When will my hours come in from my employer?
Your employer will send your benefits for hours worked to the Administrator’s office the month after they are worked.
If you are working on travel card, it will take two months for your benefits to arrive at your home local.
I am a new member, when will I become eligible for group insurance benefits?
You will become eligible for group insurance benefits when you have accumulated 3 months worth of premiums in your banked welfare account.
I am currently not eligible for benefits, how can I be reinstated?
To be reinstated, you will have to accumulate 2 months worth of premiums in your banked welfare.
Please note that you can pay direct to keep your benefits going, however, you can not pay directly to come back into benefit once you have been terminated.
I would like to change my beneficiary for my life insurance.
To change a beneficiary, you must complete a new Welfare Plan Enrollment form.
I would like to add my new born son to my benefits
I would like to add my common law spouse to my benefits
Once you have been living in a common law relationship for more than 1 year, you are able to add your common law spouse to your benefits. You will be required to complete the Common Law Spouse Affidavit form an submit it to the Administrator’s office.
Why is a certain benefit or service not covered by my benefit plan?
Benefit eligibility, dollar maximums and frequency limitations are determined by our Group Benefit Plan and outlined in your booklet and our master contract with GSC. The benefits are administered by GSC, according to the terms and conditions of our contract/policy.
To what age are my dependent children covered?
Coverage for eligible children is to 21 years of age and/or to age 25 years if the child is attending full time school in an accredited college/university. Proof of school attendance will be required to be submitted on a yearly basis.
I’ve moved, so how can I change the address GSC has on file for me?
Your address is provided to GSC by Reliable Administration Services Inc. It is important that we have your current address on file at all times.
- Your ‘claim address’ – is the mailing address you supply to GSC on the claim form you send in with each claim. This is the address GSC uses 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 from GSC in a timely manner. Also, please remember to include your GSC ID number on all correspondence.
- Your ‘enrolment address’ – is the address supplied to GSC by Reliable Administrative Services Inc. when you were initially enrolled in the benefit plan. Because the address originates from us, GSC Customer Service Representatives are not able to make this change for you directly. To change the enrolment address, you must advise your Reliable Administrative Services Inc. and we will advise GSC.
ID CARD & BENEFIT BOOKLET
Where can I find my GSC ID number?
Your unique GSC ID number is located on the front of your Green Shield 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. If you are still unsure how to do this, please contact Reliable Administrative Services Inc.
Who do I contact if the information on my ID card is incorrect?
Contact Reliable Administrative Services Inc. to report any errors or omissions on your card. GSC Customer Service Representatives are not able to process these changes for you directly.
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 or Reliable Administrative Services Inc. The ID card will be sent to Reliable Administrative Services Inc. for distribution to you.
Where can I get a booklet that provides a description of my benefits?
Please contact Reliable Administrative Services Inc. who will be happy to send you a physical booklet or if you would prefer and electronic version of your booklet. You can always find the electronic version of the booklet on our website under the Health & Welfare Benefits tab.
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, call Reliable Administrative Services Inc. or the GSC Customer Service Centre.
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 the GSC 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 GSC a call to get started.
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 GSC claim form 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
You can find claim forms for Health, Dental and Health Care Spending Account on our website under the Member Information/Forms tab.
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 GSC has in their claims processing centre at their head office. If information is missing from a claim form, they 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 their Online Services.
When will I get paid?
For the fastest claim payment, sign up for Direct Deposit through your Online Services account. GSC will email you once the claim is processed and funds are deposited into your account.
Otherwise, they aim to have a cheque in the mail to you one to two business days after processing.
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 or use the fillable form available to you from our website under the Member Information/Forms tab.
- Print the form and remember to sign it.
- Be sure to include your original receipts (take a photocopy for your records) and provide your full mailing address
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 GSC asks 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.
Are my receipts returned to me after my claim has been paid?
Instead of returning your receipt(s) 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?
GSC recognizes that fraud is often unintentional. But, whether intentional or not, abuse, misuse, and overuse of benefit plans are a reality. So periodically GSC will have to audit claims. Sometimes, through their auditing processes, inappropriate claiming behavior is suspected. In those situations, we need to take extra steps when they adjudicate and pay claims. Please complete claim audit questionnaires when you get them. These help GSC protect all our plan members and our benefit plans from abuse, misuse and overuse.
I was mailed a ‘Release of Information Authorization Form’. What do I do?
From time to time, GSC may send you a ‘Release of Information Authorization Form’ because they 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 GSC 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 GSC needs to take extra steps when they adjudicate and pay claims. As a result, they 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 GSC 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). GSC apologizes for any inconvenience. However, it is good for you and the protection of the UA Local 67 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 on the GSC on the Go app. And don’t worry, they also accept old-fashioned paper claims.
How do I know whether a particular item or service is covered under our plan?
GSC has several ways for you to check your coverage:
- Online Servicesand 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
- Your benefit booklet provides a summary of our benefit plan. You can find a copy of our benefit booklet on our website on the Benefits/Health & Welfare Benefits tab. You can also check eligibility for benefits through GSC on the Go
- Contact GSC Customer Service. Their 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 their 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.
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.
Can’t find your answer here, please contact us.