green shield benefits - helpful tips

for specific or detailed information regarding eligibility for a specific item or service, plan members should contact the customer service centre at 1.888.711.1119 or register for plan member online services at greenshield.ca

all claims must be received by gsc no later than 12 months from the date the eligible expense was incurred.

to help you with the administration of your plan, claim forms are available at greenshield.ca. you can access them without a user name or password.

pre-authorization: to confirm eligibility on certain services, a pre-authorization form must be completed and sent to gsc. gsc recommends that plan members have all claims over $300 pre-authorized prior to receiving the service.
plan members should submit dental treatment plans and estimated amounts to gsc for pre-approval. crowns and fixed bridgework must be pre-authorized by gsc.
although comprehensive periodontal treatment, orthodontic treatment, and extensive restorations do not require pre-authorization, in order for your plan member to fully understand their financial responsibility, a pre-authorization form is still advisable.
to process a claim, gsc requires the claim form be completed in full, signed, and submitted with the original paid receipt enclosed. (photocopies and faxed receipts are not accepted.)

claim submission options

gsc assesses the claims based on the information provided on the claim form. it is important that our records are up to date so that incoming plan member information matches our data. please advise plan members to complete the forms in full and submit them within the timeframes specified in your contract. to make submitting claims as efficient and convenient as possible, there are a number of claim submission options.

provider of service online claims submission:

claims may be submitted on behalf of your plan member by the provider of the service. below are the various ways this may happen:

drug claims electronically from the pharmacy:

the pharmacy may submit prescription drug claims electronically to gsc if the plan member has a pay-direct plan.
if your plan member has the deferred payment option, they must pay the pharmacy in full, and the pharmacy can submit the claim electronically to gsc.

reimbursement will be sent directly to your plan member.

dental claims electronically from the dental office:

the dentist may submit claims electronically to gsc. if your plan member has the deferred payment option, they must pay the dentist in full and the dental office can submit the claim electronically to gsc. reimbursement will be sent directly to your plan member.

health service provider electronic submission:

a wide variety of health providers can check plan member eligibility and submit claims online through provider online services, called providerconnect™, at greenshield.ca (e.g., physiotherapy, massage therapy, chiropractic services, and vision care).

plan member online claims submission:

if applicable, when a plan member is registered for full access to plan member online services, they will have access to submit their claims online for the following:

acupuncture services
chiropody treatment
chiropractic treatment
massage therapy
medical items (examples: lancet, compression stockings, incontinence supplies, etc.)
naturopathic treatment
orthodontic monthly fee (initial payment and records must be submitted manually)
physiotherapy treatment
podiatry treatment
prescription contact lenses
prescription glasses
routine eye examinations
speech therapy
health care spending account claims

online claims submission is a self-serve option that puts quick and easy claims processing at your plan member’s fingertips. plan members can benefit from real-time claims adjudication so they will know immediately how much their plan covers.

manual claims submission:

all manual claims must be submitted with the original fully paid receipt. copies will not be accepted. plan members can submit paper claims via mail to:

attn: drug department
po box 1652
windsor, on n9a 7g5

attn: medical items
po box 1623
windsor, on n9a 7b3

attn: professional services
po box 1699
windsor, on n9a 7g6

attn: hospital/vision department
po box 1615
windsor, on n9a 7j3

attn: out-of-country department
po box 1606
windsor, on n9a 6w1

attn: dental department
po box 1608
windsor, on n9a 7g1

personalized claim forms are available at greenshield.ca under plan member online services.