GET TO KNOW YOUR HEALTH & DENTAL PLAN 2016 - Doctors Nova Scotia
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Doctors Nova Scotia
GET TO KNOW YOUR
HEALTH & DENTAL PLAN
2016
HEALTH & DENTAL PLAN USER’S GUIDE 2016
GET TO KNOW YOUR
2
HEALTH PLAN
DOCTORS NOVA SCOTIA
GET TO KNOW YOUR
HEALTH & DENTAL
PLAN
2016
TABLE OF CONTENTS
3 Message from the Board of Trustees
4 Frequently Asked Questions
7 Top 5 Benefits
9 How to Make a Claim
11 Your Health Care Spending Account
12 How to Submit an HCSA Claim
13 Top 5 Services Offered by Great-West Life
14 Groupnet for Members
15 Member Eligibility
15 Key Contacts
HEALTH & DENTAL PLAN USER’S GUIDE 2016
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YOUR HEALTH
PLAN
MESSAGE DEAR MEMBER,
Doctors Nova Scotia (DNS) is one of the few provincial medical associations to provide a
FROM THE comprehensive health and dental plan for its members and their families. The plan includes
prescriptions, vision and dental coverage, medical equipment and orthotics, ambulance and
at-home nursing services, hospital and travel coverage, and more.
BOARD In the 2015 DNS Member Satisfaction Survey, 83 per cent of respondents indicated that
they consider the extended health and dental plan to be a valuable benefit of their DNS
OF membership.
The organization strives to offer a benefits plan that meets the needs of its members while
TRUSTEES also remaining affordable to DNS and individual subscribers. As such, in 2014, the Board
of Trustees commissioned a study to evaluate the cost-effectiveness of the DNS health and
dental plan.
As a result of that study, in April 2015, DNS transitioned its health plan provider from
Medavie Blue Cross to Great-West Life. While the benefits offered by the plan remain similar,
naturally, the change in provider resulted in some changes for plan subscribers.
This booklet is like a cheat-sheet for plan subscribers – it aims to clarify the benefits you’re
eligible to receive, offer tips to support you in accessing these benefits and to help you gain
the greatest benefit from your health and dental plan. Read on for information about what
services are covered, how to make a claim and how to get the best value from the plan.
We welcome your feedback. If you have suggestions or questions, please don’t hesitate to
get in touch by emailing trustee.chair@doctorsns.com.
Yours truly,
Dr. Lisa Bonang
Chair, Board of Trustees
Doctors Nova Scotia
HEALTH & DENTAL PLAN USER’S GUIDE 2016
GET TO KNOW YOUR
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HEALTH PLAN
GET TO KNOW
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PLAN
FAQ JOINING THE PLAN
How do I join the plan?
and renewal of DNS membership are required
in order for you to continue to be covered
a. Within 60-day enrolment period: Members under the plan.
of Doctors Nova Scotia are eligible to join
the health and dental plan without providing What happens to my plan once I turn 65?
satisfactory evidence of good health during At age 65, all coverage remains the same
the 60-day period after they have been a full except drug and out-of-country coverage.
member for six months (including when their All Nova Scotians are expected to apply for
membership dues were paid through Mari- provincial coverage under the Nova Scotia
time Resident Doctors and DMSS). Seniors’ Pharmacare Plan at the age of 65;
b. After 60-day enrolment period: Any mem- as such, drug coverage under the DNS plan is
ber who wishes to join the plan after the 60- terminated. Seniors with pre-existing health
CHECK FIRST day period is considered a late applicant and conditions may need to provide three months
Before incurring any large must provide satisfactory evidence of good of health records to qualify for out-of-country
dental expenses or beginning health. Late applicants must to submit an coverage.
any orthodontic treatment, Evidence of Good Health form to Great-West
ASK YOUR DENTAL SERVICE Life. (Contact Catherine Carnegy, Benefits Is my disabled and fully dependent adult
PROVIDER TO COMPLETE A Adminstrator, for more information: 902-481- child eligible for coverage under my plan?
