as well as any deductibles, maximums, or co-payments applied to the payment of your claim. This statement can also be used to submit Co-ordination of Benefit (COB) claims if you have other coverage. Please take a copy of all receipts and forms for your records before submitting claims to GSC.

We can re-issue a new/replacement cheque three weeks after the date the original cheque was issued. To avoid this in the future, we suggest you register for Plan Member Online Services and sign up for Direct Deposit. You will receive payment once your claim is processed, along with an e-mail to confirm the deposit—no need to wait for mail delivery.

No, all claim reimbursements are made payable to the plan member (ID number ends with -00).

We recognize that fraud is often unintentional however, whether intentional or not, abuse, misuse, and overuse of benefit plans are a reality. So periodically we have to audit claims. Sometimes, through our auditing processes, inappropriate claiming behavior is suspected. In those situations, we need to take extra steps when we adjudicate and pay claims. Please complete claim audit questionnaires when you get them. These help us protect all of our plan members and their benefit plans from abuse, misuse and overuse.

From time to time, we may send you a ‘Release of Information Authorization Form’ because we require additional information related to one of your claims. That additional information, in accordance with legislation, can only be obtained with your written consent. By signing the form, you are giving us permission to review your claims information to make sure claims are appropriate and properly submitted on your behalf.

Sometimes we need to take extra steps when we adjudicate and pay claims. As a result, we have some policies in place to ensure that the services being claimed were performed and paid for in full. For example, sometimes providers aren’t allowed to submit your claims or bill us directly. Although for the most part a temporary inconvenience, in these cases, you will have to pay out-of-pocket for the services that are provided to you and submit a claim form and your receipts directly to GSC (with confirmation of payment). We apologize for any inconvenience. However, it is good for you and the protection of your benefit plan in the long run.