Welfare Plan Claims
We understand that filing a claim can sometimes be confusing. That’s why we’re here to guide you, whether you’re submitting a claim for health, dental, travel medical, HCSA, disability, or life insurance.
Understanding Your Claims
There are different steps depending on the benefit you’re claiming. Click to jump straight to the type of claim you need to submit.
Health & Dental Claims
Always confirm with your health/dental provider or pharmacist if they can submit Health & Dental claims directly to the insurer (GreenShield) on your behalf.
If your provider or pharmacist does not submit claims directly to GreenShield, you have two options:
Submitting Claims Online
- Register for Plan Member Online Services at greenshieldplus.ca or use the GreenShield+ App. Click on Submit A Claim in the menu.
- Select the claim type and provider, enter the claim details, and submit. You can find the dependent number on the back of your GreenShield card.
- Always hold on to any receipts or supporting documents for 13 months, in the event that you are randomly audited by GreenShield. If your claim is audited, you can submit supporting documents online or if you prefer, you can send them by mail to the following address:
GreenShield Canada
Audit Department
P.O. Box 1605
Windsor, ON N9A 0C1
You can find more information and tutorial videos on how to submit online claims at greenshieldplus.zendesk.com.
What are the benefits of submitting your claim online?
- Your claim will be processed by GreenShield quickly.
- You can easily submit supporting documents for audited claims.
- You can easily check the status of your claim and remaining balances online.
- You don’t have to worry about mail delays or lost letters. You are reimbursed directly to your bank account, if you added your direct deposit details to your GreenShield+ online account.
- This is the most secure way to submit your claims.
Submitting Paper Claims
Paper claims require:
- An original itemized paid receipt, showing the health provider’s name and address, and the date and charges for each service or supply; and
- A claim form, complete with the patient’s name, GreenShield ID number and dependent code (00,01,02) and signed by the plan member.
If you have all of the above, and would like to submit a paper claim by mail:
- Log in to GreenShield+ and click on View Personalized Claim Forms to print the required form. You can also request a form from UA Local 67 Benefits or pick one up in person.
- Complete and sign the form. A separate form is required for each dependent. You can find the dependent number on the back of your GreenShield card.
- Include any supporting documents and receipts.
- Mail the completed form to the GreenShield address listed at the bottom of the claim form.
Remember to add your Direct Deposit details to your GreenShield+ online account to receive your reimbursement faster.
Considerations for Health & Dental Claims
Avoid Unpaid Claims: Check Provider Status
GreenShield partners with providerConnect®, who keeps a national database—called the Provider Registry—of health service providers across Canada. This database includes key info like the provider’s name, license or registration number, type of service they offer, and their billing status. providerConnect® regularly updates its database of accredited healthcare providers to protect against potential fraud.
You can get reimbursed for services if they’re covered by the UA Local 67 Benefits Plan and the provider is either licensed by their province’s regulatory body or is a registered member of a professional association that providerConnect® recognizes.
It is your responsibility to verify a provider’s eligibility before purchasing items or paying for services. Services or products purchased from providers/locations that are not recognized by GreenShield/providerConnect® will not be reimbursed. You can check for delisted providers by logging into your GreenShield+ account or using the GreenShield+App. Select Find a Health Provider and filter your search by Delisted Providers.
Coordination of Benefits
If you have coverage under multiple insurance plans, you can maximize your claims coverage and minimize out-of-pocket expenses. Discover how to effectively combine your benefits for the most protection and peace of mind.
Reasonable & Customary Limits
Each insurance carrier follows its own set of administrative rules for handling claims under a given plan. One common rule is the use of Reasonable and Customary (R&C) limits. These limits set the maximum amount a plan will reimburse for a service or item, based on several factors—like what other providers charge, provincial and association guidelines, manufacturer pricing, and industry data. Since each carrier uses its own data, these limits can vary.
GreenShield regularly reviews the typical fees charged by practitioners (chiropractor, physiotherapist, psychologist, etc.) in your province. GreenShield then uses this information to create and update their R&C list as a guide when they pay claims.
If your provider charges more than GreenShield’s R&C limit, you’ll have to cover the difference out of pocket. The purpose of R&C limits is to keep the plan sustainable and affordable—especially for services like physiotherapy or massage—by helping ensure providers aren’t charging more than typical.
At any time, you can contact GreenShield to ask about the reasonable and customary limit for a specific professional service. Knowing the R&C limit can help you determine if a provider’s price for service will be covered and avoid surprises when you submit your claim.
Health Care Spending Account (HCSA) Claims
Your Health Care Spending Account works like a bank account. You can use it to pay for eligible health and dental expenses that aren’t fully covered by your group benefits plan or your provincial health coverage.
The HCSA can be used for a wide range of expenses, including prescription drugs, medical equipment, eyeglasses, orthodontic treatments, services from paramedical practitioners (like chiropractors or physiotherapists), and even co-payments or deductibles.
