USER GUIDE - Great-West Life

 
USER GUIDE
PLANDIRECT USER GUIDE
This User Guide provides practical information on using your PlanDirect plan.
It includes additional information on features of PlanDirect, how to access
services and how to claim benefits.

This is not your PlanDirect policy. The actual terms and conditions of PlanDirect
coverage are set out in the policy issued to you by Great-West and included in
your PlanDirect information kit. The policy contains important information
concerning terms, conditions, limitations and exceptions. Please read it carefully.

PLANDIRECT HEALTHCARE COVERAGE
Your PlanDirect plan is underwritten by The Great-West Life Assurance Company. A leading provider of life
and health insurance in Canada, Great-West has been helping Canadians achieve financial security for more
than a century.

Administration services for PlanDirect are provided by PDAssure, including handling client services, premium
collection, maintaining policy information and distributing policy and renewal materials to policyholders.
PDAssure is an innovative third party administrator, partnering with some of the largest and most financially
sound insurance companies in Canada and providing unparalleled sales and service in the health & dental
and emergency travel health insurance markets.

Electronic drug claim services with the Assure Card® are provided by a leading full service pharmacy benefits
manager in Canada, adjudicating drug claims online in the pharmacy. Electronic adjudication services are
provided for 10,500 groups covering over 3.5 million Canadians.

Shepell·fgi provides the Health Information, Family Support and Nutrition Support services for PlanDirect.
Shepell·fgi, the leading provider of prevention-focused Employee Assistance Programs, also offers an
enhanced choice of services that address physical, mental and social health issues. Shepell·fgi provides
complete health solutions to more than six million employees and their families across the world.

As part of your PlanDirect healthcare coverage, you have access to Great-West Life’s Health & Wellness Site. It
offers comprehensive health information and interactive health-related tools, available online 24 hours a day,
seven days a week.
TABLE OF CONTENTS

COVERAGE HIGHLIGHTS
		                      Who’s covered  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
		                      Where to find information on your coverage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SPECIAL FEATURES
		                      PVS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
		                      Assistance Services  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

PRESCRIPTION DRUG COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

OPTIONAL COVERAGE
		                      Emergency Travel Medical  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
		                      Accidental Death, Dismemberment and Specific Loss  . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
		                      Hospital Cash  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
		                      Major Dental Services and Supplies  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

SUBMITTING CLAIMS
		                      Prescription drug claims  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
		                                For Basic with Drug Card, Comprehensive with Drug Card, or Premier plan  . . . 7
		                                For Basic or Comprehensive plan  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
		                      Other healthcare claims  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
		                      Dental claims  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
		                      Optional coverage claims  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ADMINISTRATION
		                      Premiums  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
		                      Renewing your coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
		                      Changing your coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
		                      When your coverage ends  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
		                      Reinstating your coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
		                      Cancelling your coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
		                      Surviving spouse and children coverage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

WHO TO CALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

                                                                                                                                                                            1 PLANDIRECT
COVERAGE HIGHLIGHTS

WHO’S COVERED
Your PlanDirect Policy Specifications lists everyone who is covered under your PlanDirect plan.

WHERE TO FIND INFORMATION ON YOUR COVERAGE
Your PlanDirect Policy sets out the health and dental coverage that is provided under your policy.

If you purchased any of the optional benefits available with PlanDirect (such as Emergency Travel Medical,
Hospital Cash, Accidental Death, Dismemberment and Specific Loss or Major Dental Services and Supplies), your
information package will include a benefit rider for each optional benefit you purchased. These riders set out your
coverage.

Your Policy Specifications show who’s covered under your plan, your monthly premium and such information as
your plan’s reimbursement levels and benefit maximums. The Policy Specifications will also include information on
any optional coverage you purchased, plus ID cards showing your policy number and effective date.

If you can’t find the information you need, your financial security advisor or PDAssure can help you. There are also
phone numbers listed on page 17 of this guide.

SPECIAL FEATURES
Your PlanDirect policy and riders set out the details of your coverage. This section provides additional information
on PlanDirect services you may find useful.

PVS
The PVS visioncare and hearing aid program is an added feature of your PlanDirect plan.

