USER GUIDE - Great-West Life
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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 PLANDIRECTCOVERAGE 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.
PLANDIRECT 2ASSISTANCE 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 PLANDIRECTPRESCRIPTION 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. PLANDIRECT 4
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 PLANDIRECTYou 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 PLANDIRECTCommon 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 8DENTAL 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 PLANDIRECTOPTIONAL 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 PLANDIRECTADMINISTRATION
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 12If 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 PLANDIRECTDecreasing 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 14MAKING 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 PLANDIRECTWHEN 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
PLANDIRECT1-800-565-4066
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.You can also read
