Green Shield Canada benefits implementation questions

We have gathered some common questions to best support our University community with this benefit provider changeover to Green Shield Canada that occured on January 1, 2023.

This page will be updated as new questions or information become available. Please check back regularly. (Last Updated: January 31, 2023)

Should you have a question not included here about the Green Shield Canada benefits implementation project, please contact gsci2023@uwaterloo.ca

Did my benefits change as well?

There are no changes to your current benefit plan.

As required through the RFP process, Green Shield Canada will match the existing extended health and dental benefits plan design in terms of maximums and coinsurance; however, every benefit provider has differences in terms of administration (i.e., reasonable and customary charges, technology capabilities, and other policies/practices) that apply to the adjudication decisions.

How will I be impacted by the project?

Employees will need to perform the following action items when this project is implemented on January 1, 2023: 

  • Use this video to familiarize yourself with the Green Shield Canada site (GSC Everywhere) and submission processes to prepare for submitting new claims incurred commencing January 1, 2023.
  • Update any stored benefits information on record at your medical providers, such as your pharmacy, dentist, physiotherapy, chiropractor, etc., with your new your member identification number on/after January 1. 
  • Submit any outstanding claims (incurred before January 1, 2023) with Canada Life before the cut-off period. Claims received by Canada Life after February 28, 2023 will not be processed.
  • Access your records with Canada Life (via GroupNet) before January 1, 2023 to obtain copies of any pre-determinations or approvals to support your claims experience with GSC. GroupNet will no longer be available to members after December 31, 2022.
  • Unsure where your claim should be submitted? Follow claims processes on this benefit provider change matrix.

My personal information with GSC is incorrect.

  • Active employees can access their records within Workday to confirm your dependents, personal information, or address. Add or update any missing information. This information is shared/updated with GSC weekly.
     
    • If the information cannot be updated by you, such as a birthday or misspelling, please contact hrhelp@uwaterloo.ca and advise them of this needed change, and we will update your records.
    • If the information is correct on Workday, you will need to contact GSC’s customer support line directly and have them update your information.
  • For retirees, you can contact our office with your new address information to hrhelp@uwaterloo.ca. We will update your address on the University systems.

I need my claim history with Canada Life. How do I access it without GroupNet?

You will need to contact Canada Life directly at 1-800-957-9777 to inquire on the status of your past claims or request information for taxation purposes.

What is GSC Out-of-country/travel contact information?

The toll-free out-of-country/travel contact information for GSC is 1-800-936-6226 (also, collect with operator assistance at 519-742-3556). GSC Travel Assistance is available 24/7/365 (including holidays). When contacting GSC Travel Assistance, quote your ID number on your GSC card.

Will there be differences in how claims are processed with GSC?

Possibly. While your benefit plan design is not changing, each carrier has their own unique administrative guidelines when it comes to processing claims within a plan design. As a result, you may see some changes in how claims are processed, and eligible amounts are determined.  

The University worked with GSC on a transition analysis of claims to identify protentional differences in coverage.  Some items were identified and have been reviewed with the Pension & Benefits Committee for awareness and, where options exist, for corresponding decisions. The outcome is as follows:

GSC’s compound policy represents a change from Canada Life’s practices for coverage and recognizing this, a one-time claims exception process exists for compounds that do not meet this policy to ease the transition to GSC. If your compound is declined, you can contact GSC and the claim will be pushed through as a one-time exception, but no subsequent claims will be processed. This exception process applies for the period between January 1, 2023 and April 30, 2023 only.

Letters have been sent to identified by GSC as potentially impacted by this policy, and the letter encourages individuals to speak with their physician to determine whether their compound will be an eligible expense. If you did not receive a letter from GSC, the one time claims exception process applies to you as well.

GSC would be happy to walk you through the eligibility of Compound Drugs. You can contact the GSC Customer Contact Centre at 1-888-711-1119.

