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Wilfrid Laurier University Human Resources
October 24, 2014
 
 
Canadian Excellence

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Health and Dental Care



 


?The University's Health and Dental Plan is administered by Great-West Life Insurance company.  The University provides all eligible employees and retirees with comprehensive health and dental services.  To determine if you are eligible to participate in the Health and Dental plan please see your applicable collective agreement.  

For information on the following, please click the appropriate link:

What benefits are covered under the health and dental plan

How to submit a health or dental claim

Prescription Drug Coverage

Benefit coverage while travelling

How to contact Great West Life

Information on GroupNet

BENEFIT BOOKLETS:

For detailed information on the services covered under our Health and Dental plans please view the applicable Group Benefits booklet below.

NOTE:  Effective October 1, 2013, life insurance benefits will be underwritten and provided by Great West Life.  New benefit booklets will be produced to reflect this change.  During this transition, the benefit booklets provided below should be used as reference for Health & Dental benefits only.

Faculty:

Staff - WLUSA, Management, CPAG, PAG and Special Constables:

  • Summary of Benefit Plan Coverage
  • Benefit Booklet - currently being updated.  If you have any specific questions regarding your coverage, please contact Great West Life or your Human Resources Benefit Specialist

Staff - CUPE, IATSE, UFCW, FOG:

Post-Doctoral Fellows:

Retirees:

HOW TO SUBMIT BENEFIT CLAIMS:

Did you know you can submit most of your healthcare claims online using Great West Life's online system called GroupNet?  For details see the section below regarding GroupNet.

HealthCare Claim Submissions

  • All healthcare expenses including visions claims should be submitted with original receipts to Great West Life using the Healthcare Expenses Statement.
  • Benefit claims can be submitted to Great West Life directly at the following address (ensure you keep a copy of the documents for your own records): 

    London Benefit Payments Office
    255 Dufferin Avenue
    London, ON
    N6A 4K1

  • Save money using Great West Life's preferred vision & hearing practitioners: www.pvs.ca

  • Prescription Drug Claims
  • All employees and retirees with a Great West Life Pay Direct Drug card can have their pharmacy submit their prescription claims electronically.  You will be required to pay the pharmacist directly for any expense not covered under our plan.

  • If there is a problem with an electronic submission and you are required to pay cash for your prescription please submit the Pay Direct Drug Claim form to GWL and contact the Benefits Specialist to ensure any problem with the pay-direct coverage is corrected.
  • All retirees who have a Great West Life Wallet card should submit prescription expenses using the Healthcare Expenses Statement, rather than the Assure Drug Claim form.

**Save money on your Pharmacist Dispensing Fee with the Preferred Provider Network.

Enhanced Generic Substitution of Prescription Drugs

Effective July 1, 2014, the health plan for specific employee groups (WLUSA, Managers, CPAG, PAG and Special Constables) include Enhanced Generic Substitution. With Enhanced Generic Substitution, a written note from your doctor indicating "no substitution" on your prescription will no longer be sufficient for coverage of a brand name drug that has a generic equivalent. In order for the plan to cover the costs of the brand name drug, your doctor will need to provide medical rationale supporting the need for the brand name medication rather than the generic form (e.g. negative/allergic reaction, interactions with other medication, etc). Requests for coverage can be made by having your doctor complete the required Request for Brand Name Drug Coverage Form. Without the completed form and approval from the insurance company, reimbursement will be limited to the lower cost generic drug.

Completed forms can be sent directly to Great West Life.

Doctor’s fees charged for the completion of the form will be reimbursed by the University for up to $20 per form. The receipt can be submitted to your manager for reimbursement. Please do not submit this to the insurance company, as this cost is reimbursed by the University directly, and not through the health plan.

Dental Claim Submissions

  • All dental claim submissions can be submitted electronically by your dentist to Great West Life.
  • For all orthodontic claims and if your dentist does not use electronic submissions please submit your claim along with your original receipts to Great West Life using the Standard Dental Claim form.
  • Please view link for additional Orthodontic Claim Guidelines.
    TRAVELLING OUTSIDE OF CANADA:

    Out-of-Country/Province Claims

    Our policy provides automatic out-of-country coverage for up to 90 days per trip.  This coverage is for emergency medical benefits only, and will not cover flight cancellations, etc.  For personal travel outside of Canada for more than 90 days, please ensure you purchase additional medical insurance to cover the extended trip.  For faculty travelling on Sabbatical, please notify Human Resources if your trip will be longer than 90 days.  

    Details regarding coverage for out-of-country travel are outlined in the applicable benefit booklet.  In the event of a medical emergency while travelling, please contact the insurance carrier as soon as possible using the applicable number on the back of your benefits card:

    Call collect from anywhere in the world:  410-453-6330

    Call Toll-Free

    • From within Canada and USA: 1-800-527-0218
    • From within Mexico: 001-800-101
    • *NEW* Travel to Cuba:  Call collect 905-816-1901

    To submit an out-of-country/province claim you must submit two forms:

    Pre-existing Medical Conditions:  Under our policy with Great West Life, there may be limitations to your coverage if you are travelling with a pre-existing medical condition.  For further clarification on pre-existing medical conditions and its impact on your medical coverage outside of Canada, please consult Human Resources.

    Some employees or retirees may wish to purchase stack on out-of-country/province coverage in addition to the out-of-country coverage provided under the benefits plan.  For more information, please see Medical Insurance for Snowbirds and Extended Travellers.

    GREAT WEST LIFE CONTACT INFORMATION:

    For questions regarding your coverage or any claims information, please contact Great West Life using your preferred method below: 

    Mail

    London Benefit Payments Office
    255 Dufferin Avenue
    London, ON
    N6A 4K1

    By Phone

    For all Health and Dental Claim Inquiries (please have your Employee ID and Policy Number 159632 available): 1-800-957-9777.  Service is available weekdays between the hours of 8 a.m and 7 p.m.

    GROUPNET:

    To access Great-West Life's online system Groupnet click here.  GroupNet allows members to:

    Self-registration

    • Members can access the site immediately by registering online.  For instructions on how to register, click here.

    Online claims submission — Member eClaims

    • Plan members can submit claims online, any time, by signing up for Direct Deposit.
    • eClaims include a variety of covered services such as visioncare, and paramedical services
      Pre-populated forms - Members can download forms that are pre-populated with their name, plan and employee numbers, and mailing address.

    Detailed claims information

    • Members can check the status of a claim, and see the amount paid and how the claim was assessed.
      Can view up to 24 months of claims history information.

    Coverage information

    • Can view details regarding plan coverage (including deductibles, co-insurance and maximums).
    • Can view next eligibility date and coverage balance for benefits such as dental and vision care. 

    Health and wellness information

    • GroupNet offers a rich source of health information, including a health risks self-assessment tool, plus detailed information on drugs, conditions and treatments.

    Address Change & Direct deposit

    • Members can update their address and sign up online for Direct Deposit of claim payments.