Questions & Answers - GWL

Is there any change to my benefit coverage; for example, prescription co-pay, eye glasses, physio/massage/chiropractor/etc.?

No, all benefit levels remain the same and the claim time periods all remain the same. For example, if you purchased eye glasses and were reimbursed by Blue Cross in November 2012, Great-West Life will have this information. The annual amounts for paramedical practitioners and dental services are based on a calendar year and all balances have been and will continue to be, forwarded to Great- West Life. There are no changes to the current plan and no enhanced benefits are being implemented with this change in carriers.

Is the amount deducted from my pay cheque going to increase?

No, you continue to have the same great cost-sharing from the employer (65 per cent) and you will continue to pay 35 per cent of the monthly premium on a bi-weekly deduction. The deduction amount will remain the same.

Will I have a Great-West Life card to use at the pharmacy/dentist/physio/etc. like I have with Blue Cross? If so, when will I receive my card?

You should receive the card in your mail at home by May 28, 2013, at the latest. If you have not received your card by May 28, please contact the Benefits Team: 902-473‐5757, Press 3, Press 1 (Toll Free: 1‐866‐473‐5757, Press 3, Press 1).The card will have a new policy number but your same ID number. Please destroy your Blue Cross card after June 1. It will no longer be of use.

Is my co‐pay for my prescriptions going to increase?

No, the low co‐pay of $3 remains in force.

What happens with my prescriptions on file at my current pharmacy? Will I have to have new prescriptions from my doctor?

No, you will not need new prescriptions. After June 1 you will need to provide the information on theGreat‐West Life card to your pharmacy. If you are calling in a prescription refill afterJune 1, please ensure you advise the pharmacy that you are now covered by Great‐West Life.

I have a “special authorization” for my prescription that Blue Cross has already accepted; do I have to go through the whole process again?

No,Great‐West Life will have all your prescription information and previously submitted special authorizations.

Will my spouse/children that are already covered still have coverage under Great‐West Life? What about my child in university that I’ve already provided proof of enrollment,do I have to do that again?

Any dependents that you previously had covered under your plan will continue to be covered. The rules regarding overage dependent status remain unchanged. If you have submitted ”proof of enrollment”, you will not be required to submit proof again until the September 2013 semester.

Will Great‐West Life have direct billing to my dentist/physiotherapist/chiropractor/massage therapist, optometrist, etc?

Great‐West Life has a large number of providers set up for their direct billing. It is up to your service provider whether they participate in direct billing. If your service provider is not already direct billing to Great‐West Life, they can participate by contacting: Great‐West Life: 1- 866‐240‐7492, or they can register online at eClaims Provider Registration.

My service provider has already told me they don’t have direct billing with Great‐West Life. Can I sign a form to have Great‐West Life pay the money to my provider once I submit the claim if I can’t afford to pay it to the provider?

No, if your provider does not offer direct billing to Great‐West Life, it is unlikely they will offer "assignment of benefits". Encourage your provider to contact Great‐West Life to sign up for direct billing. Great-West Life: 1- 866‐240‐749, or they can register online at eClaims Provider Registration.

How do I submit a claim to Great‐West Life to receive reimbursement for a service if my provider doesn’t have direct billing with Great‐West Life?

Either online or by mail.

  • Online: Set up your account with Great-West Life. Keep your receipts for the next 12 months (in the case of an audit). The funds for the eligible portion will be deposited to your account with in four to five days.
  • Mail: You are also able to submit paper claims to theGreat‐West Life office. You can download the claim form online.You submit a paper claim to:
    Great‐West Life Assurance Company
    Health & Dental Benefit Payment Office
    255 Dufferin Avenue, London,Ontario N6A 4K1

Will there be a “quick‐pay‐office” like Blue Cross?

No, Great‐West Life offers great flexibility for submitting claims online (laptop, smartphone, PC, internet café) with out the need to submit actual paperwork. The claimis submitted and the funds are deposited to a bank account authorized by you. The funds are deposited with in four to five business days. Even though you do not need to submit receipts when you claim online, you must keep the receipts for the 12 months and be ready to present them if asked.

How will I receive reimbursement for diabetic supplies if I used the “quick‐pay‐office”?

Diabetic supplies were previously paid on a reimbursement basis; however, Great‐West Life is able to have those paid via direct billing at the pharmacy.

Does this mean I’ll be able to use up to the maximum levels under both Blue Cross and Great‐West Life in 2013?

No, maintaining our premiums at a reasonable level for great benefits requires that the dollar value or yearly (24months for eye glasses/exams) maximums are not exceeded. Blue Cross will be providing all claims information to Great‐West Life to ensure the maximums are not exceeded.

I’m going to retire in June 2013 and am taking the Retiree Health Plan; does that mean I won’t have coverage? Will it be delayed?

The same great benefits will be available to our retiree members eligible for such coverage. You will receive a card from Great‐West Life with the Retiree policy number at the same premium for current retirees. The Retiree Extended Health Benefits are not changing.

My dentist already has obtained a pre‐approval from Blue Cross for dental work; does this mean I have to have Great‐West Life approve it too?

No, Great‐West Life will have received this information from Blue Cross and no duplicate paper work will be required.

What about Orthotics/Orthopaedic shoes under Great‐West Life, am I still eligible for them?

The terms of our contract and the benefits covered have not changed. You may wish to review the June 2012 announcement that we issued on this benefit.

Will I still be able to see my account and see how much I have left under eachs ervice? Will I be able to see how much I have for my children?

Yes, if you establish an account under Great‐West Life you will be able to view this information as well as submit your claims. See the information on the sheet that accompanied your card from Great‐West Life.

Will I be able to add dependents as a result of this change?

No, any dependents you currently have covered under your plan will remain covered. As per our current plan, if you wish to add a new dependent/spouse to your plan,the application may be considered a “late applicant” and restrictions for the first six months may apply. Please contact our Benefits Team for additional information: 902-473‐5757, Press 3, Press 1.

If I waived coverage previously, may I enroll now without being a late applicant?

If you have experienced a “life change” such as your spouse losing his/her Extended Health and/or Dental coverage or due to marriage breakdown, you have 31 days from the date of the “life event” to apply for the CDHA plan. We will require documentation from the previous provider that coverage is no longer available and the effective date.

Will I still have coordination of benefits and will the rules change?

Yes, “coordination of benefits” rules are established by the insurance industry and are not impacted by this change in carriers.

Will a new booklet be printed? How can I find out what benefits are available to me?

A new booklet will be produced and posted on this site when available. The current booklet is available on the intranet. There are no changes to the benefits; Great‐West Life will be inserted where Medavie Blue Cross currently appears.

Is our travel insurance changing?

No, SSQ Insurance Company Inc. continues to provide our travel insurance and is not impacted by this change in carriers.

Why is CDHA changing from Blue Cross to Great‐West Life?

Great-West Life (GWL) was selected through an Request for Proposal (RFP) process. This new contract provides us with reduced administration/adjudication charges for our Health and Dental benefits. This allows us to maintain your premiums and manage costs for Capital Health, which are paid 1/3 by the employee and 2/3 by Capital Health. This is very important for all of us in the face of rising prescription and health service costs.

If you have questions or concerns on eligible dependents, effective date of coverage, etc., call benefits general inquiries at 902-473‐5757, Press 3, then Press 1 at the prompts.

If you have questions on actual benefit level covered or the balance of any unused claim amounts, contact Great‐West Life: 1‐800‐957‐9777 (you’ll need your Great‐West Life policy number and ID as it shows on the Great‐West Life card).