TREATMENT PLAN and submit 4904, 1-800-563-3427 ext. 4904 or catherine. Yes. A child 21 years of age or older who by
carnegy@doctorsns.com.) Your responses reason of mental or physical disability is
it to Great-West Life for pre-
will be reviewed and you will receive a letter incapable of self-sustaining employment and
approval.
advising you whether you have been ap- is totally dependent upon a plan member for
proved for coverage. You may be contacted support is covered under the plan, provided
and asked to submit additional information. the child was covered under this plan prior to
age 21. Plan members are required to apply
HOW LIFE CHANGES AFFECT YOUR for disabled dependent status and need to
ENROLMENT be approved by Great-West Life before they
I’m on parental leave – do I still have can continue on the plan.
coverage?
DNS members who are eligible for coverage ACCESSING BENEFITS
(see page 15) and have paid their annual What benefits require pre-approval?
premiums are covered under the plan. This Benefits that require pre-approval from
includes members who are on parental leave. Great-West Life include the following:
Will my coverage continue after I retire from Dental benefits:
active practice? Before incurring any large dental expenses
Yes, your coverage will continue after your or beginning any orthodontic treatment, ask
retirement. Note that Nova Scotia residency your dental service provider to complete a
HEALTH & DENTAL PLAN USER’S GUIDE 2016
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GET TO KNOW
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PLAN
treatment plan and submit it to Great-West • A pre-care assessment should be submit-
Life for pre-approval. Great-West Life will cal- ted before home nursing begins
culate the benefits payable for the proposed • Estimates should be submitted for other
treatment, so you will know in advance the health-care benefits, as we may require
approximate portion of the cost you will have supporting information for some medical
to pay. equipment, supplies or services to deter-
The DNS dental plan provides coverage mine whether the expense is eligible for
for eight units of scaling and root planing coverage
(combined) every nine months. Additional Contact a Great-West Life representative for
units may be considered in cases of severe more information: 1-800-957-9777.
periodontal conditions. The additional units
must be pre-approved (for a 12-month Drug benefits:
period) before the service is rendered. Great-West Life requires prior authorization
for certain high-cost drugs. See “Does my
Are X-rays ever required before a dental ben- plan provide catastrophic drug coverage?”
efit will be approved? below.
Dental X-rays are required prior to dental
Great-West Life requires benefits being approved in the following Does my plan provide catastrophic drug
prior authorization for circumstances: coverage?
certain high-cost drugs. • For pre-approval of additional units Catastrophic drug coverage is defined as the
A LIST OF DRUGS of scaling and root planing. In addi- provision of a general level of coverage that
REQUIRING PRIOR tion to current periodontal charting protects individuals from drug expenses that
AUTHORIZATION is and clinical notes, the Great-West Life threaten their financial security or cause un-
provided at www.groupnet. dental consultant requires current X-rays due financial hardship. Great-West Life pro-
greatwestlife.com (within the past three years) to determine vides this coverage for DNS plan members.
if additional units of scaling and root plan- Great-West Life requires prior authorization
ing can be approved. for certain high-cost drugs. The patient must
• For appeals for previously declined claims meet certain medical criteria before they will
or estimates, we require supporting be authorized for these drugs. A list of the
documentation, which may include X-rays, drugs requiring prior authorization is pro-
for review by the Great-West Life dental vided on the Great-West Life website.
consultant. Prior authorization is intended to help
ensure that a drug represents a reasonable
Health-care benefits: treatment. If the use of a lower-cost alterna-
Most health-care benefits do not require pre- tive service or supply represents reasonable
approval, with the following exceptions: treatment, you or your dependent may be
• Pre-approval is required for treatment fol- required to provide medical evidence to
lowing a dental accident Great-West Life showing why the lower cost
HEALTH & DENTAL PLAN USER’S GUIDE 2016
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YOUR HEALTH
PLAN
alternative service or supply cannot be used plan invoices on an annual basis. You will re-
before coverage may be provided. ceive your invoice in mid-February each year;
Prior authorization is also required for payments are due in March.
