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YOU ASKED, WE ANSWERED... ALL ABOUT YOUR COVERAGE.

Here are some FAQs (frequently asked questions) and the FAAs (freaking awesome answers) about your group benefits.

General

Why is a certain benefit or service not covered by my benefit plan?

Benefit eligibility, dollar maximums and frequency limitations are determined by your plan sponsor and outlined in their master contract with GSC. The benefits are administered by GSC, according to the terms and conditions of that contract/policy.

To what age are my dependent children covered?

Not all health and dental benefit plans are the same, so it is important to check your benefits booklet or check with your Human Resources department or benefits administrator.

You can find a copy of your benefits booklets online through GSC’s Online Services.

I’ve moved, so how can I change the address GSC has on file for me?

GSC keeps two types of addresses on file for you (because nothing in the world of benefits is easy):

  • Your ‘claim address’ –the mailing address you supply to GSC on the claim form you send in with each claim. This is the address we use when sending correspondence to you, like claim reimbursement or statements. Your current mailing address should be noted on every paper claim you submit to ensure you receive correspondence in a timely manner. Also, please remember to include your GSC ID number on all correspondence.
  • Your ‘enrolment address’ –the address supplied to GSC by your plan sponsor (e.g., your employer) when you were initially enroled in the benefit plan. Some group plans do not allow us to use the claim address you submit on your claim form, so in this case we must always send correspondence to your enrolment address. Because the address originates from your plan sponsor’s data files, GSC Customer Service Representatives are not able to make this change for you. To change the enrolment address, you must advise your benefit administrator and they will advise GSC. (Note: Your benefit administrator is usually your HR department. But if you aren’t sure, then ask someone you trust.)
I’m leaving my group plan. Can I get coverage under a GSC Individual plan?

Yes! We’re sorry to hear that you’re losing your coverage. But we certainly have options for getting you access to the health and dental coverage you need. Our conversion plans offer varying degrees of protection, depending on your situation. Plus they’re guaranteed issue (a fancy way of saying you can get them with no medical questionnaire, as long as you apply within 90 days of losing your group coverage). You can buy directly from GSC (via SureHealth) or work with an advisor. Click here to learn more about your options.

Why would I buy direct from you vs. going through an advisor?

GSC is all about providing options for getting you access to the health and dental coverage you need. It comes down to your comfort level. If you prefer to shop around on your own, then you might want to check out SureHealth™, GSC’s “Direct-to-Consumer” brand of personal health plans.

We also offer our individual products in partnership with advisors. They can help you select a plan best suited to your health coverage needs, like Prism® (in partnership with Special Benefits Insurance Services) and GSC Health Assist™ (in partnership with advisors across Canada).

If you want to buy direct, you can visit us at surehealth.ca or call the SureHealth™ information line at 1.844.850-SURE (7873). Our representatives will be happy to walk you through the process.

Click here if you want be put in touch with an advisor, or click here to learn more.

ID Card & Booklet

Where can I find my GSC ID number?

Your unique GSC ID number is located on the front of your ID card, beneath your name. GSC ID numbers for dependents (if applicable) can be found on the reverse side of the card. As the plan member (or the cardholder), your GSC ID Number ends with -00. GSC calls this your dependent code. Each of your eligible dependents will have their own unique dependent code. For example, it is typical that your spouse will have a dependent code of -01, and your children will have a dependent code of -02, -03, etc. (in subsequent birth order).

You can print a copy of your ID card through Online Services or view a digital version through our mobile app – GSC on the Go.

Who do I contact if the information on my ID card is incorrect?

Contact your benefits administrator to report any errors or omissions on your card. GSC Customer Service Representatives are not able to process these changes for you. (Note: Your benefit administrator is usually your HR department. But if you aren’t sure, ask someone you trust.)

I lost my ID card. Who do I contact to get a replacement card?

Good news! If you need to replace a lost ID card, simply login to your Online Service account and you can print one off yourself. And if you have GSC on the Go on your mobile device, you’ll always have an electronic version of your ID card available. If you require another ID card to be sent to you, please call a GSC Customer Service Representative at 1-888-711-1119. The ID card will be sent to your benefits administrator for distribution (unless otherwise arranged by your administrator).

