Health and Dental Provider Change Questions & Answers

New Benefits Provider

Answer: A Request for Proposal was posted on BC Bid for a service provider to administer the extended health and dental plans for BC Public Service employees.  The current contract was expiring with no further options for renewals.

The RFP process in the Public Service must support the principles of fair, open, and transparent procurement and satisfy the business requirements. The proposals were evaluated against criteria set out in the RFP by a committee of public service employees and the process was overseen by a procurement specialist. The evaluation was based on: Corporate Capability; Service Requirements; Technology Requirements; Performance Standards and Reliability; and Price.

The Great-West Life Assurance Company was the successful proponent selected through this competitive process. As a result, effective April 1, 2017, the plans will be transitioned from Pacific Blue Cross to Great-West Life Assurance Company. The new contract provides the best value for the Province and fully meets our service requirements.

It’s important to note that your health and dental coverage and benefit maximums will not change. This is only a change in the service provider who administers the plans.

 

Question:  When will Great-West Life start providing Extended Health and Dental benefits?

Answer: Great-West Life (GWL) has taken over administration of the Extended Health and Dental plan benefits effective April 1, 2017.

Answer: Share your GWL Plan number with your dentist, pharmacist and other healthcare service providers. You’ll find the numbers on your GWL ID card (called the Assure Card) which was recently mailed out to you. If you did not receive a your ID card in the mail, you can register with GroupNet and print out a card. Register,  using Plan number 50088 and your existing ID number .

You can submit claims online, using GroupNet, or complete a claim form and mail to Great-West Life. Claim forms are available on GroupNet and MyHR.

 

Question:  Will my health and dental coverage change? Will there be a different plan design?

Answer:  No. There are no changes to extended health and dental plan design, eligible items and services, annual and lifetime maximums, or prior approved drug authorizations for specialty medications.

Great-West Life will continue to provide coverage on the same basis as your dental plan cover today, including reimbursing eligible ongoing treatments (e.g., orthodontic services) that were pre-approved by PBC prior to the transition on April 1, 2017.   You or your service provider will need to attach a copy of the pre-approval notice to the first claim that is submitted to Great-West Life.

Answer:  GWL offers easy access to online services 24 hours a day, 7 days a week and a customer service call centre, operating Mondays through Fridays from 5 a.m. to 5 p.m. (Pacific Time).

GWL is among the largest insurance companies and was chosen because it meets all service requirements and provides the best value for the BC Public Service.

While the vast majority of health and dental claims are processed electronically through member eClaims or provider direct billing, paper claims are processed within 5 calendar days. Most electronic claims are processed within the next business day.

Answer: Your identification card with GWL is called the Assure Card. You should have received it by now. If you have not received the card by now please see the answer to "Question: What if I have not received a new identification card (called the Assure card) from Great West Life by the end of March?" below. You can show this card at your pharmacy, dental office, or other service providers for reimbursement at point of sale. 

Answer: MyHR provides information on how to update your benefit enrolment information (such as adding or cancelling a spouse or dependent from your plans) for Bargaining Unit Employees and Excluded Employees in the Flexible Benefits Program.

Answer: Your new GWL Plan Number is 50088 and your identification number is the same as that on your current Pacific Blue Cross identification card. With that information you will be able to sign into GroupNet for Plan Members  and print off a copy of your identification card. Please ensure that your address is up to date with your employer and in GroupNet for Plan Members.

NOTE: if you have access to Employee Self Service (ESS), you can update your address online, otherwise you can call MyHR (1-877-277-0772) and a Service Representative will be able to update your information in PeopleSoft. 

If you have any issues registering with GroupNet please call GWL at 1-855 644-0538.

 

Question: I received my Assure Card from Great-West Life and I did not receive a card for my dependent children.  Does this mean that they are not on my coverage when we transition to Great-West Life?

Answer: You will receive an Assure card for yourself and one for your spouse if applicable.  Dependent children will not receive a card and they will not be listed on the card.  Your dependent information has been forwarded to Great-West Life. You can now  register for GroupNet and see your dependents listed under your coverage.

Answer: For any updates to your enrolment records such as the information on your identification card, please contact AskMyHR. For question about benefits coverage such as eligible items/services or claims, please review your benefits guide or contact GWL.

GWL offers easy access to online services and a customer service centre, operating Mondays through Fridays from 5 a.m. to 5 p.m. (Pacific Time). Starting April 1, 2017, you can contact them at 1-855-644-0538.