The PVS program provides a discount* of up to 20 per cent on prescription eyewear, a discount on laser surgery
and a 10 per cent discount on hearing aids purchased from a registered PVS location. Most locations also apply the
discount to non-prescription eyewear and accessories. Show your eligibility card at the time of purchase and pay the
reduced price.
*Discount can vary by participating outlets. In some cases you cannot combine the PVS discount with a promotional discount that the
practitioner is offering. Some providers do not offer a discount on contact lenses. Check with the practitioner before making your purchase.

Shopping through PVS is easy:
      • Visit the PVS website at www.pvs.ca or call the PVS Information Hotline toll free at 1-800-668-6444 for more
         information, including a list of practitioners affiliated with PVS.
      • Arrange for a fitting, an eye examination, a hearing assessment or a hearing test, if needed.
      • When you visit the practitioner and before you make your purchase, identify your PVS program member
         status by presenting your PlanDirect ID card.
      • Some providers do not offer a discount on contact lenses. Check with the practitioner before making
         your purchase.
      • You can use the PVS network as often as you wish for yourself and your dependants.

If your PlanDirect plan provides coverage for visioncare or hearing aids, submit your claim as usual.

PVS does not impact the practitioner’s clinical role or professional judgment.

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ASSISTANCE SERVICES
Your PlanDirect plan includes these assistance services:

Health Information Service
A reliable remedy for health concerns

Need answers to simple health questions, or worry that symptoms may point to something more serious? This
service can help. You get information and reassurance with one phone call, 24 hours a day, seven days a week. A
registered nurse provides personalized telephone assistance.

Family Support Service
Support for what matters most

Links you to a network of qualified, on-call healthcare and home care professionals. Whether you are looking for
a solution to a home care emergency or planning long-term care, you get the guidance you need. This is a referral
service only, it does not cover the fees for professional and support services.

Nutrition Support Service
Nourishing expert advice

Offers a proactive, self-care approach to wellness. Helps you make positive changes to your diet by examining the
underlying issues associated with weight loss/gain, eating routines and lifestyle changes. Solutions include a
self-directed package of useful tips, information and resources as well as professional consultation with a registered
dietician in more complex situations.

Great-West Life’s Health & Wellness Site
Health information and interactive health-related tools

With in-depth information on diseases, conditions, drugs and treatment options, and regularly updated health and
wellness articles, the Health & Wellness Site is a valuable online resource.

    Health Information Service, Family Support Service and Nutrition Support Service are
    confidential services available to you and your immediate family. To access these services,
    call the toll-free line, 24 hours a day, seven days a week:

                                       1-800-387-4765 for service in English

                                       1-800-361-5676 for service in French

                                          1-877-338-0275 for TTY service

All services related to Health Information, Family Support and Nutrition Support are offered by PDAssure
through Shepell·fgi. These services do not form part of the PlanDirect policy and are not underwritten by
The Great-West Life Assurance Company.

                                                                                                             3 PLANDIRECT
PRESCRIPTION DRUG COVERAGE

THE ASSURE CARD®
For Basic with Drug Card, Comprehensive with Drug Card and Premier plans

If you have the Basic or Comprehensive plan with the drug card option, or the Premier plan, your prescription drug
coverage includes the convenience of the Assure Card and the Assure ClaimsTM drug safety service.

The Assure Card is an electronic payment system that provides on-the-spot processing of prescription drug claims at
almost any pharmacy in Canada. It’s a convenient, easy-to-use alternative to submitting claim forms and waiting to be
reimbursed. Your personalized Assure Card is administered by a leading full service pharmacy benefits manager.

The Assure Claims drug utilization review program

It is not always practical or possible to visit the same pharmacist to have your prescriptions filled. We also realize how
important it is for the pharmacist filling your prescriptions to be aware of your recent drug history. This helps ensure
the safety of you and your family, wherever and whenever prescriptions are filled.

