How do I Submit a Claim?

Inquiries

For detailed inquiries, contact your Benefits Administrator or contact Green Shield:

  • Call the Customer Service Centre at 1.888.711.1119 to determine eligibility for a specific item or service and Green Shield’s pre-authorization requirements, or
  • Visit the website at greenshield.ca to email your question

Pre-authorization

For pre-authorization forward a Pre-Authorization Form OR a physician’s prescription indicating the diagnosis and what is prescribed.

Submitting Claims

When submitting a claim to Green Shield, you must show the Green Shield Identification Number for the person who has received the benefit. You can find the applicable Green Shield Identification Number for yourself and each of your dependents listed on your Green Shield Identification Card. Original itemized paid receipts are required for claims reimbursement (cash receipts or credit card receipts alone are not acceptable as proof of payment).

For claims reimbursement forward an original itemized paid receipt (cash receipts or credit card receipts alone are not acceptable) including:

  • Covered person’s name, address and Green Shield Identification Number
  • Provider’s name and address
  • Date of service (this is the date of pick up)
  • Charges for each service or supply
  • A detailed description of the service or supply
  • Medical referral/ physician prescription when required
  • For Audio, a copy of audiogram and details of provincial funding, if applicable
  • For Hospital, admission and discharge dates; daily accommodation charges; number of days in preferred accommodation

For dental claims, forward a dental claim form, completed by both the plan member and the dentist. If your claim is the result of an accident, a Dental Accident Report Form and your dental X-rays must be submitted to Green Shield for prior approval. Failure to comply may result in non-payment.

When Green Shield is identified as a secondary carrier, submit the original Explanation of Benefits statement from the primary carrier and a copy of the claim form in order to receive any balances owing.

All claims must be received by Green Shield no later than 12 months from the date the eligible benefit was incurred.

Submit all Claim Forms to Green Shield Canada

Attn: Drug Department PO Box 1652 Windsor, ON N9A 7G5
Attn: Medical Items PO Box 1623 Windsor, ON N9A 7B3
Attn: Paramedical Services PO Box 1699 Windsor, ON N9A 7G6
Attn: Hospital/ Vision Department PO Box 1615 Windsor, ON N9A 7J3
Attn: Out-of-Country Department PO Box 1606 Windsor, ON N9A 6W1
Attn: Dental Department PO Box 1608 Windsor, ON N9A 7G1

Reimbursement

Reimbursement will be made by one of the following methods:

  • a) Direct deposit to your personal bank account, when requested;
  • b) A reimbursement cheque; or
  • c) Direct payment to the provider of services, where applicable.

All maximums and limitations stated are in Canadian currency. Reimbursement will be made in Canadian or U.S. funds for both providers and plan members, based on the country of the payee.

Direct Payment to the Provider of Service (where applicable)

Present your Green Shield Identification Card to your provider and, after you pay any applicable co-payment, they may bill Green Shield directly and in many cases, payment will be made directly to your provider of service. Most providers will also have a supply of claim forms.

Emergency Travel

Green Shield Travel Assistance must be contacted by phone within 48 hours of commencement of treatment.

Call our Customer Service Centre at 1.888.711.1119 for detailed claims submission instructions.

If you have incurred out of pocket expenses, claims must be submitted together with supporting original receipts to Green Shield Travel Assistance who will then co-ordinate with the provincial health insurance plan reimbursement of those approved, eligible expenses.

To make a claim, submit the patient name, provincial health insurance plan number, address and Green Shield Identification Number with a detailed statement showing the services rendered and the fees charged for each service.

Subrogation

Green Shield retains the right of subrogation if benefits paid on behalf of you or your dependent are or should have been paid or provided by a third party liability. This means that Green Shield has the right to recover payment for reimbursement where you or your dependent receives reimbursement, in whole or in part, in respect of benefits or payments made or provided by Green Shield, from a third party or other coverage(s). In cases of third party liability, you must advise your lawyer of our subrogation rights.

Co-ordination of Benefits (COB)

If you are covered for extended health and dental benefits under more than one plan, your benefits under this plan will be coordinated with the other plan so that you may be reimbursed up to 100% of the eligible expense incurred.

Claims must be submitted to the primary payer first. Any unpaid balances should then be submitted to the secondary plan(s). Use the following guidelines to identify the primary and secondary plans:

Green Shield Plan Member

Green Shield coverage for you is always primary. If you are the plan member under two group plans, priority goes in the following order:

  • The plan where you are a full-time plan member
  • The plan where you are a part-time plan member
  • The plan where you are a retiree

Spouse

If your spouse is a plan member under another benefit plan, this Green Shield coverage is always secondary. Your spouse must first submit claims to his/her benefit plan.

Children

When dependent children are covered under both your Green Shield plan and your spouse’s benefit plan, use the following order to determine where to submit the claims:

  • The plan of the parent whose birth date (month and day) occurs earliest in the calendar year
  • The plan of the parent whose first name begins with the earlier letter of the alphabet, if the parents have the same birth date
  • In cases of separation or divorce with multiple benefit plans for the children, the following order applies:
    • The benefit plan of the parent who has custody of the dependent child
    • The plan of the spouse of the parent who has custody of the dependent child
    • The plan of the parent who does not have custody of the dependent child
    • The plan of the spouse of the parent who does not have custody of the dependent child

If the parents have joint custody and both have the children listed as dependents under their plans, claims should first be submitted to the plan of the parent whose birth date (month and day) occurs earliest in the calendar year. Balances can then be submitted to the other parent’s plan.

When Green Shield is identified as a secondary carrier, submit the original Explanation of Benefits statement from the primary carrier and a copy of the claim form in order to receive any balances owing.

Travel Benefits

In the event of a travel claim, all plans equally share the cost of the claim.

Preferred Provider Vision Network Arrangement

As a Green Shield plan member, you have access to our national preferred provider vision network arrangement where all Green Shield plan members are eligible to receive a discount on eyewear and laser eye surgery.

Features of this great value-added service for either eyewear or laser eye surgery include:

1. Offer applies to any Green Shield plan member, regardless of whether you have Green Shield vision benefits or not;

2. The vision provider may bill Green Shield directly; the plan member just pays any portion of the expense not covered under their vision benefit;

3. Trustworthy retail chains with convenient locations;

4. The discount offer applies to everything such as all extra coatings, upgrades and accessories;

5. Hundreds of the latest frame styles to choose from plus the latest lens and coating technology;

6. Professional opticians to assist in selecting products;

7. For some vendors, this offer applies to non-disposable contact lenses only (excludes disposable contact lenses).

Visit our website at greenshield.ca or call our Customer Service Centre at 1.888.711.1119 for information on the vision providers.

How to Submit Your Vision Claim

1. Present your Green Shield Identification Card as proof of being a Green Shield plan member.

2. The vision provider will apply the appropriate discount(s) to your claim and may submit the claim directly to Green Shield for payment. You pay your vision provider any balance not covered under your vision benefit.

3. If no vision benefit exists, you pay your provider the full balance owing after the applicable discounts have been applied.