hospital use drugs (HUD). Before paying out
an eligible HUD, Great-West Life will confirm Are my premiums tax deductible?
where the patient is being administered the According to the Canada Revenue Agency,
drug (not eligible if administered in hospital employee-paid premiums to a private health
on an in-patient basis). The following HUD services plan are considered qualifying
drugs require the patient to meet medi- medical expenses and can be claimed by
cal criteria before the cost of the drugs will the employee on his or her income tax and
be covered: Abraxane, Camptosar, Eloxa- benefit returns. Although DNS members are
tin, Erbitux, Fludara (vial only), Fludarabine not technically employees of Doctors Nova
phosphate, Halaven, Herceptin, Irinotecan, Scotia, this ruling applies to the premiums
Istodax, Jevtana, Mabcampath, Taxotere/ you pay for your benefits.
docetaxel, Treanda, Trisenox, Vectibix and
Velcade. MORE QUESTIONS?
We’re always available to help. If you need
GREAT-WEST LIFE SERVICE more information, don’t hesitate to contact
FEATURES Catherine Carnegy, Benefits Administrator, at
How do I make a claim? 902-481-4904, 1-800-563-3427 ext. 4904, or
Plan subscribers may make a claim in one of catherine.carnegy@doctorsns.com.
three ways: automatically, via their health- You can also contact a customer service
care provider (i.e., dentist, physiotherapist representative at Great-West Life for assis-
or pharmacist); by a paper claim form; or tance with your medical and dental coverage.
online, using GroupNet. (More on page 12.) Call 1-800-957-9777.
What is GroupNet, and why should I sign up?
GroupNet (www.groupnet.greatwestlife.com)
is the online portal for Great-West Life. It
allows plan members to make claims online, There are some
to monitor the status of their claims and to coverage limits
review a summary of their claims. It also and pre-approval
offers a variety of health-care information. may be required.
(Read more on page 14.) SEE THE EXTENDED
HEALTH AND DEN-
FINANCIAL MATTERS TAL PLAN BOOKLET.
How will I be billed for my premiums?
Doctors Nova Scotia issues health and dental
HEALTH & DENTAL PLAN USER’S GUIDE 2016
GET TO KNOW YOUR
7
HEALTH PLAN
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YOUR HEALTH
PLAN
TOP 5 THE DOCTORS NOVA SCOTIA EXTENDED
health and dental plan offers comprehensive
a prescription. Members under 65 pay a
$20 co-pay.
BENEFITS coverage for its members. In this section, we
briefly cover the plan’s top benefits – and
• Need medical supplies or equipment?
You’re covered from head to toe. The plan
uncover some lesser-known benefits that you covers 80 per cent of the cost of the rental
might be interested in. (These are just the or (at the plan’s discretion) purchase of
highlights; for full details, see the Extended certain medical supplies, including: wigs
Health and Dental Plan booklet provided for cancer patients, hearing aids, speech
by Doctors Nova Scotia. It’s also available aids, breathing equipment, feeding/ali-
online.) mentation systems, intrauterine devices,
diabetic supplies, ostomy appliances,
1. Health custom-made compression hose and or-
When it comes to health benefits, the DNS thotics. The plan also covers medical pros-
plan has you covered: theses and medical equipment such as
• Need to get to a hospital? Your plan covers canes, crutches and wheelchairs, hospital
80 per cent of the cost of transportation by beds, and blood glucose and blood pres-
ambulance (or by air, rail or water, if neces- sure monitors. (See the full plan booklet
sary) to the nearest centre where adequate for a comprehensive list.)
treatment is available (to a maximum of • Dental injuries bite. Your plan covers the
$1,000 per trip). treatment of accidental injury to sound
• Sometimes, only in-patient care will do. natural teeth.
Whether you need acute, convalescent or
palliative care, your semi-private hospital 2. Paramedical
Need a listening ear?
room is 50 per cent covered. Your plan provides coverage for a variety of
THE PROFESSIONAL
• When you’re out of the hospital but not out-of-hospital treatments by a variety of
SUPPORT PROGRAM OFFERS
quite out of the woods, a registered nurse paramedical practitioners. You can claim up
CONFIDENTIAL HELP TO PHY-
or licensed practical nurse can make all to $600 per practitioner each calendar year.