Where can I get a booklet that provides a description of my benefits?

Benefit booklets are usually available online via GSC’s Online Services. Please contact your benefits administrator for another format. (Your benefit administrator is usually your HR department. But if you aren’t sure, ask someone you trust.)

Is everything I need to know about my benefits in my benefit booklet?

The booklet provided to you is intended as a high level overview of your benefit plan. For more specific or detailed eligibility information regarding your plan, register today for Online Services or call our Customer Service Centre. 

Claims

Is pre-authorization or pre-approval required?

Yes, some services and medical items require pre-authorization or pre-approval. In most cases you can use Online Services tools to check coverage and see if pre-authorization is needed.

If you expect the cost of any proposed treatment 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 1.888.711.1119.

Can my health provider bill GSC directly?

Yes! You can use the Find A Health Provider search tool in Online Services or GSC on the Go to see if the provider is eligible with GSC and can bill directly. You can also ask your provider. If they do not direct bill to GSC, please encourage them to give us a call to get started.

For help with using the Find A Health Provider search, click here.

If I am sending a claim form through the postal service, which address do I use?

Please use the address listed on the bottom of the for the type of claim you are submitting. If you are submitting different types of claims in a single package, or for general mail, please use the address below.

Green Shield Canada
P.O. Box 1606
Windsor, Ontario N9A 6W1

Looking for claim forms? Login to Online Services for personalized, pre-filled claim forms.

When are health and dental claims processed?

Claims submitted online (via Online Services or the app, GSC on the Go) are processed immediately and finished as soon as you receive confirmation. You will then get an email letting you know that a statement is ready to review. If GSC owes you money, it will be paid within two business days of the processing date, but often sooner.

Claims submitted on a paper claim form via the postal service, or scanned and uploaded through Online Services take a little longer to process. Processing time depends on how many claims we have in our claims processing centre at our head office. If information is missing from a claim form, we may have to return the claim to you and this will delay payment. Any funds owing will be paid within two business days of the processing date, and then sent via postal service. To get paid faster, we encourage you to sign up for direct deposit via Online Services.

When will I get paid?

For the fastest claim payment, sign up for Direct Deposit through your Online Services account. We will email you once the claim is processed and funds are deposited into your account.

Otherwise, we aim to have a cheque in the mail to you one to two business days after processing.

Want to learn more about Direct Deposit? Watch this video

What information is required on a health and dental claim form?

Please note: Paper claim forms are only required if you are mailing your claim

To submit a paper claim:

  • Print a pre-filled, personalized claim form via Online Services. The form will pre-fill the plan member name, patient(s) name, and GSC ID Number, including the dependent code(s)
  • Remember to sign the form
  • Be sure to include your original receipts (take a photocopy for your records) and provide your full mailing address


For a look at alternatives to paper claims, please click here.

What else do I need to send with my completed claim form? Proof of payment?

If you submit claims online, you only need to provide proof of payment if we ask for it. But, keep a copy of your proof of payment for 13 months after the date of service.

If submitting health or dental claims through the mail or via online upload, you need to send a receipt showing confirmation of payment with your claim form. The 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)

For a paper or online upload drug claim, you need to send an official prescription receipt, along with the receipt for confirmation of payment. The official prescription receipt must show:

  • prescriber's name
  • drug identification number (DIN)
  • name of the drug
  • strength of the drug
  • quantity provided
  • prescription number
How long do I have to submit a health or dental claim?

In order to be considered for reimbursement, claims must be received by GSC within 12 months of the date of service (unless otherwise stated in your benefit plan documentation).

Are my receipts returned to me after my claim has been paid?

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.

Can you issue me a new/replacement cheque?

We can re-issue a new/replacement cheque three weeks from 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.

Can I have my claims reimbursement made payable to someone else?

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

Does GSC audit claims?

We recognize that fraud is often unintentional. But, 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 our plan members and their benefit plans from abuse, misuse and overuse.

I was mailed a ‘Release of Information Authorization Form’. What do I do?

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.

Why can’t my health service provider submit my claims or bill GSC directly?