The Assure Claims drug utilization review program, included with your Assure Card, promotes safe and effective use
of prescription drugs. It reviews the prescription being filled to help ensure it agrees with the drug manufacturer’s
recommended use, and will not interfere with other prescriptions you have purchased with your Assure Card. If a risk
is detected, the Assure Claims Network issues a warning to your pharmacist indicating the nature of the concern. Your
pharmacist is then able to discuss the risk with you and, if required, consult your physician.

Balancing safety with confidentiality

With the Assure Card and Assure Claims, your personal prescription information is completely confidential. Our
pharmacy benefits manager will only release information about your claims history and warning notices about
possible drug conflicts to your pharmacist. No information concerning what you are being treated for is ever shared.

For information on how to use your Assure Card, read the Submitting Claims section on page 7.

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OPTIONAL COVERAGE

There are four optional benefits available with PlanDirect:

        • Emergency Travel Medical
        • Accidental Death, Dismemberment and Specific Loss (AD&D)
        • Hospital Cash
        • Major Dental Services and Supplies

You may add the Emergency Travel Medical and Accidental Death, Dismemberment and Specific Loss options
to your PlanDirect plan at any time. The Hospital Cash, and Major Dental Services and Supplies options are only
available at the time of initial purchase of your PlanDirect plan.

For more information or to add optional coverage, contact your financial security advisor or PDAssure.

EMERGENCY TRAVEL MEDICAL COVERAGE
The PlanDirect Emergency Travel Medical coverage has two components: coverage for emergency treatment when
you’re travelling outside Canada on trips up to 30 consecutive days for under age 65, or up to 15 consecutive days for
age 65 to 74, and assistance services for a medical emergency while you are travelling outside Canada or more than
500 kilometres from your home. Courtesy Assistance Services are also available.

Emergency Medical Treatment

If you purchased Emergency Travel Medical coverage, your information package will include an Emergency Travel
Medical Benefit rider, which sets out your coverage in detail, and Emergency Travel Assistance wallet cards to take
along while you are travelling.

In a medical emergency, immediately call the toll-free Assistance Centre number on the back of your PlanDirect
Emergency Travel Assistance card.

You’ll reach the Assistance Centre, which will help you find qualified medical care and provide other emergency
assistance. The Assistance Centre operates 24 hours a day, every day, and can help you locate hospitals, clinics and
physicians who can provide appropriate medical care.

    WHO TO CALL

    In a medical emergency, immediately call the toll-free Assistance Centre number on the back
    of your PlanDirect Emergency Travel Assistance card:

    • while travelling in Canada or the United States, call: 1-855-222-4051
    • outside of Canada or the United States, refer to the list of countries on the back of your
    Emergency Travel Assistance card.

    The Assistance Centre will obtain Great-West’s approval for covered medical expenses
    and provide assistance services when you’re outside Canada or more than 500 kilometres
    from home.

                                                                                                            5 PLANDIRECT
You must notify the Assistance Centre as required in your policy. Otherwise, any benefits you receive may be
reduced as set out in your policy.

Hospitals will not accept your PlanDirect Emergency Travel Assistance card as proof of coverage, but will use it to
contact the Assistance Centre, which will in turn contact Great-West to verify your coverage.

It is important that you read your Emergency Travel Medical Benefit rider carefully before travelling. Your coverage
is subject to certain limitations and exceptions. An exclusion applies to pre-existing medical conditions and/or
symptoms that existed before your trip. The rider explains how this applies and how it relates to your departure date,
date of purchase and effective date.

You should also review your provincial coverage before travelling, to ensure you have sufficient insurance. Your
provincial coverage may have time limits on submitting claims that would also apply to your PlanDirect policy.

ACCIDENTAL DEATH, DISMEMBERMENT AND SPECIFIC LOSS (AD&D)
PlanDirect’s optional AD&D insurance is available in units of $25,000, up to a maximum of $250,000 for the owner of
the policy. An insured spouse is covered for 50 per cent of the amount covered for the owner, and each insured child
is covered for 10 per cent of the amount covered for the owner.

If you purchased this coverage, your information package will include an AD&D rider. It sets out the covered losses
and the amount payable for those losses. Your Policy Specifications will show the amount of coverage you purchased
and the amount of coverage for each family member.

