Submitting a Claim
Overview
Prescription drug claims that are purchased at the point-of-sale using the Plan Member’s pay-direct drug card are submitted directly to the insurance company and the Plan Member is not required to pay out-of-pocket. Any portion of the claim not reimbursed because of plan limitations (e.g., coinsurance amounts, deductibles, etc.) is the responsibility of the claimant.
Your insurer provides a health claim form for prescription drug claims that are not reimbursed using a pay-direct drug card as well as any other type of health claim (e.g., paramedical practitioners, vision care, supplies etc). This form must be completed and signed by the Plan Member. Please advise Plan Members to attach original receipts when submitting a claim (photocopies not accepted). Plan Member should keep a photocopy of all claim documents.
Dental claims are typically submitted electronically through your Dental office.
Prescription Drugs
Most transactions will occur at the point of sale (i.e., pharmacy).
If, for any reason, the Plan Member’s pay-direct drug card was not used at the point of sale, or if the Plan Member loses hispay-direct card, simply have the Plan Member complete the insurer’s drug claim form and attach the original receipt(s). Plan Member may submit claims directly to the insurer.
Other Health Claims (e.g., vision care, health professional services, prostheses, etc.)
Have the Plan Member complete the appropriate claim form and attach the original receipt(s). Plan Member may submit claims directly to the insurer.
Authorization from a physician is required for certain paramedical practitioners - please refer to the master contract for additional details. Paper claim submission forms can be obtained here.
For any extensive course of treatment involving crowns, bridgework, etc., which may exceed $300, we recommend the Plan Member ask his/her dentist to complete a cost estimate before the work is completed. Send the estimate to the insurer’s claim department to determine how the expenses will be reimbursed.
Before incurring any large dental expenses, or beginning any orthodontic treatment, the dental service provider should complete a treatment plan and submit it to the insurer. The insurer will calculate the benefits payable for the proposed treatment, so the Plan Member will know in advance the approximate portion of the cost they will have to pay.
Long Term Disability
In case of a disability due to sickness or injury, Great-West Life must be notified at least 6 weeks prior to the end of the waiting period. To ensure timely claim processing, all forms/sections contained in the package must be completed.
How to Make a Claim
To submit claims online, click on the following link. You have the option of submitting paper or electronic claims. Please follow the instructions on the Great-West Life site. There is a guide available for paper submissions on the site.
Submitting a claim for Long Term Disability Income Benefits can be completed in three steps:
Click here to begin the online claim process
If you have any questions about submitting the documents online, contact GWL at 1-855-755-6729.
To help the Plan Member submit a paper claim click on the link below for a guide on the claim submission process for the Plan Member.
http://www.greatwestlife.com/001/Client_Services/Group_Plan_Members/Forms/Standard_Claim_Forms/
The guide contains the applicable forms, which can be mailed or faxed to the local Disability Management Services Office.
Ontario
Complete the claim form found on the carrier site along with the Attending Physician Statement for a dismemberment or loss and submit it with the Plan Members original enrollment form. Also attach an accident report, if applicable.