 Enrollment & Deposits

Answer: You do not have to do anything; you and your dependents will be automatically enrolled with Great-West Life. Your enrolment information will be provided directly to Great-West Life. Your new GWL Plan Number is 50088 and your identification number is the same as that on your current Pacific Blue Cross identification card.

 

Question:  Will my banking information for direct deposits be switched over automatically from Pacific Blue Cross?

Answer: No, you must register for GroupNet  and provide your banking information if you wish to receive reimbursements from GWL via direct deposit. For more details, check out the video at this link: Sign up for GroupNet for Plan Members and Direct Deposit. Note that your GWL plan number is 50088 and your ID number is the same number you had under PBC except that you will not need to enter the leading zeros (e.g., your ID number for GWL will be  “12345” if your ID number for PBC was “00012345”).

Answer: You should let your pharmacist, dental office, and health care providers know about the April 1 change and show your new GWL identification card called the Assure Card.

Submitting Claims

 

Question:  Will I see changes to the way I submit my claims?

Answer:  Great-West Life has an effective claim submission process including online claims submission. You will also have access to a benefits card for electronic submission of claims. Great-West Life also has direct claims submissions available for service providers, so dental offices, pharmacies and some paramedical providers can submit the claims directly on your behalf.

Providers such as chiropractors, physiotherapists, optometrists, opticians, massage, acupuncture and naturopaths that are registered to direct bill with Great-West Life, will be able to submit on your behalf.

For more information, check out the following videos:

You can still submit claims by mail. Claim forms are available on MyHR.

Answer: The deductible was temporarily waived by Great-West Life during the transition period. On Monday, July 24th all of the claims information will be loaded into Great West Life’s system, and any outstanding deductible amounts will be applied to future extended health claims. If you do not satisfy the deductible within the 2017 calendar year and were reimbursed for expenses, the outstanding amounts at the end of the 2017 calendar year will carry forward into the next year.

Answer: If you were charged the deductible twice, Great West Life will refund you the second deductible. Your refund should be processed by mid-August.

 

Question:  When and how will benefits guides and claim forms be provided?

Answer: Updated benefits guides, references and claim forms are available on MyHR. Claim forms will also be available through the Great-West Life website.

Answer: For visits before April 1, 2017, the claim should be submitted to Pacific Blue Cross.  For visits on or after April 1, 2017, the claim should go to Great-West Life.

Answer: Your Pacific Blue Cross access ID and claims history will remain valid on CaresNet for two years after March 31, 2017.

Answer: For claims with a date of service up to and including March 31, 2017, submit to Pacific Blue Cross. Pacific Blue Cross must receive your claims no later than June 30, 2017. Visit the MyHR website for instructions on how to submit your claims.

For claims with a date of service of April 1, 2017 or later, submit to Great-West Life. Great-West Life must receive both extended health and dental claims no later than 15 months from the date of service. GWL provides online claim submission for plan members through their website, and direct claims submission is available for service providers such as dentists, pharmacies, optometrists, physiotherapists and other paramedical services providers.

For excluded employees who are in the Flexible Benefits Program and have elected a Health Spending Account, the claims deadline for expenses incurred in 2016 was February 28, 2017.

We always suggest that you send your claims in as incurred.

Answer: You are able to search for service providers signed up for eClaims on the Providers eClaims Listing.

GroupNet (Online Services)

Answer:  You are able to register for GroupNet through the online form which gives you access to your benefits and claims information. You can also download the GroupNet Mobile app to your personal device. Remember, when you are entering your 10 digit ID found on your assure card, drop the leading zeros (for example, instead of 0000123456, enter only 123456).

Answer: Claims balances will be available through GroupNet by mid-August.

Answer:  Health 170688 in GroupNet is your travel assistance plan, which provides assistance if you experience a medical emergency while traveling out-of-province. See the Travel Assistance brochure for further details.

Answer:   If you prefer, you may submit claims with a date of service on or after January 1, 2017 to Great-West Life for reimbursement.

Pre-authorized drugs

Answer:  Similar to our plan with Pacific Blue Cross, certain prescription drugs call for a more detailed assessment and management process to help ensure that they represent reasonable treatment. Prior authorization requires that you request approval from Great-West Life for coverage of certain prescription drugs prior to purchase.

If you are prescribed one of these drugs on or after April 1st you will need to complete and submit a prior authorization form available on GWL website listed by drug name. You will receive instructions on the steps involved in submitting these claims.

