Benefits FAQ

The policy number for the health and dental plan is 51801. Your member ID is your 9-digit employee ID. If you were hired prior to 2001, your member ID is your previous 5-digit employee ID.

Typically, we will ask you as a new employee to wait approximately 3 weeks in order to receive your Great-West Life pay direct wallet drug card before submitting any claims. This will ensure that you are set up on the Great-West Life system and that your claims will be processed smoothly.

You can contact Great-West Life directly at 1-800-957-9777. A representative will provide you with information regarding your coverage eligibility. Please note that you will be asked to provide your policy number and member ID.

Please see your Benefits Package for details.

To enrol or change benefits information, fill in a Group Coverage Change Form and submit it to Benefits Services in Human Resources.

Upon hire or loss of benefits coverage from another provider you have 31 days to enroll in the Carleton plans. Late enrollment for any other reason will require that you provide evidence of insurability and will limit your dental benefits to $250 per person for the first year.

Emergency Travel Insurance is included in your Extended Health Care Plan. You and your dependents registered under your policy will be covered up to 180 days. Coverage is for emergency care only.

Note: CUASA members and their eligible dependants travelling on university business or on sabbatical leave are not limited to the 180 day maximum.

If you are planning a trip outside your province of residence and you have a medical condition that required treatment or had a change in medication in the three months prior to your departure, be aware of the following.

Coverage may be denied if a problem related to that condition or change in medication arises while you are away.

You may want to contact Great-West Life to clarify coverage before traveling outside of the province.

Initial placement of dentures is not covered under the plan. Repairs, rebasing and relining of dentures every twelve months are covered at 100%.

Dependents are covered under the plan until they reach the age of 21.

If your dependents are registered full time in school they will be covered until age 25. Proof of registration must be forwarded to your Benefits Administrator at the beginning of each school year to ensure coverage continues.

Notify your Benefits Administrator of new dependents, changes in your marital status, etc. The Benefits Administrator will update your records with Great-West Life.

This is called Coordination of Benefits (COB). You must notify your Benefits Administrator of any changes regarding coordination of benefits. The following steps will help you submit a COB claim:

• To determine which insurer pays a claim, you and your spouse must submit claims to your own plan first. Children must submit their claims to the plan of the parent with the earlier birth date in the calendar year.
• Take photocopies of your claim and receipts.
• Submit your original claim forms and receipts to the insurer who is the first payer based on the above criteria.
• Once you receive your cheque and statement, complete a new claim form, ensuring you include your spouses plan and ID numbers. Attach to this claim the statement from the insurer and photocopies of your original claim and receipts. Submit this information to the coordinating plan.

Notes:

• If your spouse is also insured with Great-West Life, submit your claim form indicating both plan numbers. Great-West Life will look after coordinating between the plans. You will receive two separate cheques.
• If you and your spouse are both employees of Carleton you may not co-ordinate benefits. You must choose which of you will be the employee with benefits. The other will have dependent status.

• Assure Health handles drug claims for Great-West Life and requires a separate claim form.
• You will receive two cheques any time you submit a claim through the mail that has prescriptions and other medical expenses attached.
• Great-West Life’s cheque will usually arrive prior to Assure Health’s cheque.
• In future, use the Assure Card Claim Form for prescription drugs and you will receive your reimbursement quicker.

Charges for the services of a Registered Nurse (R.N.), Registered Nursing Assistant or Licensed Practical Nurse for private duty nursing are covered when provided in the home; provided such services are certified as medically necessary by the attending physician. Payment for such services shall exclude:

• Charges in excess of the fee level set by the largest nursing registry of Ontario
• Agency fees, commissions or overtime fees
• Charges by a nurse who is related to the patient by birth or marriage or who lives in the home of the covered person
• Charges for the services of a homemaker or any person who is not described above
• Charges incurred by any person while confined in a hospital

There are two situations in which a predetermination is required:

• Private Duty Nursing, speech treatment plans and long-term use of medical aids and appliances should be submitted for pre-authorization of benefits.
• When dental treatment will involve the use of crowns, bridges or dentures and is expected to cost $300 or more, you must obtain a written estimate from the attending dentist.

The plan allows for two pairs of orthodics every twelve months. The plan will reimburse 80% of the cost to a maximum of $450.00 every twelve months.

No. The plan pays 100 % of the difference in cost between standard ward and semi-private room accommodation in a hospital.

Access your group benefits and claims information for the past 24 months through GroupNet at Great West Life. You can also sign up for direct deposit claim payments (claims will be paid directly to your bank account).

Yes, except for members of CUPE 3778 and Visiting Scholars. For members who do have coverage, the eye examination fee is taken into consideration in the total amount payable under the Vision Care plan.

For members of CUPE 3778 and Visiting Scholars, if you are under age 20 or over age 64 you may be covered under the provincial health plan. To find out more, contact the provincial health plan organization in the province where you live.