Updates to Green Shield Canada’s administrative guideline for non-emergency claims incurred outside Canada
Last year our Green Shield Canada (GSC) members were notified of GSC’s position on non-emergency extended health and dental claims incurred outside of Canada (not including drug claims) and that GSC would take a phased approach to provide a better plan member experience. As a reminder:
- Effective January 1, 2020, plan members must submit all non-emergency claims in either English or French before they can be processed.
- Effective March 1, 2020, non-emergency claims incurred outside Canada are no longer eligible under the benefit plan.
As part of GSC’s preparations for implementation, they made the following updates to the administrative guideline:
- Not all dental claims incurred outside of Canada will be excluded. If the claim appears to be urgent and unplanned, it may be eligible – per the plan limitations. For example, if a plan member has an abscess and requires immediate care, this is not planned treatment so the claim would not be declined. Compare this to a plan member travelling to get a crown or multiple crowns; this claim would be declined per the administrative guideline.
- Prescription eyewear and medical items purchased online will continue to be eligible through the benefits plan – per the plan limitations. However, purchases for these items in retail stores located outside of Canada will be declined.
- If a plan member contacts GSC requesting to continue to see their provider located outside of Canada for ongoing counselling services only, they will be allowed to do so as an exception. (This is on an appeal basis.)
It’s worth stating once more that plans with contract language that specifically includes these types of claims – non-emergency claims incurred outside of Canada (this isn’t common practice), plan members whose country of residence is outside of Canada and plan members on work assignments outside of Canada will not be affected by this administrative update.
If you want to share this information directly with your plan members, click here to access the applicable Plan Member Update. Contact your account team if you have any questions.