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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 1 st 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 4 th ! 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
Plan Member Online Services – Benefit Eligibility