SICIANS AND THEIR FAMILIES. the difference. After receiving pre-ap- The list of eligible service providers includes:
Call 1-855-275-8215 or email proval, you can claim up to $13,000 worth • Acupuncturists
professionalsupport@ of these services each calendar year. (See • Chiropractors
doctorsns.com. the full plan booklet for details.) • Massage therapists
• Prescription drugs are taken care of. This • Naturopaths
includes oral contraceptives, drugs to treat • Occupational therapists
erectile dysfunction (up to $250 each cal- • Osteopaths
endar year), fertility drugs ($3,000 lifetime • Physiotherapists
maximum), injectable drugs and syringes, • Podiatrists and chiropodists
preventative immunization vaccines and • Psychologists and qualified social workers
toxoids, and some drugs that don’t require • Speech therapists
HEALTH & DENTAL PLAN USER’S GUIDE 20168
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To be reimbursed for these services, Your health plan covers a comprehen- required for admission, to a maxi-
your service provider must be appro- sive array of dental care services for you mum of $1,000.
priately qualified. You do not and your dependents. Basic dental • If suitable local care is not avail-
need a doctor’s referral to services are 80 per cent covered able, medical evacuation to the
claim these services. and major services are 50 per nearest suitable hospital.
For information on cent covered, up to $1,500 • A variety of health-care services,
3. Vision DISCOUNTS ON EYEWEAR annually. such as diagnostic exams, X-rays,
Your extended AND VISION CARE • Diagnostic services medical treatment and hospital
health and dental SERVICES, refer to the > Such as X-rays, casts stays.
plan covers vision Preferred Vision Services and examinations • Travel assistance provides aid to
care and corrective section of the Extended • Preventative services> international travellers through
lenses for you and Health and Dental Plan Including scaling, polish- 24-hour-a-day, seven-day-a-week
your dependents. booklet (p. 25). ing and fluoride application access to a travel assistance provider
• See your way clear. • Minor restorative services that can direct you to a health-care
You’re eligible to have > Such as filling cavities, pain facility or assist with travel arrange-
an eye exam performed by a control, and pins, posts and pre- ments following a medical emergen-
licensed ophthalmologist or optom- fabricated crowns cy. Benefits include:
etrist every 24 months. • Endodontic and periodontal services, • Lodging for a travelling compan-
• Look sharp. Your plan covers up to and oral surgery > Including root ca- ion if the return trip is delayed by
$200 every 24 months to be used to- nals, root planing and wisdom tooth your (or your dependent’s) medi-
ward glasses, contact lenses or laser extraction cal condition
eye surgery required to correct vision, • Dentures and bridgework • Transportation and lodging for
as long as they’re provided by a li- • Orthodontics > For dependents be- one family member joining a pa-
censed ophthalmologist, optometrist tween the ages of 6 and 18 tient hospitalized for more than
or optician. You’re also covered for seven days while travelling alone.
contact lenses for impaired cornea, 5. Travel (Restrictions apply; see booklet
when the cornea is impaired so that Your health and dental plan offers up for details.)
visual acuity cannot be improved to to 180 days of travel coverage each
at least the 20/40 level in the better calendar year. (Members over 65 with
eye with eyeglasses, to a maximum of a pre-existing condition may need pre- Have the right informa-
$250 every 24 months. approval.) tion when you travel:
• Note: Coverage amounts and time • Out-of-country emergency care Always carry your your
periods are different for dependent coverage provides benefits during a provincial health card
children under the age of 18. Check medical emergency while you or your and Great-West Life card.
the Extended Health and Dental covered dependents are temporarily
YOUR GWL CARD SHOWS
booklet for details. outside Canada for business, educa-
WHAT NUMBER TO CALL
tion or vacation. This includes:
IN CASE OF EMERGENCY.
