Post on 26-May-2020
CONFIDENTIAL
WELCOME
2/13/2020
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CONFIDENTIAL
Agenda
• Benefits
▪ Health Benefis and Annual Maximums
▪ Dental Benefits and Annual Maximums
▪ Out of Pocket Maximum
▪ Government changes to Out of Country
• Coordination of Benefits
• Orthopedic Coverage
▪ Submitting claims and requirements
• GroupNet
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Canada Life
Combining our strengths
• For over 125 years, our 3 companies—Great-West Life, London Life and Canada Life— have been trusted by Canadians for keeping their promises and helping Canadians reach their full potential, every day.
• Transitioning to one brand allows us to combine the strengths of our 3 companies, so we can better deliver on our purpose.
Our existing brands
• You’ll continue to see the Great-West Life, London Life and old Canada Life logos for some time as we transition to the new Canada Life brand
New brand, same commitment
• Our commitment to providing you with excellent customer service every step of the way won’t change. Each of our three companies will continue to operate as they do today.▪ We'll focus on doing the right thing at the right time for our customers.▪ We believe in the value of advice and the critical role a trusted financial advisor plays in helping you reach
your potential, every day.▪ We’ll still be easy to connect with and accessible to all Canadians.
February 13, 2020
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CONFIDENTIAL
February 13, 2020
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Our vision: Customers are at the centre of what we do.
Our purpose:To improve the financial, physical and mentalwell-being of Canadians.
Health care
Reimbursement levels
Benefits
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Benefit Coinsurance
Out-of-Country and GMA 100%
Prescription Drug
Expenses
80%
Hospital – Semi Private 80% first 5 days and then
100% for remainder of
the calendar year.
Home Nursing 80% of the first 10 days
of nursing expenses and
100% for the remainder
of the calendar year
All Other Expenses 80%
Paramedical Practitioners Annual MaximumsBenefits
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Benefits Maximums
• Dieticians * $717 per calendar year
• Massage Therapists * $717 per calendar year
• Naturopaths $717 per calendar year
• Osteopaths $717 per calendar year including 1 x-ray per calendar year
• Physiotherapists/Occupational Therapists $717 per calendar year
• Podiatrists $717 per calendar year including 1 x-ray per calendar year
• Psychologists/Social Workers * $717 per calendar year
• Speech Therapists * $717 per calendar year
• Chiropractors $717 per calendar year, limited to $12 per visit for the first 15 visits
per calendar year. Overall max includes 1 x-ray per calendar year.
* Must have a Doctors referral
Other Benefits Annual MaximumsBenefits
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Benefits Maximums
Home Nursing Care $21,739 per calendar year
Hearing Aids $717 per ear, every 5 years
Compression Hose 12 pairs each calendar year
Orthopedic Shoes 3 pairs every 2 calendar years
Orthotics $717 per calendar year
Surgical Brassieres 4 per calendar year
Out-of-Country Emergency Care $1,000,000 per lifetime
Dental care
Reimbursement levels
Basic: 95%
▪ Check ups/recalls once every 9 months
▪ Scaling units 16 per calendar year
Major: 50%
• Crowns, dentures, bridgework
Dental accident: 100%
Benefits
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Dental carePlan maximums
• Basic: $2,328 per calendar year
• Major: $3,508
• Dental accident: None
Fee guide: 2020 year (according to the province
where the treatment is rendered)
A treatment plan (estimate) is recommended for
any treatment costing $200 or more.
Benefits
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Dental care - orthodontics
Reimbursement 50%
Plan maximum $3,508 per lifetime
Benefits
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Benefits
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Out of Pocket Maximum
➢Out of Pocket maximums are expenses incurred based on a two tier coinsurance plan. Claims are
accumulate to an overall amount throughout the year at the first tier. Once this amount has been reached,
claims then will be paid at the higher coinsurance for the remainder of that year.
➢Effective January 1, 2020 your out of pocket maximum has increased to the following:
❑Single coverage - $129 per calendar year
❑Family coverage - $259 per calendar year
➢ For example – when you have submitted $644 in claims for single, this would be before the coinsurance has
been applied, you then will be paying the 20% of those claims up to a maximum of $129. The same is for
family, you will need to submit $1,297 in claims before the coinsurance has been applied, you will then be
paying the 20% of those claims up to a maximum of $259 per calendar year.
➢Once you have met this, your coinsurance will increase from 80% coverage to 100% coverage per calendar
year.
CONFIDENTIAL
Government Changes to Out of Country12
➢With the changes to the OHIP coverage by the province, Canada Life will still require the
employee/dependents to be covered under the government health plan in their home province or a
government provincial replacement plan in order to qualify for Out of Country (OOC) and Travel Assistance
(GMA) benefits.
➢While the province doesn't need to include coverage for treatment outside of Canada, the person
needs to be registered in Canada for health coverage. This provision ensures we can repatriate a
person home as soon as medically possible, as they must be considered a resident to do this.