  1. Prior authorization medications – All participants with previously paid prior authorization drugs will be "grandparented" to ensure no interruption of treatment. Those with an approval before November 2022 will have their records updated in GSC’s system in advance of January 1, 2023; those with an approval during November or December 2022 will have their records updated in GSC’s claims system in early to mid-January 2023. Please access your Canada Life records before December 31, 2022 to obtain a record of this prior authorization, just in case.
  2. Reasonable & Customary (R&C) Charges – a review of Canada Life’s claims data relative to GSC’s R&C charges indicates that differences exist. The Pension & Benefits Committee decided to place a percentage buffer on the GSC levels, which will be removed at a future date as GSC’s R&C limits increase. Plan members are encouraged to use “GSC everywhere” to inform an understanding of the R&C limits that apply to services and discuss coverage available with corresponding practitioners.
  3. Compounds –For a compound to be eligible with Green Shield Canada, it needs to have the following characteristics:
     
    • Contains an active ingredient in a therapeutic concentration that is considered an eligible benefit  
    • Is not a duplication of a formulation of a manufactured pharmaceutical product  
    • Not experimental or cosmetic

      GSC’s compound policy represents a change from Canada Life’s practices for coverage and recognizing this, a one-time claims exception process exists for compounds that do not meet this policy to ease the transition to GSC. If your compound is declined, you can contact GSC and the claim will be pushed through as a one-time exception, but no subsequent claims will be processed. This exception process applies for the period between January 1, 2023 and April 30, 2023 only.

      Letters have been sent to identified by GSC as potentially impacted by this policy, and the letter encourages individuals to speak with their physician to determine whether their compound will be an eligible expense. If you did not receive a letter from GSC, the one time claims exception process applies to you as well.

      GSC would be happy to walk you through the eligibility of Compound Drugs. You can contact the GSC Customer Contact Centre at 1-888-711-1119.
  4. Oxycodone – this medication can be a concern from a safety perspective and, as such, GSC will send a letter to those with a previous claim to advise that if they have a need for ongoing pain treatment with a long-acting formulation of oxycodone, they will need to switch to OxyNEO.®
  5. Over the Counter (OTC) drugs and Natural Health Products (NPH) – these expenses are not eligible for reimbursement under the current plan design. Those who received reimbursement for an OTC drug or NPH will receive a letter from GSC to confirm that these expenses are not covered.
  6. Finasteride (Proscar) – this drug is used to treat symptoms of Benign Prostatic Hyperplasia (BPH) and is eligible for males over the age of 50 or those who are diagnosed with BPH. GSC will send a letter to those under age 50 who have received reimbursement for this drug and request proof from the physician of the diagnosis. If diagnosis for BPH does not exist, the member will be advised that the medication is not eligible for reimbursement.
  7. Flonase (and its generic equivalent) – this drug is eligible for reimbursement if the members are between the ages of 4-17 since it requires a prescription for children whereas it is an OTC medication for adults. GSC will send letters to any adults who received reimbursement through Canada Life to confirm that the medication is not eligible for reimbursement.
  8. Gardasil – per Health Canada guidelines, this vaccine is eligible for participants between the ages of 9-45. For those outside of this age group who have received reimbursement for this vaccine, GSC will apply an exception to the claim system to enable members to be covered for their remaining doses (i.e. maximum of 3). New claimants must fall within the Health Canada guideline in order to be eligible for reimbursement.
  9. Facility fees and other “non-dental” procedures are not eligible for reimbursement through GSC.
  10. GSC’s narcotic policy and migraine policy will be used to administer coverage for corresponding expenses.

  11. Specialty Care Program is a Preferred Pharmacy Network (PPN) for high-cost specialty drugs. This program limits the financial impact on the plan and ensure the plan members taking these medications receive the treatment support required. GSC's review of claims data from Canada Life will enable them to send letters to impacted members. These individuals will have an exception on GSC's claims system until the end of February 2023 in order to have sufficient time to make the change in pharmacy.

Letters referenced above will be issued in two batches: one in mid-December 2022 based on data available to GSC at present and another batch in mid-January 2023 based on an updated set of data supplied by Canada Life to GSC in early January 2023.

Will there be a change in my current member ID or card? 

Yes, you will be receiving a new card for your coverage with Green Shield Canada. Your new card will have the precursor WTL to identify you as a member of the University of Waterloo benefit plan, followed by the employee ID (WTLemplID-00). Note: There is no policy number with Green Shield Canada. You will only need the member ID information on your card. Note: the -00 will show who is the plan member. Plan member dependents will have -01, -02, etc., after the member information. The WTL must be in allcaps.