4. Dental • On-site hospital payment when
HEALTH & DENTAL PLAN USER’S GUIDE 2016GET TO KNOW YOUR
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HEALTH PLAN
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MAKING A CLAIM FOR MEDICAL or dental
HOW TO expenses shouldn’t be complicated. In most
cases – especially for vision care, dental
Tired of shuffling
papers? Signing up
MAKE A care and at the hospital – your provider will
be set up to file electronically. Just present
for GROUPNET FOR
PLAN MEMBERS CAN
CLAIM your subscriber card – that’s it, you’re done!
If your provider isn’t set up to e-file, you
HELP YOU GO PA-
can either submit a claim form or file online
PERLESS. Watch this
through GroupNet for Plan Members. video to learn more:
goo.gl/wmn5X2.
Provider e-file Claim form Online Notes
HEALTH In most cases, the If you need to submit Register for GroupNet For hospital services,
(medical treatment; provider will submit the a Healthcare Expenses for Plan Members present your subscrib-
prescriptions; required form to Great- Statement, use form and sign up for direct er information card to
medical supplies/ West Life on your behalf. M635D. Don’t forget to deposit of claim pay- the hospital and they
equipment; This includes hospital include an itemized re- ments with eDetails. will bill Great-West
paramedical services. ceipt and any support- You usually don’t need Life directly. Some
treatment) ing documentation. to submit receipts drugs, medical sup-
Download the form at when filing online, but plies and equipment
doctorsNS.com be sure to retain them require predetermina-
for your records. tions. Find out more
on page 4.
VISION Present your subscriber In most cases, the Register for GroupNet You’ll also need to
(eye exams, glasses, identification card to provider will submit for Plan Members submit an itemized re-
contact lenses and participating optome- the required form to and sign up for direct ceipt for paper claims.
laser eye surgery) trist/optician when your Great-West Life on your deposit of claim pay-
prescription is filled. behalf. If they don’t, ments with eDetails.
you’ll need to submit a You usually don’t need
Visioncare Claim Form to submit receipts
(form M1214D). when filing online, but
Download the form at be sure to retain them
doctorsNS.com for your records.
HEALTH & DENTAL PLAN USER’S GUIDE 201610
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Provider e-file Claim form Online Notes
DENTAL Present your subscriber In most instances the Register for GroupNet Great-West Life offers
(preventative and identification card dental service pro- for Plan Members predeterminations for
routine care; minor when paying for dental vider will submit the and sign up for direct dental work. They will
and major restorative services. required claim form deposit of claim pay- tell you exactly how
services; periodontics to Great-West Life for ments with eDetails. much your plan will
and orthodontics; payment. If they don’t, You usually don’t need cover and how much
dentures) submit a Dentalcare to submit receipts you will have to pay
Expenses Statement when filing online, but out-of-pocket. Ask
(form M445D) You’ll be sure to retain them your dentist or call
also need to submit an for your records. Great-West Life for
itemized receipt. more information.
Download the form at
doctorsNS.com
HEALTH CARE N/A First, submit all claims Register for GroupNet Claims incurred by
SPENDING to any government and for Plan Members Dec. 31 must be filed
ACCOUNT private insurance plans and sign up for direct by March 31 of the fol-
under which you or any deposit of claim pay- lowing year.
eligible dependents ments with eDetails.
are covered. Then You usually don’t need
complete a claim form. to submit receipts
For health, vision and when filing online, but
travel claims: use form be sure to retain them
M635D (HCSA). for your records.
For dental claims, use
form M445D (HCSA).
Download the form at
doctorsNS.com
TRAVEL Call the toll-free num- N/A N/A Pre-approval may be
(Out-of-country emer- ber on the back of your required.
gency care coverage; Great-West Life identi-
travel assistance) fication card for assis-
tance when an unex-
pected illness or injury
happens while travelling
outside Nova Scotia.
HEALTH & DENTAL PLAN USER’S GUIDE 2016GET TO KNOW YOUR
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HEALTH PLAN
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THE HEALTH CARE SPENDING ACCOUNT to the roll-over amount to reduce the chance
YOUR (HCSA) is similar to a bank account; each
plan member has an HCSA with $300 of
of forfeiture by the end of the second year.