➢The Ontario government has allowed for a 12 month claim submission period for OOC claims incurred in
2019. We require a completed OHIP Authorization & Release form (M5500) with the submission of any OOC
emergency medical claims incurred in 2019. Beginning Jan 1, 2020 the current OHIP Authorization and
Release form will be replaced by a new form for Ontarians to confirm their residency and OHIP health
insurance number.
➢Going forward, Out of Country claims for Ontarians incurred January 2020 or later will be assessed under
the group benefits plan coverage as primary payer.
Benefits
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Out of Country Authorization Form
➢This is the new form that will be required with the Out of
Country claims.
➢You can find this form at the following link:
https://www.greatwestlife.com/you-and-your-
family/forms/group-claim-forms/out-of-country-claim-
forms.html
Coordination of Benefits➢Benefits that have been reduced through another group plan can be
coordinated through the plan member’s group plan.
➢Through coordinating the benefits, this ensures that any remaining balances from the claims being submitted will be paid
➢Canada Life will not pay balances that exceed the reasonable and customary charges eligible under the plan. (If a dentist charges more than the dental fee guide, Canada Life will only pay the difference up to that fee guide)
➢Claims for the plan member needs to come to your group plan before submitting to your spouses plan. Your spouse will need to submit their claims to their own group plan before submitting to yours.
➢For children’s claims, the first payor would be the parent who has the earlier birth date in the calendar year. (If your birthday is in June and your spouse is March – then your spouse’s group plan is the first payor)
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Orthopedic Coverage• Custom-made orthopedic shoes
▪ footwear made specifically for one patient, from raw materials, using a variety of measurements and a three-dimensional cast of the patient’s feet
• Custom-fitted or modified orthopedic shoes▪ a shoe is considered to be modified when the orthopedic
shoe is permanently changed, for example, adding a rocker sole, or leather patches to accommodate a foot deformity.
• Custom-made foot orthotics▪ a device made from a cast of the foot that can be inserted
in the shoe to support, align, prevent or accommodate foot abnormalities and improve how the foot functions.
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Orthopedic Coverage
Requirements
• Prescription from one of the following:
▪ Physician (MD)
▪ Chiropodist
▪ Podiatrist
▪ Orthopedic Surgeon
• The prescription must indicate the medical diagnosis necessitating the orthopedic appliance.
• Prescriptions outlining symptoms rather than medical diagnosis would not be accepted.
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Orthopedic Coverage
Submitting Claims for Orthopedic Shoes
Require the following information in addition to the above requirements:
• Custom-made orthopedic shoes
▪ Details of the casting technique used
▪ Description of the process and material used to fabricate the shoes
• Custom-fitted orthopedic shoes
▪ The brand name and model of the shoes
▪ A description of each modification made to the shoes (if applicable)
▪ A breakdown of the cost of the shoes and each modification (if applicable)
Benefits
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Orthopedic CoverageSubmitting Claims for Orthotics
Require the following information in addition to the above requirements:
• Custom-made foot orthotics
▪ A copy of a detailed biomechanical examination or gait analysis
▪ Details of the casting technique used
▪ A detailed description of the type of orthotic provided
▪ A breakdown of the charges for the orthotic
Not covered:▪ Off-the-shelf, non-orthopedic footwear (e.g. comforts shoes and sandals)
▪ Shoes purchased specifically for participation in sports or recreational activities
▪ Off-the-shelf, non-custom or pre-fabricated orthotics (e.g. Dr. Scholl’s insoles)
Benefits
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Orthopedic CoverageReasonable & customary charges are the lowest of:
• Representative prices in the area where the treatment was provided,
• Prices shown in any applicable professional association fee guide, and
• Maximum prices established by law.
For a pair of custom made orthotics, the reasonable & customary allowance is $450.00.
Benefits
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GroupNet for Plan Members
Registration
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You’ll need your plan number and
member ID to register. You can find
this on your benefits card.
Sign up for direct deposit and get
claims paid directly into your bank
account.
Steps for enrolment• Go to https://www.canadalife.com/sign-
in.html
• Complete the form
• Agree to terms of application and submit
• Go to page for electronic benefits card and summary of enrolment record
Note you cannot register on GroupNet until 2 days after your coverage is eligible.
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Easy Claim Submission
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Smart benefits on the go
Same access to benefits and card through your:
• Smart phone
• Apple Watch
Tap into these key features:
• Submit claims quickly
• Review coverage and balances
• Find healthcare providers
• Save benefit cards to Google Pay or Apple Wallet
• Get notified when claims have been processed.
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Notifications
Receive a text or email when your claim has been processed
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Ask about your coverage
• Paper claims
• Provider eClaims
• Online claims
• Website or app on your smart phone
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Make smart choices
• Don’t submit claims for services you didn’t receive
• Don’t give a service provider a blank claim form
• Check your explanation of benefits
• Report at confide@gwl.ca or 1-866-810-8477
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CONFIDENTIAL
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We’re done!
Questions or feedback?
If you have questions concerning
your coverage, claims, how to log
in or to navigate GroupNet for plan
members after this presentation,
you can reach our call centre team
at 1-800-957-9777. Service is
available between the hours of
8:00 AM to 7:00 PM EST on
weekdays.
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THANK YOU Canada Life