Transcript From Green Shield Canada

University of Toronto
Post Doctoral Fellows Information Session
January 2008
Our meeting today
From Green Shield Canada
Robert Cross
Senior Account Executive
Susan Griffith
Client Service Representative
Agenda
Overview of Green Shield Canada
Plan Member Communication / Customer Service
Online Services for Plan Members
Drug & Extended Health Services Information
Dental Services Information
Questions ?
Overview of Green Shield Canada
Plan Member Communications
ID Cards:
One Card - all purpose for all benefits
Booklets :
• Printed version will be sent
• Online versions will be available
Customer Service Centre
Supported by state-of-the-art technology
1st call resolution
Toll-free access
Monday to Friday, 8:30 a.m. to 7:30 p.m.
Eastern Time
Bilingual call centre
62 Agents
• Commitment to intensive training (initial and
ongoing)
• Low staff turnover
1-888-711-1119
Plan Member Communications
Explanation Of Benefit Statements:
• Dynamic messages giving specific claim
details to employees
• Coordination of Benefits Information
• User Friendly!
Online Services
Self Service online access for plan members
Printer friendly claims forms
Fully Secure – User ID and Password required
Fully interactive and bilingual
Employees can look up benefit eligibility such as vision care
and dental visits
Personal benefit statements and employee claims history
Employees can email inquires to Customer Service
Direct Deposit available
Visit www.greenshield.ca !
Drug Plan Information
Drugs must be only available by law
with a written prescription.
Lifestyle drugs – smoking cessation,
anti-obesity, erectile dysfunction and
over the counter drugs and vitamins
are NOT covered.
A 40% co-pay applies for the first
$500 and 20% thereafter up to a
maximum of $ 2,000 per covered
individual per calendar year
Generic drug coverage applies
• Green Shield Pharmacy Network
• Dispensing Fee Maximum $ 10.99
Extended Health Services
Overall plan maximum is $ 2,000 per covered
individual per calendar year.
Medical items and Durable Medical
Equipment are covered where medically
necessary.
Footwear - such as molded arch supports and
orthopaedic shoes is covered ( by
prescription) to a maximum of $ 150 per
calendar year.
Eye Exams are covered once per 24 months up to a
maximum of $80.
Paramedical Services:
Registered Physiotherapy, Chiropractor, Massage
Therapy ( with an Rx ), Speech Therapy,
Psychologist, and Podiatrist are covered up to a
combined maximum of $300 per calendar year.
Semi Private Hospital is covered up to $1,000
per calendar year.
Dental Benefits
Basic Dental benefits are covered up to a
maximum of $500 per calendar year per covered
individual.
A co-pay of 20% applies.
The provincial fee guide is based on the prior
year.
Recall exams are once per 9 months for adults
and once per 6 months for dependent children.
Cleaning and polishing limited to 1 unit and
scaling 1 unit per calendar year.
Extractions, basic restorations, fillings, inlays,
x-rays, fluoride treatments and surgical services
are covered.
Major Services such as crowns, bridges &
orthodontics are not covered under your plan.
Claims Submission
Present your Green Shield Identification
Card to your provider for online claims
submission.
For paper reimbursement claims you will
pay the provider and keep your original
receipt. Claim forms are available on our
website www.greenshield.ca
Send in the completed claim form and
original receipt to the Green Shield Head
Office and your claim will be handled
and returned within 2 weeks.
Once enrolled you can call our Customer
Service Centre 1-888-711-1119 for
assistance!
Enrollment Process
1. Enrollment forms distributed today.
2. Plan summary and enrollment info.
3. Completed form returned by Feb 4th !
4. Waiver of benefits only allowed if you are
covered through your spouse’s benefits.
5. Only expenses or services Feb 1 and
onward are eligible for reimbursement.
6. Once your are enrolled by Green Shield
you will receive your ID Card and Benefit
Booklet in the mail.
www.greenshield.ca
Microsoft Office Excel 2003.lnk
Plan Member Online Services – Benefit Eligibility
Questions ?