Medical providers (e.g., pharmacies, dentists) cannot submit your out-of-pocket expenses to your HCSA. You must submit claims directly to GreenShield.
Submitting Claims Online
Register for Plan Member Online Services at greenshieldplus.ca or use the GreenShield+ App.
GreenShield+ Website
- From the Navigation Bar, select Coverage.
- In the Spending Accounts section, select Health Care Spending Account.
- Select a Claim Type and an Expense Type.
- Select Continue To Provider Search and enter the provider details.
- Select Continue To Expense Details.
- On the Expense Details page, enter the name of the person the claim is for and fill in the additional details.
- Select Review And Submit Claim.
Once you submit your claim you will be brought to one of three pages:
- If your claim has been submitted successfully and automatically processed, you will be directed to the Claim Complete page where your expenses will show as Processed.
- If your claim is being processed you will be directed to a Claim Complete page where your claim will show as In Progress, while it is manually reviewed.
- If your claim has been denied you will be directed to the Claim Complete page, but your expenses will say Denied, with the reason.
GreenShield+ App
- Navigate to the Claims screen, and select Submit A claim.
- Select who you are submitting the claim for, and select Continue.
- Select what the claim is for, also known as the Claim Type. Search for Health Care Spending Or Personal Spending Account.
- Enter the required information for your claim when prompted.
- On the Review And Submit Claim page, review the information you have entered, then select Submit Claim.
- Read over the Terms and Conditions and select Accept Terms and Submit Claim.
- Select Done.
Submitting Paper Claims
Paper claims require (i) an original itemized paid receipt, with the health provider’s name and address, date, and charges for each service or supply; and (ii) an HCSA claim form, complete with the patient’s name, GreenShield ID number and dependent code (00,01,02) and signed by the plan member.
- Log in to GreenShield+ and click on View Personalized Claim Forms.
- Select Health Care Spending Account Form to print the required form. You can also request a form from UA Local 67 Benefits or pick one up in person.
- Complete and sign the form. A separate form is required for each dependent. You can find the dependent number on the back of your GreenShield card.
- Include any supporting documents and receipts.
- Mail the completed form to the GreenShield address listed at the bottom of the claim form.
HCSA Claim Submission Deadline
Eligible claims must be received by GreenShield with all supporting documents by January 31 of the following year (the claims deadline), for the claim to be considered for reimbursement. If submitting by mail, allow extra time for potential delays.
You don’t need to wait until the end of the year! Submitting your HCSA claims as soon as they happen ensures you get reimbursed earlier and avoid missing the deadline.
Claiming Premiums
If you are self-paying for your benefits and want to submit this to the HCSA for reimbursement, contact UA Local 67 Benefits for a receipt of the Health and Dental premium you paid. Note that Life and Disability premiums are not eligible.
Important to Know
- Claim Submission Order: Submit claims to your primary health or dental plan first, then to your spouse’s plan (if applicable), before submitting any remaining balance to your HCSA. See Coordination of Benefits for more information.
- Avoid Duplicate Claims: Claims reimbursed by another plan are not eligible.
- Ineligible Expenses: Sales tax, shipping fees, and expenses paid by gift cards are not eligible.
Group Travel Medical Claims
Submitting Travel Medical Claims
In the event of a medical emergency while travelling, you or someone on your behalf must call Travel Guard (AIG Assist) immediately, or as soon as you are medically able.
Travel Guard (AIG Assist)
U.S. and Canada toll free: 1 877 204-2017
Phone (Outside U.S. and Canada Collect): +1-715-295-9967
An operator will ask you the following:
- Your name, location, and the details of your emergency
- Your Group name: U.A. Local 67 Welfare Plan
- Your Policy Number: 9429604
All claims are submitted directly to AIG at the time of your call.
Disability Claims
If you become sick or injured and unable to work, notify UA Local 67 Benefits and your employer as soon as you’re able. We’ll support you in first making a Supplemental Employment Benefits (SUB) claim, if applicable, and then a Short-Term Disability (STD) claim.
Submitting STD Claims
- We’ll provide you with a UA Local 67 Benefits Plan Disability Guide, and the Canada Life claim forms.
- Return your claim forms (completed by you and your physician) to UA Local 67 Benefits. We will then finalize and submit your STD application to Canada Life.
- To be eligible for STD benefits, you must provide proof to UA Local 67 Benefits that your EI Sickness benefits are exhausted or that your EI Sickness claim was denied due to insufficient hours.
Long-Term Disability (LTD) eligibility and claim requirements will be part of the STD monitoring process, if a member is deemed to be totally disabled from any occupation.
Life Insurance Claims
In the event of a covered member’s death, the beneficiary(ies) should contact UA Local 67 Benefits. We will assist them through a simple Life Insurance claim process.
Have Questions About Submitting a Claim?
Alongside our benefits partners, we’re here to make the process easier.