GreenShield Personal Health Coverage Begins When Your Employee Benefits End

Frequently Asked Questions

• What prescription drugs are eligible for coverage under GreenShield insurance plans?

  To be eligible for coverage, the medication needs to be approved for use in Canada, must require a prescription and be prescribed by an authorized medical or dental practitioner (as you might expect). Most generic prescription medications are eligible for coverage, as long as they are on GreenShield’s formulary. Some drugs may require GreenShield Special Pre-Authorization.
  
  Please keep in mind that prescription drug coverage is subject to medical underwriting (if you apply for a medically underwritten plan), to reasonable and customary charges, and to the co-pay and maximum of the plan you select.

• What is a Co-Pay?

  'Co-payment' is a fixed amount (for example $15) you'll pay for a covered health care service, when you receive the service.

• Are brand name drugs eligible for coverage?

  GreenShield Insurance drug benefits are designed to provide coverage for generic prescription drugs. However, they will provide coverage for brand name drugs if no generic equivalent exists. If you submit a claim for a brand name drug instead of the generic, the plan benefit will pay to the price of the lower cost equivalent. (Example: If your benefit pays 70% of eligible prescription costs, the brand name drug costs $100 and the generic equivalent costs $80, your benefit would pay 70% of $80.)
  
  Please keep in mind that prescription drug coverage is subject to medical underwriting (if you apply for a medically underwritten plan), to reasonable and customary charges, and to the co-pay and maximum of the plan you select.

• I’d like to apply online without speaking to a customer service rep, can I do that?

  Definitely. That’s why we’ve designed this website to walk you through the entire process from start to finish. You can explore our plans, find the one that’s right for you, get a quote and apply, all online. We all have busy lives, which is why we want to ensure easy access to the information you need, and that getting the insurance plan that’s right for you is as simple as can be.

• Will my GreenShield Insurance rates ever decrease?

  
  Yes — when your rate category changes from family to couple, or from couple to single. And in the majority of cases, if your GreenShield Insurance plan includes prescription drug coverage, your rates will decrease when the primary applicant on your plan reaches 65 years of age.

• How long does it take to get coverage?

  Coverage starts on the first of the month following GreenShield’s approval of your application. The length of time approvals take depends on the type of plan you choose and how you apply.
  
  If you apply for a guaranteed acceptance plan, like LINK or ZONE 2, 3 or the ZONE Fundamental plan, there are no health questions to answer, there is no medical underwriting. If you apply online or over the phone, your application is approved as soon as GreenShield receives your payment, which could be within a day or two.
  
  When you apply for a medically underwritten plan like ZONE 5, 6 or 7, you’re required to complete a health questionnaire. The GreenShield Medical Underwriting team evaluates your health info. If you apply online or over the phone, please allow two weeks for us to process your application and get back to you. The team evaluates each application on a case-by-case basis.
  
  If you apply by completing a paper application and mailing it to us, please allow three weeks for processing. (It’s so much more efficient to apply online! Or give us a call – we’ll be happy to take your application over the phone. Easy!)

• Do you offer travel benefits?

  An Emergency Medical Travel benefit is included in all GreenShield Insurance plans. The benefit covers multiple trips during a year (which is very convenient). The number of days covered depends on the GreenShield Insurance plan you chose.