HOSPITAL CASH
Available only with the initial purchase of your PlanDirect policy

PlanDirect’s Hospital Cash Benefit pays cash to the policy owner if anyone insured under the policy is hospitalized
in Canada.

If you purchased this optional coverage, your information package will include a Hospital Cash Benefit rider, which
sets out your coverage in detail.

MAJOR DENTAL SERVICES AND SUPPLIES
Available with Comprehensive plans, and only with the initial purchase of your PlanDirect policy

PlanDirect offers an optional Major Dental Services and Supplies benefit to Comprehensive plan policyholders.
This option pays benefits for covered major dental services, including dentures, overdentures and denture-related
surgery, bridgework and implant retained appliances, appliance maintenance, and crowns and onlays, for you and
all insured family members. To qualify for this optional benefit, you must have had similar prior coverage.

Benefits payable under this option are reimbursed at 50 per cent for eligible major dental expenses, up to $750 per
insured per calendar year.

If you purchased this optional coverage, your information package will include a Major Dental Services and Supplies
Benefit rider, which sets out your coverage in detail.

PLANDIRECT 6
SUBMITTING CLAIMS

PRESCRIPTION DRUG CLAIMS
Using your Assure Card
For Basic with Drug Card, Comprehensive with Drug Card and Premier plans

If you have the Basic or Comprehensive plan with the drug card option, or the Premier plan, your prescription drug
claims will be settled right in the pharmacy, with your Assure Card.

When you fill a prescription:
   • Present your Assure Card to your pharmacist, before he or she fills the prescription.
   • Your pharmacist will require the following information about the patient:
		        • name
		        • address and postal code
		        • telephone number
		        • date of birth
		        • relationship to the policyowner
		        • policy number
   • Your pharmacist will use the card to verify your eligibility and drug coverage, and to apply any deductibles
		 or coverage limits.
   • Your leading full service pharmacy manager electronically pays your pharmacist the amount covered by
      your PlanDirect plan. You pay only for fees not covered by PlanDirect.
   • You do not have to fill out any claim forms or wait for reimbursement. It’s all handled on the spot.

Pharmacies that recognize the Assure Card are also linked electronically with the provincial Pharmacare plans. The
pharmacist will know how much your provincial plan will cover, and how much you can claim under PlanDirect.

Always provide your card when filling a prescription. For security reasons, pharmacies generally don’t share computer
systems, even if they’re part of the same chain. If you forget your card, you can still get your prescription filled, but
you will have to pay the full amount up front, submit a Healthcare Expenses Statement, and wait for reimbursement.

Keep your information up to date. Be sure to advise PDAssure if your marital status changes, you adopt or have a
baby, or if any children are attending post-secondary education. Also, let your pharmacist know of any changes to
your benefits, or if you are issued a new Assure Card.

                                                                                                              7 PLANDIRECT
Common questions

What if I forget my card?
You will still be covered by your plan if you forget your card. However, you may have to pay for your prescription
in full at the pharmacy, then submit your receipt and a completed Healthcare Expenses Statement for the amount
covered by your plan, as with other healthcare claims (See the “OTHER HEALTHCARE CLAIMS” section below).

What if my card is lost or stolen?
Report a lost or stolen card to PDAssure immediately. Your card number will be cancelled for your protection and a
new card will be issued as a replacement. If you find your original card after receiving your new one, please return
the original card to PDAssure.

Do I have to use the card to fill my prescription?
No, however, using your Assure Card has many advantages. You don’t have to complete a claim form and wait for
reimbursement. Your claim is automatically processed when your prescription is filled, and you get the added
advantage of the Assure Claims drug utilization review.

If you are unable to use your drug card for any reason, you may submit paper claims for prescription drugs. See the
“Submitting paper claims” section below for more information.

Submitting paper claims
For Basic or Comprehensive plans.

If your plan does not include a drug card you can submit prescription drug claims in the same way you submit all
healthcare claims. See the “OTHER HEALTHCARE CLAIMS” section below for instructions.

    DISPENSE FEES

    There are two components to the cost of a prescription drug – the ingredient cost and the
    dispense fee.