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 you’re provided 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.

How do I submit my claims to GSC?

You have a few options for submitting your claims to GSC. Many health care professionals will submit claims on your behalf – all you have to do is ask them. You can also submit many types of claims yourself electronically via Online Services or our GSC on the Go app. And don’t worry, we also accept old-fashioned paper claims.

Want to learn more? Click here for some tips to help you. 

How do I know whether a particular item or service is covered under my plan?

GSC has several ways for you to check your coverage:

  1. Online Services and GSC on the Go (mobile app) offer a Find A Health Provider tool that allows you to check certain coverage as well as specific drug coverage
  2. Your benefit booklet provides a summary of your benefit plan. You can find a copy of your benefit booklet on Online Services. You can also check eligibility for benefits through GSC on the Go
  3. Contact Customer Service. Our skilled agents will assist you (or your health service provider) with the details of coverage and eligibility
How do I complete a paper claim form?

Paper claim forms are only needed if you are mailing a claim through the postal service to our head office in Windsor, Ontario. If sending a paper claim, 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)
  • 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).
What is confirmation of payment or proof of payment?

Sometimes cash isn’t an acceptable form of payment for health services or items that you are submitting for reimbursement. From time to time, valid traceable and identifiable proof or confirmation of payment is required. What does that mean? It means you need to submit a copy of your payment transaction with your claim to confirm the claim was paid in full. For some claims, we may require additional confirmation of payment. We recommend you keep a copy of some other identifiable payment confirmation, 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 bank statement that does not pertain to the claim awaiting payment may be omitted.

Travel Benefits

Who is GSC’s Travel Assistance provider?

GSC has partnered with Allianz Global Assistance to facilitate our travel claims processing. Allianz Global Assistance is one of the largest travel insurance and international medical service organizations in Canada. All of GSC’s out-of-province/Canada claims are adjudicated and managed by Allianz Global Assistance.  

Allianz Global Assistance deals directly with provincial plans and ensures that all liabilities are properly assessed. They also have a 24/7 toll-free Call Centre that provides assistance to callers in over 20 languages, 365 days a year.

If I have a medical emergency outside my province, what do I do? Who do I call?

First and foremost, evaluate your emergency. If your emergency is such that you require immediate medical assistance, call an ambulance. Click here for a list of emergency telephone numbers from around the world

Once you arrive at the hospital, have a family member contact GSC Travel Assistance to open a case. The contact number is 1-800-936-6226 toll free. If the toll free number does not work, you can use the collect number: operator+519-742-3556. GSC Travel Assistance is available 24/7 including holidays. You can also call this number before leaving your province of residence for pre-trip assistance.

When contacting GSC Travel Assistance, quote the GSC ID number on your card. If your emergency is one that does not require immediate urgent medical assistance, contact GSC Travel Assistance to open a case prior to seeking medical treatment so they can assist in directing you to the nearest clinic or hospital.

Why do I need to contact GSC Travel Assistance anyway?

GSC Travel Assistance can help you find a clinic/hospital close to you that can provide the best medical treatment appropriate for your condition. They can contact the hospital or clinic in advance to let them know you’re coming in and (where possible) arrange for direct payment of the medical bills. If you are admitted to the hospital, GSC Travel Assistance will manage your care to ensure that all procedures performed will be covered under your plan, and, if necessary, make arrangements to have you returned home to Canada for continued medical treatment. During your admission to the hospital, GSC’s Travel Assistance maintains contact with the treating physicians, case workers and nurses to evaluate your condition.

How long does it take to open a case when I call GSC’s Travel Assistance?

Typically, it will take 10-15 minutes to open a case. During this process, GSC Travel Assistance will require you to answer some brief medical questions, provide your home/traveling contact numbers, GSC ID number (found on your card), and date of birth. Privacy statements will also be read to you to ensure you understand the privacy procedures relevant to your medical situation. Eligibility and assurance of coverage are not always able to be given at the time you open your case. You will be advised that your coverage is limited to the provisions under your plan which will need to be confirmed. This is especially important to know if have pre-existing conditions and medical records need to be obtained. You’ll need to complete claim forms to provide authorization for obtaining the documents necessary to process your claims for the medical emergency. These forms will be sent to you upon case opening.

