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.
Benefit eligibility/entitlement, dollar maximums and frequency limitations are determined by your employer and outlined in its master contract with GSC. The benefits are administered by GSC, according to the terms and conditions of the contract/policy.
Dependent children are covered according to the details noted in your benefit plan documentation. If coverage allows for over-age dependents, their eligibility and provisions defined are determined by the contract between GSC and you/your association/your employer. Please refer to your benefit plan documentation and/or your employer for additional information.
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.)
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 60 days of losing your group coverage) You can buy directly from GSC or work with an advisor. Click here to learn more about your options.
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.
ID Card & Booklet
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).
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.)
Good news! If you need to replace a lost ID card, simply register for Plan Member Online Services 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 a plastic ID card, 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).
Benefit booklets are available online via GSC’s Plan Member 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.)
The booklet provided to you is intended as a guide. For more specific or detailed information regarding eligibility, please call our Customer Service Centre at 1.888.711.1119 or register today for Plan Member Online Services.
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.
Yes! Your health service provider can bill GSC directly, and payment will be made directly to the provider. You won’t have any claim forms to fill out, and in some cases you won’t have to pay anything out-of-pocket (other than your portion of the benefit). Be sure to talk to your provider today so 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
P.O. Box 1652
Windsor, Ontario N9A 7G5
Green Shield Canada
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
P.O. Box 1623
Windsor, Ontario N9A 7B3
Green Shield Canada
P.O. Box 1699
Windsor, Ontario N9A 7G6
To avoid additional postage costs, just 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)
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!
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 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. 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.
All claims must be received by GSC within 12 months of the date of service (unless otherwise stated in your benefit plan documentation).
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 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.
No, all claim reimbursements are made payable to the plan member (ID number ends with -00).
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.
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 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.
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 Plan Member Online Services or our GSC on the Go app. And don’t worry, we also accept old-fashioned paper claims. Click here to see more about submitting claims.
Allianz Global Assistance is the international medical service organization that GSC has partnered with to facilitate our travel claims processing. All of GSC’s out-of-province/Canada claims are adjudicated and managed by Allianz Global Assistance. Allianz Global Assistance is a specialized service organization with revenues of over $200 million and the exclusive North American member of Allianz Global Assistance. Allianz Global Assistance is a $1 billion company: the undisputed worldwide leader in travel insurance and 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.
First and foremost, evaluate your emergency. If your emergency is such that you require immediate medical assistance, call an ambulance (911 if available where you’re located). 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 group number and 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.
If you contact GSC Travel Assistance before seeking treatment, they can help you find a clinic/hospital closest to you and 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, make billing arrangements for direct payment of the medical bills. If you are admitted to the hospital, GSC Travel Assistance will make arrangements for your medical bills, 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.
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 and traveling contact numbers, certificate number, group number and date of birth. Privacy statements will also be read to you to ensure you understand the privacy procedures relevant to your medical situation. You’ll need to complete claim forms to process your claims for the medical emergency. These forms will be sent to you once your eligibility has been confirmed.
You are not assigned a case manager as GSC Travel Assistance provides assistant service 24/7. As complications may occur any time of the day, all the medical staff and case managers need access to your file to assist at any time. You can call 1.866.222.0427 for updates regarding your emergency. It is important to note: upon case opening, if you wish for a family member to have access to your 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 prior consent.
One of the most important items provided are international dialing codes 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 assist. GSC Travel Assistance can break down the process of opening a claim and what to expect. It 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.
The claim payment process can be lengthy if we’re waiting for specific information. When you seek treatment 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 a different way. If we don’t receive an itemized bill, we’ll have to ask the billing department to provide this due to provincial health care requirements, which could lead to a wait time of up to four weeks to receive this from the facility. Since GSC Travel Assistance sends these bills to the Government Health Insurance Plan (GHIP) on your behalf, the original itemized statements are required. 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 expedite or support the information being received by GSC Travel Assistance. Complete your claim forms right away and forward them to GSC Travel Assistance.
It’s important to note that 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 GHIP. Under the GHIP regulations, original bills are required. If you are incurring a claim in the United States, it is helpful to obtain a UB92 or HCFA, which are types of bills that GHIP would require and would help get your claims processed faster. Delays commonly happen when plan members follow up for these bills after arriving home, which can drastically impact claim payment time.
If all documents are complete and received there is a 10 business day processing timeline. These 10 days are due to the cheque printing time and do not include any mailing delays.
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.
You should receive an Explanation of Benefits (EOB) statement that will explain why you only received a partial reimbursement. There are several possible reasons you only received partial reimbursement:
- 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.
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.
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.
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 Group number on the back of the card).
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.