    The ingredient cost is the cost the drug manufacturer charges for the drug. The dispense fee
    is charged by the pharmacy to cover the pharmacy’s business expenses, and can vary widely
    from pharmacy to pharmacy. The cost of the prescription drugs charged by the pharmacy
    is the sum of the ingredient cost plus the dispense fee. To get the most from your PlanDirect
    drug coverage, shop around to find the best value.

OTHER HEALTHCARE CLAIMS
For healthcare expense claims (including prescription drugs if your plan does not have a drug card), please use the
Healthcare Expenses Statement. You received a small supply of this form in your PlanDirect information package.
Additional copies are available from PDAssure, the Individual Health Unit, or on the Client Services section of the
Great-West website at www.greatwestlife.com.

Mail the completed form, along with your original receipts, to:

The Great-West Life Assurance Company
Individual Health Unit
PO Box 6000
Winnipeg MB R3C 3A5

PLANDIRECT 8
DENTAL CLAIMS
For Comprehensive and Premier plans

Great-West is electronically linked with many dentists across Canada. If your dentist has such a link with
Great-West, your claim can be settled right in the dentist’s office. The dentist submits the claim electronically and
receives confirmation of coverage. You only pay for any expenses not covered by PlanDirect. Some claims, such as those
for major dental work, must be submitted using paper claim forms.

It is a good idea to submit a treatment plan before proceeding with any treatment over $200. Great-West will then
provide you with an estimate of the amount payable under your PlanDirect policy. The estimate will be valid for 90 days.
Send the treatment plan to the same address as the claim forms.

When submitting your first claim, your dentist will need your PlanDirect policy number. Your policy and ID numbers are
shown on your Policy Specifications, and on your ID card.

Using paper forms for dental claims

You can also submit claims by mail. You received a small supply of Dentalcare Claim Forms in your PlanDirect
information package. Additional copies are available from PDAssure, the Individual Health Unit, or on the Client Services
section of the Great-West website at www.greatwestlife.com.

Complete the Policyowner Information and Patient Information sections of the form and have your dentist complete the
Dentist section. Send the form to:

The Great-West Life Assurance Company
Individual Health Unit
PO Box 6000
Winnipeg MB R3C 3A5

You will receive an explanation of benefits, which you should keep for your records. Unless you indicate you want the
payment to go directly to the dentist, Great-West will mail all cheques to your home address.

Dental fee guides

Great-West assesses dental claims using current fee guides developed and maintained by provincial dental associations.
These fee guides offer a reasonable and consistent basis for assessing claims in each province.

Since a fee guide is no longer published in Alberta, to assess claims incurred in Alberta, Great-West uses the 1997 Alberta
Dental Association fee guide, plus an inflationary adjustment determined by Great-West.

    DIRECT DEPOSIT

    You can have your PlanDirect claim payments automatically deposited to your financial
    institution. With Direct Deposit, there are no delays receiving your cheques due to mail
    disruptions, no chance your cheques will be lost or stolen, and no need to deposit your cheques
    in person.
    If you completed the Direct Deposit section on your application for PlanDirect coverage, your
    health and dental claim payments will be directly deposited into the account you requested.
    If you did not request Direct Deposit and would now like to take advantage of this convenient
    and secure option for your claim payments, please contact your representative or the Individual
    Health Unit.

                                                                                                             9 PLANDIRECT
OPTIONAL COVERAGE CLAIMS
Emergency Travel Medical claims

Before entering a hospital or being treated for a medical emergency, call the toll-free number on your PlanDirect
Emergency Travel Assistance card immediately, or have someone call on your behalf. Your benefit amount may
be reduced if you do not call before being treated. If it is not reasonable for you to call prior to seeking medical
treatment, please contact the Assistance Centre as soon as possible following a medical emergency.

In addition to helping you find appropriate medical care, the Assistance Centre will obtain Great-West’s approval,
where required, and will arrange to have hospital and doctor bills sent directly to us for payment.

You should contact your provincial health plan before leaving the country to determine the extent of your province’s
health plan coverage. Many provincial health plans have time limits for submitting your claims. These time limits
will apply to your PlanDirect claim as well.