Am I assigned a contact during my emergency? Who can I get updates from?

You will not be assigned a dedicated case manager. You will be given a case number when you first call that you should refer to each time you call. All medical staff and case managers have access to your file 24/7 as you may need assistance at any time of the day. You can call 1.866.222.0427 for updates regarding your emergency. Please note that if you wish for a family member to have access to medical updates regarding your case, you must authorize us to speak to them. Due to privacy laws, we cannot disclose personal information about your case even to family members without your prior consent.

What pre-trip assistance can you provide?

One of the most important things we can provide is the international dialing code(s) for the location you are traveling to. With the proper international dialing code, you will be able to contact GSC Travel Assistance with ease, should an incident occur. If you have questions regarding certain benefits before you travel, GSC Travel Assistance can help. GSC Travel Assistance can outline the process of opening a claim and let you know what to expect. They can also advise you of any Canadian Travel Advisories that are issued for the country you are visiting. Also, GSC Travel Assistance may provide some useful tips to remember, such as bringing your GSC ID card.

What can I do to speed up the claim payment process?

If you have to get care at a clinic/hospital, be sure to tell the facility that you have emergency travel coverage. Although GSC Travel Assistance notifies the medical facility that we require itemized billing statements, some facilities may choose to bill differently. If we don’t receive an itemized bill, we’ll have to ask the facility’s billing department to provide one. Not receiving one could cause a delay. Since GSC Travel Assistance sends these bills to your Government Health Insurance Plan (GHIP) on your behalf, the original itemized statements are required. If you incur a claim in the United States, it would be helpful to obtain a UB92 or HCFA. These are types of bills that your GHIP would require and would help get your claims processed faster. If admitted to the hospital, we’ll also need your discharge summaries. In all cases, please make every effort to obtain copies of all documentation. This may help support the information being received by GSC Travel Assistance and expedite your payment. Complete your claim forms right away and forward them to GSC Travel Assistance.

Please note: insurance coverage is intended to supplement GHIP coverage. Claim reimbursement is dependent on the service being a GHIP-approved benefit. As such, all bills and supporting documentation must to be sent to your GHIP.

What is the standard turnaround time for reimbursements?

If we receive all the necessary, completed documentation, there is a 10 business day processing timeline. This includes the processing of the claim and printing of the cheque. It does not include the mailing time.

If there’s a problem with my claim, how and when will I be notified?

If GSC Travel Assistance requires any further documentation, they will issue a letter requesting the required documentation. If you call for an update, you’ll be instructed at that time what is required. Some items, like proper original bills, will be followed up on by the claims team on behalf of the plan member.

I have only a partial reimbursement. What now?

You will receive an Explanation of Benefits (EOB) statement once your claim has been processed. The EOB will explain why you only received a partial reimbursement. Below are some of the reasons why you might not have received full reimbursement for your claim:

  • If payment has been made directly to a provider, there may be a discount applied to your claim. The discount amount will show on your EOB as ineligible with a note indicating that you are not required to pay this amount.
  • Items may not have been covered under your policy.
  • Part of the items may be covered under your regular benefits, and would be forwarded to GSC to issue payment.
  • Some of the bills were processed, while others need proper original bills. GSC Travel Assistance is following up on those bills. If you receive partial reimbursement and have questions, you can call the claims department for a more detailed explanation at 1.800.363.1835.
I got a bill from a collection agency, but GSC said they’ve paid the bills. Why?

Unfortunately this can sometimes happen. The billing departments are not always located within the medical facility; they are often a separate service. There are times when GSC Travel Assistance has made a payment to the medical facility, but the information may not have yet reached the billing department and therefore a reminder bill is automatically generated and sent to the member. If you receive a bill from a collection agency do not worry. Contact the GSC Travel Assistance claims department at 1.800.363.1835 immediately. They will contact the facility and the collection agency and have this rectified.

I’m travelling abroad… Is there anything I need to know?

Canadian Consular Affairs publishes a list of regions where normal travel coverage and services cannot be guaranteed. Many travel health insurance carriers use this list to determine where they can guarantee coverage. If you have coverage through GSC Travel Assistance, it is important to review the list.