Answer: If you are taking a drug that PBC approved through their prior authorization process and if you have filed a claim in the last six months, GWL will honour that approval. You will not be required to complete the prior authorization application process again.

If you have been approved for such a drug but have not filed a claim in the last six months, you will be required to complete GWL’s prior authorization process. You will receive instructions on the steps involved in submitting these claims.

Benefits Maximums

Answer: No. Benefits involving maximums (e.g. dental, eye care etc.) will not be reset to $0 when we transition. Your claims history will be carried forward to the new carrier.

Coordinating with your spouse

Answer: The rules enabling coordination of benefits will not change as a result of moving from Pacific Blue Cross to Great-West Life Assurance Company.

Answer:  Coordination of benefits (COB) is available with Great-West Life.

If you and your spouse are both with Great-West Life, you only need to submit one claim form and Great-West Life will coordinate benefits for you. Ensure you include your spouse’s information and ID number on the claim form.

If your spouse is with another carrier, your claims should be sent first to Great-West Life, and then to your spouse’s plan with the explanation of benefits statement. Your spouse’s claims should be sent to their carrier first, and then to Great-West Life with the explanation of benefits statement.

Your dependent children’s claims should always be sent first to the carrier of the spouse whose birthday occurs first in the year, and then to the other carrier with the explanation of benefits statement.

Travel

 

Question: I bought an annual travel medical insurance plan with Pacific Blue Cross?  Will this coverage be transitioned over?

Answer: If you bought an annual individual travel medical insurance plan with Pacific Blue Cross, it will continue until the expiry date on the policy. This individual travel medical plan is specific to Pacific Blue Cross and will not be transitioned to Great-West Life. As you will no longer be covered under a group plan with PBC as of April 1, 2017, your PBC individual travel plan will no longer be first payer after March 31, 2017 based on the terms and conditions of their travel policy, and pro-rated refunds for annual plans are not available. You may want to review the Optional Medical Travel Plan available for purchase through GWL for coverage beginning April 1, 2017.  The individual travel medical plan through GWL is first payer to your group plan with GWL. Visit GWL’s special travel website for more information.

Answer: Our group extended health plan provides some emergency medical coverage when travelling for work or pleasure. Please review your benefits guide carefully to see what is available to you. You will then be able to determine whether (given your individual circumstances) you want to purchase additional coverage.

GWL has launched a special travel website to enable you to purchase optional travel medical insurance. For more information, please see the GWL’s Optional Emergency Travel Medical Benefit information sheet. This travel medical insurance is first payor to your group plan with Great-West Life, and you’ll save 10% by purchasing it from this website.

NOTE: that if you have other similar coverage – such as through a credit card plan or another group or individual insurance plan – claims will be coordinated within the guidelines for out-of-province/country coverage issued by the Canadian Life and Health Insurance Association.

To apply, you will need your Great-West Life group plan number (50088) and your identification number. Your identification number with GWL is the same as the number on your current Pacific Blue Cross identification card.

This travel insurance has a maximum amount payable per covered trip of $2 million Canadian. Coverage is available for 30-, 60-, or 90-day multi-trips if you are under age 80. The individual travel plan that Great-West Life is offering is an annual travel plan and there is no limit to the number of trips taken during your policy year.  The 30 days refers to the maximum number of days for each trip. There are exclusions for pre-existing conditions. Single trip plans will be available for purchase on June 1, 2017.

 

Question:  What is a first payer medical travel policy?

Answer:  If you purchase a travel policy that is first payer, the travel insurance will pay any medical travel claims first, before your extended health group plan pays. By purchasing a first-payer travel policy, you protect your lifetime maximum under your extended health group plan from being impacted by the cost of an out-of-country medical emergency.

Note, many medical travel insurance policies are not first payer and require that any expenses be paid first from your extended health group plan, before the individual travel plan. Without a first-payer provision, your travel policy will only pay expenses after your lifetime maximum under the extended health group plan has been reached.

Under these types of plans, if you, for example, had an out-of-country medical emergency costing $600,000 in medical expenses, and your lifetime maximum under your extended health group plan was $500,000, your group plan would pay up to your $500,000  lifetime maximum and then the travel insurance policy would pay for the remainder. In this situation, you would have reached your lifetime maximum under the extended health group plan and would no longer have any extended health coverage.  

Retirement

Answer:  Once you retire, you are no longer under the Public Service Benefit plan. Information about the retiree extended health and dental coverage can be found on the Public Service Pension Plan website.

Privacy

Answer: Yes, your personal information will remain in Canada.