Great-West will pay your provincial health plan’s share of the claim for you, on the province’s behalf. The provincial
health plan requires that you sign a release permitting them to reimburse Great-West for their portion of the claim.

If your provincial health plan refuses payment, you may be asked to reimburse Great-West for any amount we have
already paid on their behalf.

If you have paid a medical provider for services outside Canada, contact Great-West’s Individual Health Unit when
you return home at:

The Great-West Life Assurance Company		 1-866-430-2863
Individual Health Unit					individual.health@gwl.ca
PO Box 6000
Winnipeg MB R3C 3A5

Great-West will send you the necessary forms and will assist you in preparing and submitting a claim. Claim forms
are also available from our website or by contacting Great-West’s Individual Health Unit at the number listed above.

Hospital Cash Benefit claims

If you purchased the Hospital Cash Benefit, you will receive your cash benefit automatically when you submit your
claim for hospital accommodations. You do not have to file a separate claim or provide receipts.

Accidental Death, Dismemberment and Specific Loss claims

To make a claim for Accidental Death, Dismemberment and Specific Loss benefits, contact your financial security
advisor or PDAssure. They will assist you in making your claim.

Major Dental Services and Supplies claims
For Comprehensive plans

You may submit claims for the Major Dental Services and Supplies benefit in the same way that you submit claims
for your standard PlanDirect dentalcare coverage. For more details, please see page 9 of this guide.

PLANDIRECT 10
For claims information, call the Individual Health Unit at Great-West toll-free at 1-866-430-2863.

   HOW TO GET CLAIM FORMS
   Your PlanDirect information package includes an initial supply of the forms you will need.
   These include:
         • Healthcare Expenses Statement
         • Dentalcare Claim Form (for plans with dentalcare coverage)

   Claim forms are also available through the Client Services section of the Great-West website
   at www.greatwestlife.com, the PlanDirect website at www.plandirect.com, or by contacting
   the Individual Health Unit or PDAssure using the contact information on page 17 of
   this guide.

   PROMPT CLAIMS PAYMENT
   There are several things you can do to ensure your claims are paid as quickly as possible:
         • We need all the information that we ask for on the forms, so be sure to answer
            all the questions. Otherwise, we may return the form and ask you to provide the
            missing information.
         • Be sure to include your policy number on all claim forms. You can find your policy
            number on the Policy Specifications page, in your PlanDirect information package or
            on your personalized ID card.
         • Make sure you’ve attached all the receipts supporting your claim and that all receipts
            are originals. We cannot accept photocopies. Your original receipts will not be returned.
            You will, however, receive an itemized statement that you can use for your records.
         • Please sign and date the claim form, in ink.
         • If you’re uncertain about how to complete a form, call the Individual Health Unit
            at 1-866-430-2863.

   You can ask Great-West to send payments directly to hospitals, dentists or providers of
   out-of-country emergency medical treatment. Otherwise, Great-West will mail all cheques,
   and a complete explanation of benefits paid, directly to your home address.

                                                                                                     11 PLANDIRECT
ADMINISTRATION

PREMIUMS
Your first year premium is set on your plan’s effective date, shown on your Policy Specifications. Your premium is
based on:
         • the PlanDirect plan you chose
         • any optional coverage you chose
         • whether you’re insuring just yourself or yourself and other dependants
         • your age or your spouse’s age
         • your home province or territory; and
         • whether you’ve had similar coverage in the 60 days before you applied for PlanDirect coverage.

You can pay monthly or annually for your PlanDirect plan.

Monthly payments

The Policy Specifications in your PlanDirect information package indicate your monthly premium payment and
when it is due. Premium payments will automatically be withdrawn monthly from your financial institution account.

Annual payments

If you choose to make an annual premium payment, your full payment is due in advance and a cheque should be
attached to your application.

You have a grace period of 30 days after the date your premium is due, in which to pay your premium without losing
your coverage.

PLANDIRECT 12
If your premium payment is returned due to non-sufficient funds, NSF charges may apply.

There are several points at which your premium may change:
       • at renewal
       • if you add or remove coverage for a dependant
       • if you change plans
       • if you add or remove optional coverage
       • if you or an insured family member move to another province or territory.