Any rolled-over HCSA credits that have not
HEALTH credit that can be used to pay for expenses
beyond what is typically covered by your
been used by Dec. 31 of the second year (as
above, GWL must receive the claim by March
extended health and dental plan. Doctors 31 of the following year) will be forfeited.
CARE Nova Scotia plan subscribers each have an
HCSA credit of $300 each calendar year. The 3. What types of expenses are covered by the
SPENDING plan subscriber may claim expenses for the
whole family up to a total of $300. If you are
HCSA?
You can use HCSA credits to top up or cover
ACCOUNT covered by multiple plans, the HCSA will
reimburse you for the balance of the expense
expenses that are only partly covered or that
aren’t covered by group health plans, includ-
remaining after all other insurance plans ing deductibles and co-payment amounts.
have paid out. Also, since annual credits are in the form of
before-tax dollars, the HCSA is a tax-effective
1. How do I make a claim to my HCSA? way of paying for your health-related
First submit all claims to any government and expenses.
private insurance plans under which you or
SAVE RECEIPTS any eligible dependents are covered. Once HOW TO SUBMIT AN HCSA CLAIM
SAVE YOUR RECEIPTS FOR 12 you have received reimbursement for the ex- Before you submit a claim to your HCSA, you
MONTHS FROM THE DATE YOU pense from all other plans, you may submit a must first submit it to any government and
SUBMIT YOUR CLAIM to Great- claim against the HCSA. Follow the flow chart private insurance plans under which you or
West Life; you’ll need to send on page 10. any eligible dependents are covered. This
them in if Great-West Life asks includes your health plan, your spouse’s
2. Is there a time limit on HCSA claims? health plan and provincial seniors’ pharma-
for proof of payment.
Generally, you have three months following care (for members over 65 years old). Once
the end of the year in which the claim was in- you have been reimbursed by all other plans,
curred to make your claim against the HCSA. you are ready to submit a claim to your HCSA.
In other words, if you incurred the expense
by Dec. 31, you have until March 31 of the NOTE: Expenses incurred before December 31
following year to submit your claim against must be received before March 31 of the fol-
the HCSA. Claims from the previous year that lowing year to be eligible for reimbursement
are received by Great-West Life after March 31 from the HCSA.
will not be paid.
Unused HCSA credits may be carried over
to the following year’s account. If unused
credits are rolled forward, any claims in-
curred in the new year must be applied first
HEALTH & DENTAL PLAN USER’S GUIDE 2016HOW TO SUBMIT AN
!
HCSA CLAIM
Gather the following information
before beginning your claim:
• Your GWL member number and plan
number (find this on your member
card or a recent statement)
• Detailed receipt from the service 12
Was your expense GET TO KNOW
provider (not a credit card receipt or YOUR HEALTH
non-itemized cash register receipt) incurred in Canada?
PLAN
• Copy of the original claim form(s)
and proof of payment or denial
YES NO
Do you want to submit SUBMIT BY
your claim online or by MAIL
mail?
SUBMIT
ONLINE
Is your claim for a
dental expense or other
health-care expense?
Have you signed up for
GroupNet for Members
and direct deposit?
