Why am I paying a portion of a fee when I didn't have to before?
Eligible drug expenses are shared between the plan and the employee. The plan covers 80% of the eligible expenses until the employee’s 20% cost reaches the out-of-packet cap, after which point the plan covers 100% of eligible expenses, subject to the benefit maxima. Until you have reached the out-of-pocket maximum you will have to pay a portion of the costs. For more information, please visit the Extended Health Care Benefit page.
What am I eligible for as a temporary employee on a one-year contract?
How does coordination of benefits work?
When two or more plans are involved, one plan is considered to be the primary plan. The primary carrier pays its eligible amount first. The secondary carrier then reduces its payment by the amount in which total payments would exceed eligible expenses available through both plans. Eligible expenses are as defined in each carrier's contract before limitations like deductibles, co-insurance, fee guides, and maximums are applied.
As a plan member your claims should be processed through your benefit plan first. Claims for your spouse must be processed through your spouse's plan first. Any remaining balance can then be processed through the other insurance plan.
When a child is covered under both parents' plans, the plan of the parent whose birthday (month and day) falls earlier in the calendar year is billed first.
How does our chiropractic coverage work?
Our chiropractic coverage includes 80% of $12.00 for the first 15 visits within the year. After 15 visits, 80% of reasonable and customary per visit charges (100% if out-of-pocket limit is reached) applies. All chiropractor expenses apply to the 2016 annual maximum of $649 per covered person per calendar year.
For more information, please refer to Annual Benefit Maxima.
Why am I being charged a dispensing fee?
Our plan includes a dispensing fee cap for prescription drugs, which is currently $7.00. If this fee (charged by the pharmacy) exceeds the dispensing fee cap, the difference is the responsibility of the employee and the fee is not applied to the employee’s out-of-pocket amount.
What is the pregnancy/parental leave benefit and process at Waterloo?
Is _____ covered? How much will it cost?
To determine if a specific medication/treatment will be covered by our plan, we advise you to contact Great-West Life directly at 1-800-957-9777.
How much will a treatment be covered?
In the event that you expect any significant medical expenses (prescription drug and other expensive treatments/supplies), we advise employees to submit a cost estimate/predetermination to Great-West Life so that the employee will be aware of how much is covered and how much can be expected to be reimbursed.
For timely assessment when submitting a predetermination, please ensure the word 'Estimate' or 'Predetermination' is clearly indicated on a completed claim form and include the following information:
- Name and description of supply/service
- Name of supplier/provider of service and their professional designation (if applicable)
- Nature of condition/condition being treated
- Copy of prescription (if applicable)
The estimate can be mailed to the benefit payment office indicated on the top of your claim form.
Estimates for major dental work should be mailed as we may require x-rays and/or study models. X-rays and/or study models will be returned to your dental office once the assessment has been completed. Please contact your dental office for assistance with submitting a dental estimate.
How do I register for the Great-West Life plan member site?
Visit GroupNet for Plan Members on Great-West Life. You will need our plan number (57130) and your 6 digit employee ID number, which is located on your benefit card. Remember to register your address when completing your profile so that Great-West Life can locate you.
How do I submit a claim?
When completing paper claim forms, you will need to include the policy number and your employee identification number. The policy number for extended health care (including prescription drugs) and dental claims is 57130. Out-of-country claims are processed under 325156. Please visit Submitting Claims to determine your method of submission.
What should I do with an issue to fill a prescription?
If you are having trouble filling your prescription, it is recommended that you contact Great-West Life at 1-800-957-9777, as they may be able to give you direct information on why the claim was rejected and assistance on how to obtain the prescription.If the problem still cannot be corrected please contact firstname.lastname@example.org for further assistance.
How do I get a new benefit card?
Contact email@example.com to order a new card. Please note that your new card will take four weeks to reach the Human Resources department, and the new card will have a different sequence number at the end indicating that it is a replacement card.
In the meantime, you can use our policy number 57130 and your 6 digit employee ID.
How do I receive benefit cards for my children?
Cards are issued only under the name of the plan member and spouse.The pharmacy will ask your dependent to confirm his/her relationship to you to verify that he/she is an eligible dependent.
Does my coverage apply outside of Canada?
An important and valued feature of the extended health benefit is the Great-West Life out of country travel benefit which covers 100% of medically necessary services or supplies required as a result of a medical emergency, up to $1,000,000 (Canadian) per lifetime per covered person. Please visit the Out-Of-Country Benefit page for more information.
Does my coverage include cancellation insurance?
The plan does not cover transportation costs if you are unable to leave home at the start of a trip due to emergencies. This type of coverage is provided by flight cancellation insurance.
If you miss prearranged and prepaid return transportation to Canada because you are in a hospital, the assistance company will arrange and pay the cost of comparable return transportation for you.
Do I need a letter indicating that I have benefits coverage if I travel outside of Canada?
Currently the only country that requires proof of coverage is Cuba. Employees who will be traveling to Cuba are advised to contact firstname.lastname@example.org for a letter indicating the type of coverage and any covered dependents.