RENEWING YOUR COVERAGE
Your policy is for a term of one year beginning on the effective date shown on your Policy Specifications.

Great-West will automatically renew your PlanDirect policy each year, on your policy’s annual renewal date. Your
Policy Specifications page shows your annual renewal date. At each renewal, Great-West will re-establish your
premium. Your new premium will take effect on the annual renewal date. Each year, your premium will be changed
to reflect such things as increasing healthcare costs, shifts in expenses from provincial to private plans, and whether
you’ve added or removed coverage for a spouse. In most cases, you can expect your premium to increase on renewal.
You will be notified at least 31 days before any change in premium.

CHANGING YOUR COVERAGE
Upgrading your coverage

If you did not purchase Accidental Death, Dismemberment and Specific Loss or Emergency Travel Medical coverage
when you purchased your PlanDirect policy, you may add them at any time. Contact your financial security advisor
or PDAssure to make this additional purchase.

You may also upgrade your plan level at any time, depending on your current plan. You, and your dependants, will
need to provide updated medical information at the time you apply to increase your coverage. Eligibility for a plan
upgrade is based on the medical information provided. Standard rates apply to all coverage upgrades.

        Plan				Can be upgraded to:
 Basic without drugs		 Basic, Comprehensive without drugs / Comprehensive / Comprehensive
					with Drug Card

 Basic / Basic with Drug Card Comprehensive without drugs / Comprehensive / Comprehensive with
					Drug Card

        Comprehensive without drugs      Comprehensive / Comprehensive with Drug Card

Upgrades to the Premier plan are not permitted.

                                                                                                             13 PLANDIRECT
Decreasing your coverage

Basic, Basic with Drug Card, Comprehensive without drugs, Comprehensive, Comprehensive with Drug Card and
Premier plan levels can be decreased after you have been covered at the higher level for one year. To do this, simply
submit a request in writing to PDAssure.

        Plan							Can be decreased to:

        Basic / Basic with Drug Card				                         Basic without drugs
        Comprehensive without drugs				                          Basic / Basic with Drug Card /Basic without drugs
  Comprehensive / Comprehensive with Drug Card                    Comprehensive without drugs / Basic / Basic with
		                                                                Drug Card / Basic without drugs
  Premier                                                         Comprehensive / Comprehensive with Drug Card /
		                                                                Comprehensive without drugs / Basic / Basic with
		                                                                Drug Card / Basic without drugs

Changes in your coverage may affect your premium.

Adding or removing coverage for a dependant

Your Policy Specifications lists all the dependants covered under your PlanDirect policy. To add or remove coverage
for a dependant, contact your financial security advisor or PDAssure.

Changing a beneficiary

All beneficiary changes must be made in writing. Complete the Change of Beneficiary form and return it to the
address on the form. Forms are available by calling the Individual Health Unit at 1-866-430-2863, or from the
Client Services section of the Great-West website at www.greatwestlife.com. You will receive written confirmation of
the beneficiary change.

If your beneficiary is a minor, you may appoint a trustee. Complete the Appointment of Trustee form and include
it with your application. The form is available from your financial security advisor or the PlanDirect or Great-West
websites.

If you live in Quebec, you will have to indicate whether your beneficiary is revocable or non-revocable. If you
designate your beneficiary as non-revocable, you will not be able to change that beneficiary unless you have the
written consent of your beneficiary.

Making other changes

To change your address or to make corrections to information (such as birthdates or spelling of a name), simply call,
mail or email your change to PDAssure.

To add Direct Deposit or change your banking information for Direct Deposit, please contact your financial security
advisor or Great-West’s Individual Health Unit.

PLANDIRECT 14
MAKING CHANGES

Your financial security advisor can provide the necessary forms and assist you in
modifying your coverage, adding optional benefits, or adding or removing dependant
coverage. Or, you can contact PDAssure at:

                                     PDAssure
                              200-211 Consumers Road
                              Willowdale ON M2J 4G8

                       416-490-0072 or toll free 1-800-565-4066

                                  fax: 416-490-6640
                           email: plandirect@pdassure.com
                                www.plandirect.com

                                                                           15 PLANDIRECT
WHEN YOUR COVERAGE ENDS
Your coverage will end automatically 30 days after you stop paying your premiums. Coverage will also end if you are no
longer a permanent resident of Canada or if you are no longer covered under the provincial government health plan.