HEALTH-
DENTAL CARE
NO YES
FOR DENTAL FOR OTHER
EXPENSES, USE EXPENSES, USE
FORM FORM
M445D M635D
• Visit groupnet.greatwestlife.com
• Set up a username and password • Proceed to groupnet.greatwestlife.com
• Registration notification is by posted mail* • Enter username and password
• Sign up for direct deposit: • On main page, click on “Submit a claim”
• Click on the “My Profile” tab • Under “Claim submission method” click
• V isit www.doctorsNS.com to download the
• Click on “Request Direct Deposit” on “Online claim” next to HCSA
form you need
• Enter your banking information • Enter claim information as required
• Following the instructions on the form, fill
• A llow two business days for changes to • You do not need to send in your receipts
out relevant sections (the form is a fillable
take effect unless requested by GWL, but should
PDF)
• You are now eligible to file a claim online retain your receipts for one year
• Print two copies of the form: one to submit
* This step can take up to two weeks depending • Your payment will be delivered via
and one for your records
on Canada Post’s delivery schedule direct deposit
• Attach relevant receipt to the form. Be sure
• Check the status of your claim or
to retain copies of your receipts, as originals
your claims history by clicking on the
will not be returned
“Claims” tab
• Mail form to the address listed on page two
of the claim form
HEALTH & DENTAL PLAN USER’S GUIDE 2016GET TO KNOW YOUR
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HEALTH PLAN
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TOP 5 GREAT-WEST LIFE AND DOCTORS NOVA
SCOTIA want to make it easy for you to access
3. Mobile app
Smartphone users can download the
your health and dental benefits – whether GroupNet Mobile App for free, enabling you
SERVICES that means finding out how much a service to submit claims, access coverage informa-
will cost, making a claim when and how it’s tion, view your card information and use GPS
OFFERED convenient for you, or saving a bit of money
on your prescriptions. Here’s a summary of
to locate the nearest health-care provider
signed up for direct billing with Great-West
BY the Top 5 services that Great-West Life offers
its plan members.
Life. If you sign up for the text-messaging
option, you’ll receive texts from Great-West
GREAT- 1. GroupNet for Plan Members
Life to notify you every time a claim has been
paid.
WEST When you register for GroupNet, you free
yourself from having to download, print and
You can also access “Drug Hub” – a virtual
medicine cabinet that contains information
fill out claim forms – and you save on post- on medications and reminds you and your
LIFE age. Using GroupNet means you can submit family members when to take your medica-
your claims easily online. It also enables you tion and when to order refills.
to review a summary of all of your claims –
especially helpful at income tax time. (Read 4. Provider e-claim
about how to sign up for GroupNet on page Many Canadian health-care providers are set
14.) up to file claims with Great-West Life auto-
matically. This makes it faster and easier for
2. Costco for prescriptions you to be reimbursed for your care. To find a
Save on deductibles. Plan members save on out-of-pocket costs list of providers who are set up to file claims
Regular pharma- when filling prescriptions at Costco electronically, sign in to GroupNet. If your
cies charge a $20 Wholesale pharmacies. While regular provider isn’t set up to file electronically, you
pharmacies charge a $20 deductible, can suggest they contact Great-West Life to
deductible, BUT A
at a Costco pharmacy, you only pay a register by calling 1-866-240-7492.
COSTCO PHARMACY
$15 deductible. Anyone – whether they
ONLY CHARGES A $15
have a Costco membership or not – can 5. Predeterminations for dental care
DEDUCTIBLE.
use the Costco pharmacy. Plan mem- A predetermination lets you know up front
bers who live outside the Halifax Regional the amount your benefits plan will pay, and
Municipality can take advantage of Costco’s the difference in cost that you may have to
provincial mail order service for prescrip- pay out of pocket. This information can help
tion medications and refills in Nova Scotia. you and your providers make informed deci-
Medications can be delivered to your home sions about your dental care.
or other shipping address via free standard
shipping.
HEALTH & DENTAL PLAN USER’S GUIDE 2016GET TO KNOW YOUR
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GROUPNET ALTHOUGH MANY HEALTH-CARE PROVIDERS
have registered for direct billing with Great-
• Sign up for direct deposit (this is required
if you want to submit claims online; the
West Life, sometimes you will need to submit changes take two business days to take
FOR a claim yourself. If you sign up for GroupNet effect)
for Members – a free, easy to use web Your registration will be confirmed in writing
MEMBERS portal – you can dispense with filing paper
claim forms. Using GroupNet means you can
by posted mail.
connect to a variety of secure, user-friendly GROUPNET MOBILE APP
services online, any time. The free GroupNet mobile app brings the
convenience of GroupNet to your mobile
GROUPNET FOR PLAN MEMBERS device. Enjoy all the benefits of GroupNet on
GroupNet for Plan Members is simple, secure your iPhone, BlackBerry or Android device.
and available 24-7. Registering for GroupNet Simply download the app and sign in with
enables you to: your GroupNET username and password to
• Submit claims (including for your HCSA) immediately connect to your benefits, claims
online or on paper and coverage while you’re on the move.
