Great-West Life Out-of-Country Claims Form
This file contains the Great-West Life Out-of-Country Claims form for submitting medical claims incurred outside Canada. It includes detailed instructions on how to complete the form and necessary information to ensure your claim is processed accurately. Use this form to coordinate payment with your provincial health plan.
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How do I fill this out?
To fill out this form, carefully read each section and provide accurate information as requested. Ensure you have all necessary documentation, including invoices and provincial forms. Once completed, double-check for any errors before submission.
How to fill out the Great-West Life Out-of-Country Claims Form?
1
Gather all required documents and invoices.
2
Fill out the employee and patient information sections.
3
Provide details on the medical treatment received.
4
Complete the statement of expenses with itemized bills.
5
Sign the form and submit it to Great-West Life.
Who needs the Great-West Life Out-of-Country Claims Form?
1
Employees who require reimbursement for out-of-country medical expenses.
2
Families who travel outside of Canada and need to claim medical treatment.
3
Individuals seeking to coordinate claims with their provincial health plan.
4
Healthcare providers outside Canada who need assurance of payment from Great-West Life.
5
Plan administrators managing benefits and claims for employees.
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What are the instructions for submitting this form?
To submit the Great-West Life Out-of-Country Claims form, mail it to Great-West Life's Out-of-Country Claims Department at PO Box 6000, Winnipeg, MB R3C 3A5. Alternatively, you can submit it via fax to 1-800-957-6636. Ensure all required documentation is included, and consider calling their claims department at 1-800-957-9777 for assistance with the process.
What are the important dates for this form in 2024 and 2025?
All out-of-country claims must be submitted within 90 days from the date of the services rendered. For 2024 and 2025, ensure to adhere to this timeline to avoid delays in processing your benefits.
What is the purpose of this form?
The purpose of the Great-West Life Out-of-Country Claims form is to facilitate the reimbursement of medical expenses incurred while traveling outside of Canada. This form allows insured employees and their families to submit claims for eligible out-of-country expenses. It is essential for ensuring coordination between Great-West Life and provincial health plans or other insurance providers.
Tell me about this form and its components and fields line-by-line.
- 1. Employee Information: Contains fields for name, address, employer, and identification numbers.
- 2. Patient Information: Includes patient details, travel dates, and treatment description.
- 3. Statement of Expenses: Itemizes expenses related to the out-of-country medical treatment.
- 4. Other Insurance: Details if the patient has other insurance coverage and coordination of benefits.
What happens if I fail to submit this form?
Failure to submit this form may result in denial of claims for out-of-country medical expenses. It's crucial to adhere to submission timelines to ensure processing. Without the necessary completion and timely submission, individuals risk delayed or denied benefits from both Great-West Life and provincial health plans.
- Delayed Processing: Claims may take longer to process if the form is not submitted on time.
- Denial of Benefits: Failure to comply with submission requirements can lead to denial of reimbursement.
- Lack of Coordination: Not completing the necessary sections may result in issues coordinating with other insurers.
How do I know when to use this form?
- 1. Traveling Abroad: When you receive medical treatment while outside of Canada.
- 2. Claim Reimbursement: To submit requests for reimbursement of eligible expenses.
- 3. Insurance Coordination: For coordinating benefits with provincial health plans.
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