If you’ve insured dependants under your PlanDirect plan, coverage for your dependants will end if they are no longer
permanent residents of Canada or if they are no longer covered under the provincial government health plan. Coverage
for your spouse will end once he or she is no longer considered your spouse according to the applicable provincial
legislation.

Coverage for a child who is not a full-time student will end when the child turns 21 or works more than 30 hours a week.
Coverage for a child who is a full-time student will end when the child turns 25.

Check your policy for information on when coverage ends for a child who is incapable of supporting him or herself
because of a physical or psychiatric disorder.

REINSTATING YOUR COVERAGE
If your policy was terminated because you didn’t pay premiums, were no longer covered under your provincial
government health plan or were no longer a permanent resident of Canada, you can apply to have your policy reinstated.
At the time you apply to have your policy reinstated, you must be covered under a provincial government health plan
and be a permanent resident of Canada. You may be asked to provide evidence of your insurability.

Notify PDAssure in writing within 12 months of the termination of your policy. You will have to pay all overdue premiums
and any additional fees, including NSF charges, with interest.

CANCELLING YOUR COVERAGE
To cancel your coverage or coverage for your dependants, please advise your financial security advisor or PDAssure in
writing. Your coverage will end on the last day of the month in which you cancel your coverage. If you’ve paid premiums
in advance, your premium will be refunded from the first of the month following your cancellation.

SURVIVING SPOUSE AND CHILDREN COVERAGE
Great-West will automatically continue coverage for your spouse and children upon your death, unless your spouse
terminates your policy. Your spouse will receive new Policy Specifications listing the spouse as the policyowner and
showing the change in premium. PDAssure will mail the new Policy Specifications within 31 days of receiving notice in
writing of your death.

PLANDIRECT 16
WHO TO CALL

FOR INFORMATION ON CLAIMS
You can contact Great-West’s Individual Health Unit for claims information:

Call toll free: 1-866-430-2863
Or email: individual.health@gwl.ca

FOR HEALTH INFORMATION SERVICE, FAMILY SUPPORT SERVICE OR
NUTRITION SUPPORT SERVICE
Call the toll-free line, 24 hours a day, seven days a week:

1-800-387-4765 for service in English
1-800-361-5676 for service in French
1-877-338-0275 for TTY service

FOR PVS
For information on the PVS discount, or the nearest PVS location, call the PVS Information Hotline
toll free at 1-800-668-6444 or visit the PVS website at www.pvs.ca.

FOR GENERAL INQUIRIES AND ASSISTANCE
Your PlanDirect policy is underwritten by The Great-West Life Assurance Company and administered by PDAssure.
If you would like more information on your policy, to make changes, or if you have any questions, call PDAssure at:

416-490-0072 or
toll free 1-800-565-4066
8 a.m. to 6 p.m., Monday to Friday (EST)

or write:
PDAssure
200-211 Consumers Road
Willowdale ON M2J 4G8

or email:
plandirect@pdassure.com

For additional information on PlanDirect, visit Great-West’s website at www.greatwestlife.com/plandirect,
or PlanDirect’s website at www.plandirect.com.

For more information about Great-West Life, visit www.greatwestlife.com.

                                                                                                          17 PLANDIRECT
                                                                                                             PLANDIRECT
1-800-565-4066

                                                               Assure Card is a trademark of Emergis Inc.
                                                              Shepell·fgi is a trademark of Shepell FGI LP.
                                                                PlanDirect is administered by PDAssure.
                                            PlanDirect policyowners are insured by The Great-West Life Assurance Company.
                                    Great-West Life and the key design are trademarks of The Great-West Life Assurance Company.
M6808-12/13   PlanDirect and PDAssure are trademarks of PlanDirect Insurance Services Inc., used under license by The Great-West Life Assurance Company.
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