Frequently asked questions

Coverage typically includes things like hospital services and accommodation, medical/surgical services, and emergency ambulance transportation, as well as access to pre-trip assistance. Conditions and limitations apply to the eligible items and services, and reimbursement is limited to the usual, reasonable, and customary charge in the area where they were received. A detailed description of your GreenShield travel benefit coverage can be found in your benefit booklet.

Evaluate your emergency. If you require immediate medical assistance, call for an ambulance (911 if available where you are located). Once you arrive at the hospital, have a family member or companion contact CanAssistance to open a case. The contact number is 1-800-936-6226 toll free. If the toll-free number does not work, you can use the collect number: operator+519-742-3556. CanAssistance is available 24/7 including holidays. You can also call this number for pre-trip assistance prior to leaving your province of residence.

When contacting CanAssistance, quote the GreenShield ID number (on the front of your ID card). If your emergency does not require immediate urgent medical assistance, contact CanAssistance to open a case prior to seeking medical treatment.

Stable means that all of the following statements are true during the 90 days immediately preceding your departure:

1. There hasn’t been any new treatment prescribed or recommended, or change(s) made to existing treatment (including stopping treatment); and
2. The medical condition hasn’t become worse; and
3. There haven’t been any new, more frequent, or more severe symptoms; and
4. There hasn’t been any hospitalization or referral to a specialist; and
5. There haven’t been any tests, investigation or treatment recommended, but not yet complete, nor any outstanding test results; and
6. There is no planned or pending treatment; and
7. There hasn’t been any change to an existing prescribed drug (including an increase, decrease or stoppage to prescribed dosage), or any recommendation or starting of a new prescription drug. We don’t consider the following as changes to existing prescribed drug treatment:
   • routine dosage adjustments of Coumadin, Warfarin, or insulin, as long as these medications have not been newly prescribed or stopped;
   • a change from a brand name to a generic equivalent product as long as the dosage is the same, including a transition from a biologic drug to a biosimilar drug; or
   • a decrease in the dosage of a medication due to the improvement of a condition.

For any pre-trip coverage questions, plan members can contact CanAssistance at the number listed on the back of their ID card. The pre-travel inquiries team is ready to provide the following services:

1. Information on the destination: Global Affairs Canada warnings, vaccines, visas, general questions on currency and rates, time zone differences, international dialing codes, provider references, embassies, etc.

2. Information on benefits, exclusions, and confirmations of coverage: CanAssistance agents will confirm the member’s coverage and verify specific exclusions that may apply. CanAssistance can also provide, upon request, a confirmation of coverage letter which includes: the member’s first and last name, travel dates, insurer’s name, ID number, people covered under the plan, and amount of coverage ($). The confirmation also provides instructions on how to reach CanAssistance while abroad (toll-free and collect phone numbers as well as the website), and a smart tip section encouraging members to contact CanAssistance 24/7 when in need of assistance.

3. Evaluation of known medical conditions before departure and medical review (medical questionnaire): CanAssistance’s trained professionals can establish over the phone if a member’s known medical condition is eligible for coverage during an upcoming trip, and, if need be, recommend that the member’s treating physician complete a medical questionnaire before departure.  At the end of the pre-travel inquiry call, a member will know:
   1. If their known medical condition is eligible for coverage OR
   2. If their known medical condition is excluded from coverage OR
   3. If a medical questionnaire is recommended (to be completed by the treating physician). In such a case, a decision on the eligibility of the medical condition will be rendered by CanAssistance’s medical team and the member will be advised accordingly.

Yes! Prior to seeking treatment, CanAssistance can assist you in finding the clinic/hospital closest to your area that can provide the best medical treatment appropriate to your condition. They can contact the hospital or clinic in advance to let them know that you are coming in, and where possible, make billing arrangements for direct payment of the medical bills. If you are admitted to the hospital, CanAssistance will make billing arrangements for your medical bills, manage your care to ensure that all procedures performed will be covered under your plan, and, if necessary, make arrangements to have you returned home to Canada for continued medical treatment.

During your admission to the hospital, contact is maintained with the treating physicians, case workers, and nurses to evaluate your condition. Establishing a direct billing arrangement between CanAssistance and the clinic/hospital is recommended whenever possible. This will eliminate the need to pay costly out-of-pocket expenses.

Typically, it will take 10-15 minutes to open a case. During this case-opening process, CanAssistance will require you to answer some brief medical questions, provide your home and travelling contact numbers, GreenShield ID number, and date of birth. Privacy statements will be read to you as well to ensure you understand the privacy procedures relevant to your medical situation. Completed claim forms are required to process your claims for the medical emergency. These forms will be sent to you once your eligibility has been confirmed.

The CanAssistance team provides assistance 24/7. Please call 1-800-936-6226 for updates regarding your emergency. It is important to note upon case opening: if you wish for a family member to have access to medical updates regarding your case, you must authorize CanAssistance to speak to them. Due to privacy laws, CanAssistance cannot disclose personal information regarding your case even to family members without prior consent.

The claim payment process can be lengthy if CanAssistance is waiting for specific information. When you seek treatment at a clinic/hospital, be sure to tell the facility that you have travel coverage. Although CanAssistance notifies the medical facility that they require itemized billing statements, some facilities may choose to bill in an alternative fashion. If CanAssistance does not receive an itemized bill, they will have to ask the billing department to provide this due to provincial health care requirements. The process of obtaining this bill from the facility can result in a significant wait time.

Since CanAssistance sends these bills to the government health insurance plan on your behalf, the original itemized statements are required. If you are admitted to the hospital, CanAssistance will also require your discharge summaries. In all cases, please make every effort to obtain copies of all documentation. This may help expedite or support the information received by CanAssistance.

Complete your claim forms right away and forward them to CanAssistance.

You will be eligible for payment up to the reasonable and customary charges in the area where the services were received, less the amount payable by your provincial health insurance plan. All maximums and limitations listed in your benefits booklet are in Canadian currency. Reimbursement will be made in Canadian funds or U.S. funds for both providers and plan members, based on the country of the payee.

If all documents are complete and received by CanAssistance, there is a ten-business-day processing timeline. These ten days include the cheque printing time, but do not include Canada Post delivery timelines.

If further documentation is required, CanAssistance will contact you to request the outstanding documentation we need. If you call for an update, CanAssistance will let you know what is required.

You should receive a benefits statement that will explain your reimbursement. There are several possible reasons you may have received partial reimbursement:

• Items may not have been covered under your travel coverage.
• Part of the items may be covered under your regular extended health benefit and will be forwarded to GreenShield to issue payment.
• Some of the bills were processed while others need proper original bills and CanAssistance is following up for those bills.

If you receive partial reimbursement and have questions, you can call 1-800-936-6226 for a more detailed explanation.