Submit a Benefits Claim

Extended Health

The extended health plan assists you with medical expenses such as prescription drugs, vision care, medical services, and supplies. Check out what's covered under the plan and confirm your eligibility on GroupNet prior to your purchase. Eligible expenses under the plan are subject to the deductible, coinsurance, and plan limits. If you have questions about eligible expenses, contact Great-West Life directly at 1-855-644-0538.

NOTE: If you have already satisfied the deductible for 2017 under Pacific Blue Cross’s plan, you will have satisfied the deductible under Great-West Life’s plan. If not, you will have to finish satisfying it under Great-West Life’s plan before being eligible for reimbursement. These same rules apply for annual maximums, etc.

Deadline

It is recommended that you submit your claims immediately after treatment. For claims with a date of service of April 1, 2017 or later, submit to Great-West Life. You are responsible for ensuring that claims are received by Great-West Life on or before the claiming deadline. Great-West Life must receive both extended health and dental claims no later than 15 months from the date of service. Late claims will not be accepted.

Submitting claims

You can make your extended health claim in several ways: pay direct through your provider, online or by mail.

  1. Pay Direct: Simply show your Assure card (and the card for your spouse's program if you have coordinated benefits—please refer to the Coordination of Benefits section of this article for more information), to your pharmacy or provider and you will pay only the portion of the expense that is not covered under your benefit plan. Great-West Life offers direct claims submission for prescription drugs, chiropractors, physiotherapists, acupuncturists, naturopathic doctors, podiatrists, psychologists, massage therapists and optical stores/optometrists/ophthalmologists. Your provider must be participating in the Great-West eClaims service. Check if your provider is registered in the Great-West eClaims Service. If they are not, use one of the methods below
  2. Online through GroupNet: You can submit your expenses for reimbursement through GroupNet for prescription drugs, physiotherapy, massage therapy, acupuncture, chiropractic services, naturopathy, psychology, podiatry and vision care expenses. Remember to keep your original receipts in the event that you are asked to submit them
  3. Mail: For all other eligible health expenses, you can mail in your claim. If you are submitting a paper claim, complete the Extended Health Claim Form (Bargaining Unit) (PDF, 620KB) or the Extended Health Claim Form with Healthcare Spending Account (Flexible) (PDF, 568KB). Follow the submission instructions found on the form. Make a photocopy of your expense receipt(s) as the originals will not be returned to you

Mail the signed form with your receipts to

Great-West Life
PO Box 6040, Station Main
Winnipeg, MB R3C 0S2

Dental

The dental plan is designed to assist you with the cost of your dental care and reimburses most basic and major dentistry and orthodontic services.

Deadline

Dental claims must be received by Great-West Life no later than 15 months following the date of service. It is recommended that your claims are submitted immediately following treatment to avoid missing the deadline.

Submitting claims

Most dental offices will bill Great-West Life directly when you present your Assure card (and the card for your spouse's plan if you have coordinated benefits), and you will pay only the portion of the service not covered by your benefit plan(s).

If your dental office does not submit claims directly to Great-West Life through eClaims, fill out a the Great-West Life Extended Dental Plan Claim Form (Bargaining Unit) (PDF, 218KB) or Extended Dental Plan Claim Form with Healthcare Spending Account (Flexible) (PDF, 607KB).

  • Mail the signed form with your receipts to

Great-West Life
PO Box 6040, Station Main
Winnipeg, MB R3C 0S2

You can submit monthly orthodontic treatments for reimbursement through GroupNet.

Reimbursement

If you have provided Great-West Life with your banking information, reimbursement will be directly deposited into your bank account and you will receive an email confirmation that your claim statement is available to view and download on GroupNet. You can set up banking information on the Great-West Life website. Learn how to sign up for GroupNet for Plan Members and Direct Deposit. If you are not set up for direct deposit, you will receive a cheque in the mail.

Pharmacare

All plan members are required to sign up for PharmaCare to assist with prescription coverage, limiting the impact on your lifetime maximum. In addition, some high-cost drugs will require you to complete a Special Authority Request Form (HTML) before you can be reimbursed.

Health Spending Account (Excluded Employees)

Pay direct

If you are using Pay Direct, any portion of your expenses that are not covered can be claimed against your Health Spending Account (HSA). Complete the form (available April 1) and submit with your receipt(s).

Online claims

If you are making an online claim through GroupNet, you can claim any unpaid balances to your HSA.

Paper claims

If you are mailing in your claim, complete the Health Claim Form and include your receipts and check off that you would like to apply any unpaid balance(s) to your HSA.

You must submit claims for eligible medical expenses to your extended health and dental plan first and then to any other plans (if applicable) prior to claiming from your HSA.

Deadline

The deadline for claiming from the HSA is February 28, following the year that you obtained the service. Late claims will not be accepted.

Coordination of Benefits for Extended Health & Dental

If you are covered under more than one benefits plan, you may be able to coordinate benefits to receive maximum coverage. Check if your spouse's benefit plan allows for coordination of benefits.

Insurance companies follow the guidelines below to determine which plan pays first and how benefits are calculated.

Your claims

If the expense is for you, claim first under your own plan. Great-West Life will provide you with an explanation of benefits statement, which you can send to your spouse's insurance company.

Your spouse's claims

If the expenses are for your spouse and your spouse is covered under another plan, you must submit the claim to their plan first.

Children's claims

Claims for children should first be submitted to the plan that covers the spouse whose birthday falls earlier in the calendar year (for example, if your birthday falls in February and your spouse's falls in June, submit your children's claim to your plan first).

Any part of the claim not covered under the first plan can then be submitted to the other spouse's plan along with the explanation of benefits statement.

Retiree coverage

A retiree plan will always pay after any group plan that covers you as an employee.

How to Make a Claim When You Coordinate Benefits

  • Ensure that you have added your spouse's plan information to your record in GroupNet. You can then submit your claim to both plans at the same time by showing the ID cards at any service provider who offers Pay Direct, such as the pharmacy, paramedical services, and optometrist/optical offices. If your spouse's plan does not offer Pay Direct, you must submit to their plan separately along with the explanation of benefits statement (which you receive after submitting to your plan)
  • Otherwise, you will submit to your plan first online through GroupNet or by mailing Great-West Life a paper Great-West Life form (available April 1). Great-West Life will send you an explanation of benefits statement which you will then submit to the other insurance company.

Life Insurance

To initiate a life insurance claim, contact MyHR at 1-877-277-0772. A representative will mail out the claim information to the beneficiary and will be available to answer questions.