How to make a claim

How to make a claim

Making a claim for medical or dental expenses shouldn’t be complicated. In most cases – especially for vision care, dental care and at the hospital – your provider will be set up to file electronically. Just present your subscriber card and that’s it.

If your provider isn’t set up to e-file, you can either submit a claim form or file online through GroupNet for Plan Members. Remember that Great-West Life must receive claims for benefits within 15 months from the date of service.

Extended health benefits

Be ready to present your subscriber identification card at the time of payment for health services.

In most cases, the service provider will submit the required claim form to Great-West Life for payment. If the charges for your services exceed the benefit level under your program, you will be required to make payment for this portion only.

To obtain reimbursement for services under this benefit, you must pay the service provider, obtain an official paid-in-full receipt, and submit it to Great-West Life for processing. 

Some services may require a completed health claims submission form to accompany the receipt. Claims must be submitted within 15 months of receiving services or supplies. Attach the original receipts, and any supporting documentation, to the form.

Vision care services

You must present your subscriber identification card to any participating optometrist/optician at the time your prescription is filled.

In most cases, your optometrist/optician will submit the required claim form to Great-West Life for payment. If the charges for your vision-care services exceed the benefit level under your program, you will be required to make payment for this portion only.

If you choose an optometrist or optician who isn’t billing Great-West Life directly, forward a completed vision claim form to Great-West Life along with your itemized receipt. Payment will be made directly to you.

Hospital benefits

In most cases, there is no requirement to complete a health claims submission form to obtain hospital services. Present your subscriber identification card to the hospital and the hospital will bill Great-West Life directly.

Worldwide travel benefits

Call the toll-free number on the back of your Great-West Life identification card for assistance when an unexpected illness or injury happens while traveling outside Nova Scotia. Every effort will be made by Great-West Life to direct you toward the appropriate medical treatment and assist you in making payment to the providers of service and co-ordinate with your provincial government plan.

Dental benefits

Present your subscriber identification card at the time of payment for dental services. 
In most cases, the dental service provider will submit the required claim form to Great-West Life for payment. If the charges for your services exceed the benefit level under your program, you will be required to make payment for this portion only.

To obtain reimbursement for dental services, forward a completed dental claim form (also available from your dentist) along with an official receipt to Great-West Life.

Health care spending account

The Health Care Spending Account (HCSA) benefit is $300 per year, per plan subscriber. The plan subscriber may claim expenses for the whole family up to $300. These credits are intended to pay for medical and dental expenses not covered under your medical and dental plan or your provincial plan.

The HCSA will reimburse you for the balance of the expense remaining after all other insurance plans have paid out. You must first submit all claims to any government and private insurance plans under which you or any eligible dependents are covered. Once you have received reimbursement for the expense from all other plans, you may submit a claim against the HCSA.

Claims against the HCSA may be submitted on a claim form. To submit dental claims to HSCA, use form M445D. To submit a claim to HSCA for all other claims, use form M635D.

Submit claims online

Submit your claims easily online and review a summary of all of your claims on GroupNet for Plan Members; this can be handy for income tax purposes.

To submit claims online, you will need to be registered for GroupNet for Plan Members and signed up for direct deposit of claim payments with eDetails. For online claim submissions, your Explanation of Benefits will only be available online.

Use GroupNet for Plan Members to create a summary of your claim history by patient and/or benefit, sorted by service date or service description, as well as several other services.

Contact

Catherine Gervais
Member benefits advisor
902-481-4904
1-800-563-3427 ext. 4904