With GSC, how will claims be coordinated? My spouse has coverage with a different carrier.

With GSC, your Coordination of Benefits (COB) information will be communicated at the point of claim submission whereas with Canada Life, COB information was included in your employment records on the HR System (i.e. Workday). Effective January 1, 2023, there is no reason to provide Human Resources with your COB information and this information should be communicated directly to GSC.

If you and your spouse are both with GSC, you only need to submit one claim form, and GSC will coordinate your benefits for you. Make sure you include your spouse’s information and ID number on the claim form. 

The rules of COB will not change with the implementation of GSC and the following rules continue to apply:

  • If your spouse is with another carrier, your claims should be sent to GSC first, and then to your spouse’s plan with the explanation of benefits statement.
  • Your spouse’s claims should be sent to their carrier first, and then to GSC with the explanation of benefits statement.
  • Your dependent children’s claims should be sent to the spouse’s plan whose birthday occurs first in the year, and then to the other carrier with the explanation of benefits statement.

Was my personal information securely transferred to GSC?

Yes. Your privacy and confidentiality are protected at all times, in line with applicable Federal and Provincial privacy legislation, including but not limited to the Personal Information Protection and Electronic Documents Act (PIPEDA). Personal information will be transitioned directly to GSC. However, your banking information will not be transferred (see the next question).
 

Was my banking information for direct deposits transferred automatically?

No. If you are currently reimbursed for claims via direct deposits into your bank account, please note that your current direct deposit information will not be transferred to GSC (for privacy reasons). But it’s an easy process to set that up with GSC. 

You will need to sign up for direct deposit again via the GSC everywhere (gsceverywhere.ca). Once you’ve registered, all you have to do is select Direct Deposit from the left menu and provide your banking information. GSC will also accept a void cheque in the mail (with the claim form) as another option for setting up direct deposit information. 

Once you receive your welcome package from GSC, you will be able to contact GSC customer support for assistance with registration to GSCeverywhere.ca, as well as the corresponding functions, including setting up Direct Deposit. If you register before January 1, 2023, you may not have full access to the site and app until the effective date your plan begins. 

I have approval for dental procedures from my prior carrier. How will pre-approved work be handled?

Dental pre-determinations approved by your prior carrier will be honoured by GSC for up to six months post-transition. Just remember to submit the approved treatment plan to GSC with your claim. We will provide more details as the transition progresses. 

Canada Life’s GroupNet will not be available after December 31, 2022 and as such, you should make sure that you have obtained copies of your pre-determination in advance of that date so that you can submit it to GSC with your claim.  

I need to update my address. How do I do that?

Active employees can access their records within Workday to update their information. 

If you are a retiree, you can contact our office with your new address information to hrhelp@uwaterloo.ca. We will update your address on the University systems.

Is there a change to my out-of-country benefit?  Do I need to be in the country when the changeover takes place?

Your coverage while out of country will not be interrupted.  Employees and retirees do not need to be in the country while the changeover occurs, however material will be sent to the home address on file in the late fall that will outline all the details of this change.  This material will contain important information about the change to GSC.   More information will be included within your welcome package from GSC.

Are there changes in the way I submit claims?

You have three options for submitting claims to GSC:

  • Provider-submitted claims – Many health service providers will electronically submit claims on your behalf. As of January 1, 2023, you can simply present your GSC ID card and ask them to submit your claims directly to GSC. All the information required for direct billing is on the card.
  • Do-it-yourself online claims – Through this service, you pay for the medical product or service, then submit your claim online through GSC everywhere (web or mobile app). This is generally used for massage, physiotherapy, vision care and eye exams, chiropractic treatment, etc. If you sign up for direct deposit, your claim payment is deposited into your bank account approximately two business days from the date your payment is processed. 
  • Paper claims – For claims that are not submitted electronically, either by you or your provider, simply pay for your item or service and mail the paid receipt and claim form for reimbursement to GSC at the address indicated on the claim form. All GSC claim forms are available online through GSC everywhere. You can also call GSC’s Customer Service Centre. Be sure to include your unique GSC ID number (found on your ID card) and current mailing address on all claims you submit. 

Learn how to submit a claim on the YouTube video below:

Watch video on YouTube

Return to the Green Shield Canada benefits implementation project.