Click here for more information.

What documentation should I bring with me when travelling to Cuba?

The Republic of Cuba requires all travellers, foreigners, and Cuban overseas residents to possess a travel insurance policy (covering medical expenses) that has been issued by an insurance entity recognized by Cuba.

The Cuban government will accept a valid provincial health Insurance plan card as sufficient proof of travel insurance coverage from Canadian travellers entering Cuba. However, it is advisable that Canadians also take proof of additional travel insurance. You may use this Confirmation of Travel Insurance letter in combination with your GSC ID card (which has your GSC Travel Assistance information on the back of the card).

How do I know whether my medical condition is “stable” as required?

Emergency travel coverage is designed for sudden and unforeseen medical emergencies while travelling away from your home province. If you or an eligible dependent have been diagnosed with a medical condition or are working with a medical professional to explore a current health condition – sometimes called a “pre-existing” or prior medical condition – it’s a requirement that the condition is considered stable if any travel is planned.

 “Stable” means that during the 90 days before leaving on a trip:

  • You have been consistently using the same medications at the same dosages to control your condition. If your dosage has changed, it must be part of your regular treatment or because your condition improved. All medications must be prescribed by a legally qualified medical professional.
  • You haven’t needed additional treatment for a recurrence or complications related to your condition.
  • You haven’t been diagnosed with, or had tests or a medical consultation for, a new medical condition for which you haven’t had any treatment.
  • You don’t have any future appointments scheduled for non-routine examinations, tests, or investigations (including results) for an undiagnosed medical condition.
  • You are not scheduled for any exploratory surgical procedures for an undiagnosed medical condition or surgical procedures for a diagnosed medical condition.

A more detailed and specific definition of stable is available here. This definition will be added to your benefits booklet in the future.

What should I do before I travel?

It is recommended to gather information in advance so you can be prepared in the unfortunate event of a medical emergency while travelling, reading this FAQ is a good start.  It is also important to know your coverage and be sure you are well protected before you travel.

How do I learn about the coverage available under my GSC travel benefits?

Your travel benefits are detailed in your GSC benefits plan booklet available through Online Services. It is important to read and understand your coverage and any limitations and exclusions that apply before you travel. For specific questions on eligibility, coverage details, or amounts used to date, contact the GSC Customer Service Centre. 

What does a travel claim typically cost?

The cost of a minor medical treatment, such as an emergency visit for a bone fracture, can surpass the cost of your trip. Medical treatment costs in the United States, for example, vary greatly from state to state and hospitalization for several days for can cost hundreds of thousands of dollars!

Why would I receive a statement many months after submitting my claim?

Most travel claims involve multiple invoices being submitted to from various providers. Sometimes these come in well after you return home and are considered as long as they are received within the claim submission deadline. When a new invoice is processed as part of your travel claim, you may receive an explanation of benefit statement from Allianz indicating the amount paid. If direct billing was arranged at the time of your claim and you receive a statement of account with a balance owing or an invoice directly from a provider, please call the Claim Inquiry line at GSC Travel Assistance for further direction as you may be asked to send this information to Allianz for review and management.

If my travel claim is denied, what can I do?

If your travel claim is denied and you would like to dispute the denial, you can submit an Appeal to GSC Travel Assistance. An Appeal can be submitted by letter, email or fax. The appeal must be written or typed. A verbal appeal will not be considered. Written authorization is required if an appeal is submitted by a representative or family member. Please ensure there is supporting and/or new documentation in support of your appeal (i.e. additional medical records, documentation regarding reimbursement or payments made/received. The following options are available for an Appeals submission:

Email: Appeals@allianz-assistance.ca

Fax: (519) 742 9471
Attention: Appeals Department

Mail:
Appeals Department

P.O. Box 277
Waterloo, ON
N2J 4A4

How do I know if my travel coverage is enough protection?

It’s always best to review your benefits and dollar maximums in your benefits booklet before travelling. You can also call GSC ahead of departing or planning a trip, to ensure you are fully aware and understanding of your benefits, limitation, exclusions and dollar maximums.