• Download and print all the forms you need For more information and how-to videos,
• Sign up for direct deposit visit: http://goo.gl/KnvVz
• Get text messages or email notifications
when your claims have been processed
• View your claim status and Explanation of
Benefits for the past 24 months
KNOW YOUR
HOW TO REGISTER NUMBERS
Follow these steps to register and log in Be sure to HAVE YOUR BENEFIT
for the first time. It only takes five minutes. ID CARD HANDY WHEN SIGN-
Here’s what to do: ING UP – you’ll need to enter
• Visit www.greatwestlife.com your policy plan and member
• Click “GroupNet for Plan Members” ID numbers
• Click “Register now”
• Follow the instructions to register:
• Enter your plan and member ID informa-
tion
• Enter your name, birth date and postal
code
• Accept the site’s terms and conditions
• Choose your username, password and
security question
HEALTH & DENTAL PLAN USER’S GUIDE 2016MEMBER GET TO KNOW
15
YOUR HEALTH
ELIGIBILITY PLAN
DOCTORS NOVA SCOTIA OFFERS its Physicians who provide full-time pa- in effect or available offering the same
members several options for enrolling tient care in Nova Scotia but report their or similar coverage
in the extended health and dental ben- residence address as outside Nova • A child 21 years of age or older who by
efits plan. Full members may choose Scotia may appeal to the Board of Trust- reason of mental or physical disability
from four plans: single, family, senior ees. The Doctors Nova Scotia Board of is incapable of self-sustaining employ-
single or senior family. (Senior plans Trustees will adjudicate any appeals ment and is totally dependent upon you
are for members aged 65 and over.) regarding eligibility and benefits. for support, provided such child was
covered under this policy prior to age 21
PLAN ENROLMENT ELIGIBLE DEPENDENTS
All full members of Doctors Nova Scotia If you choose the “family” or “senior TERMINATION
are eligible to join the health and den- family” option, your extended health Benefits cease with the termination of
tal plan without satisfactory evidence of and dental benefits package will cover your membership to the association,
good health during the 60-day period the following dependents: or failure to meet eligibility require-
after they have been a full member for • Your legal spouse (the person you ments, with the exception of a surviv-
six months. Any member who wishes publicly acknowledge to be your spouse ing spouse who continues to pay full
to join the plan after the 60-day period and who has cohabited with you con- premiums.
must provide satisfactory evidence of tinuously for at least 12 months)
good health. Note: Obtaining proof of • A stepchild, legally adopted child, or CONVERSION PRIVILEGE
good health isn’t covered by MSI; it’s an natural child of yourself or your spouse If you terminate participation in the
out-of-pocket expense. (excluding a foster child) who is under group health and dental plan, you
21 years of age and not employed for may convert to an Individual Health
ELIGIBILITY CRITERIA more than 20 hours a week and Dental plan issued by Great-West
Single, family, senior single and senior • Unmarried children under 25 years of Life provided that application is made
family plans are available to members age while attending college or univer- within 31 days following your date of
whose principal residence is in Nova sity or other accredited educational in- termination. This conversion privilege
Scotia and who have been members stitution as full-time students, provided is also available to a surviving spouse
of Doctors Nova Scotia for six months. there is no mandatory student program and/or dependents.
KEY CONTACTS
If you have questions about: You should talk to: Contact information:
Plan eligibility Catherine Carnegy Doctors Nova Scotia 902-481-4904
Applying to the plan Membership officer and benefits 1-800-563-3427 ext. 4904
Invoices and billing administrator catherine.carnegy@doctorsns.com
Adding a dependent to your plan
Plan coverage Great-West Life customer service 1-800-957-9777
Pre-determinations
Pre-approvals
Tracking a claim
Appealing
HEALTH an unpaid
& DENTAL claimGUIDE 2016
PLAN USER’SYou can also read
