Frequently Asked Questions

To be eligible for coverage, the medication needs to be approved for use in Canada, must require a prescription and be prescribed by an authorized medical or dental practitioner (as you might expect). Most generic prescription medications are eligible for coverage, as long as they are on GreenShield’s formulary. Some drugs may require GreenShield Special Pre-Authorization.

Please keep in mind that prescription drug coverage is subject to medical underwriting (if you apply for a medically underwritten plan), to reasonable and customary charges, and to the co-pay and maximum of the plan you select.

This is certainly a reasonable question. If you want to confirm prescription drug coverage eligibility before you purchase your plan, just give us a call. Make sure that you have the drug names and DIN’s (Drug Identification Numbers) for the medications so that we can verify for you.

Please keep in mind that prescription drug coverage is subject to medical underwriting (if you apply for a medically underwritten plan), to reasonable and customary charges, and to the co-pay and maximum of the plan you select.

SureHealth drug benefits are designed to provide coverage for generic prescription drugs. However, they will provide coverage for brand name drugs if no generic equivalent exists. If you submit a claim for a brand name drug instead of the generic, the plan benefit will pay to the price of the lower cost equivalent. (Example: If your benefit pays 70% of eligible prescription costs, the brand name drug costs $100 and the generic equivalent costs $80, your benefit would pay 70% of $80.)

Please keep in mind that prescription drug coverage is subject to medical underwriting (if you apply for a medically underwritten plan), to reasonable and customary charges, and to the co-pay and maximum of the plan you select.

'Co-payment' is a fixed amount (for example $15) you'll pay for a covered health care service, when you receive the service.

SureHealth plans with dental benefits offer coverage towards Basic Services and Comprehensive Basic Services like routine cleaning, exams, x-rays, fillings, extractions, scaling and more. The level of benefits and annual maximums vary depending on the plan you select and your length of time on the plan.

All dental services have dental services codes. If you have a specific question, ask your dentist for the service code and give us a call. We’ll be happy to verify for you.

CPAP machines are eligible for coverage under the Medical Items benefit of SureHealth plans, with a few requirements. You’ll need a prescription from a licensed physician (MD or respirologist) that confirms you have been diagnosed with OSA or ESA (Obstructive Sleep Apnea or Essential Sleep Apnea), and documentation from a sleep study with results of 15 AHI or greater. We’ll also ask that you complete a GreenShield Pre-Authorization form and submit it to us for our approval.

Test strips, Diabetic syringes, Diabetic needles and Diabetic testing agents are eligible for coverage under prescription drug benefits. Auto injectors, insulin pen injectors, lancets and blood glucose monitors are eligible for coverage under the Medical Items benefit of SureHealth plans.

Yes, continuous glucose monitors like the Free Style Libre and Dexcom, are eligible for coverage under the Medical Items benefit included in SureHealth plans. This is subject to GreenShield Special Pre-Authorization and approval which includes documentation that confirms medical criteria (like insulin dependence and testing requirements), to reasonable and customary fees and to the maximums of the plan you select.

The rates for SureHealth insurance plans are subject to change.

GreenShield continuously monitors the Canadian health marketplace. When the cost of providing health and dental services increases, we have to adjust our rates accordingly so that we can continue to provide you with the benefits you rely on. You can rest assured we keep any rate increases as minimal as possible. Rates also increase as the age of the person listed as the primary applicant on your plan increases and shifts from one age band to the next. These rate changes will take place on the anniversary of your effective date. We’ll notify you in writing 30 days before the new rates are due.

Rates will change when your rate category changes – for example, from single to couple, from couple to family, etc. When you contact us to request a category change, we’ll confirm your new rate for you.

Rates may change if you move from one province to another. When you contact us to let us know, we’ll confirm your rate for you.

Definitely. That’s why we’ve designed this website to walk you through the entire process from start to finish. You can explore our plans, find the one that’s right for you, get a quote and apply, all online. We all have busy lives, which is why we want to ensure easy access to the information you need, and that getting the insurance plan that’s right for you is as simple as can be.

Yes — when your rate category changes from family to couple, or from couple to single. And in the majority of cases, if your SureHealth insurance plan includes prescription drug coverage, your rates will decrease when the primary applicant on your plan reaches 65 years of age.

Coverage starts on the first of the month following GreenShield’s approval of your application. The length of time approvals takes depends on the type of plan you choose and how you apply.

If you apply for a guaranteed acceptance plan, like LINK or ZONE 2, 3 or the ZONE Fundamental plan, there are no health questions to answer, there is no medical underwriting. If you apply online or over the phone, your application is approved as soon as GreenShield receives your payment, which could be within a day or two.

When you apply for a medically underwritten plan like ZONE 5, 6 or 7, you’re required to complete a health questionnaire. The GreenShield Medical Underwriting team evaluates your health info. If you apply online or over the phone, please allow two weeks for us to process your application and get back to you. The team evaluates each application on a case-by-case basis.

If you apply by completing a paper application and mailing it to us, please allow three weeks for processing. (It’s so much more efficient to apply online! Or give us a call – we’ll be happy to take your application over the phone. Easy!)

An Emergency Medical Travel benefit is included in all SureHealth plans. The benefit covers multiple trips during a year (which is very convenient). The number of days covered depends on the SureHealth plan you chose.

No, your SureHealth Emergency Medical Travel benefit continues along with your other SureHealth benefits, regardless of your age (as long as your premiums are paid, of course!).

There are no waiting periods with SureHealth plans. Your coverage begins on your effective date, which is generally the first of the month following approval of your application. (You can request to postpone your coverage effective date for a month or two, if you’re applying earlier than you need your coverage to start.)

GreenShield will notify you in a letter mailed through Canada Post 30 days in advance of the effective date of the rate change.

You can request to cancel your coverage at any time. We’d need written notice at least 10 business days before the next premium withdrawal date. Otherwise, your coverage will end at the end of the month for which premiums are paid. But if you cancel your coverage, you’ll need to wait 2 years to be eligible to apply for any GreenShield individual health plan. With this in mind, if your needs change, you may want to consider switching to another SureHealth plan that offers different benefits.

You must be under 80 to be eligible to apply for a SureHealth plan. Once your application is approved, there is no age limit – your coverage will continue as long as your premiums are paid. SureHealth coverage offers lifetime coverage.

It takes approximately 10 business days to process an application. GreenShield will contact you about two weeks after they have received your application. If you included your email address on your application, GreenShield will send you an email. If you didn’t include an email, then GreenShield will send you a letter through Canada Post.

It starts on the date of departure from your province of residence. It’s on a per trip basis. The number of days covered depends on the plan you choose.

If you have ZONE or LINK, you can downgrade to a lesser plan after you’ve had the coverage for one year. With ZONE plans, you can apply to upgrade to a more robust plan at any time. The option to upgrade to another LINK plan is not available.

Recall frequency refers to the frequency that routine dental exams are eligible for coverage. This would include the exam and services like preventative cleaning (polishing, scaling) and bite wing x-rays.

Emergency Medical Travel insurance is based on Canadian dollars.

Blood tests that are eligible for coverage would be covered under Extended Health Care, the Medical Services benefit. The tests must be prescribed by a medical practitioner and must be done in a commercial lab. Tests prescribed/done by naturopaths, for example, would not be eligible for coverage nor would those arranged by pharmacists. There are a maximum number of lab tests covered every 12-month period (from the date of the first claim/test) and a maximum coverage amount per test ($100).

Your first payment for one month’s premium will be taken when your application is approved. The next payment (for one month’s premium) will be taken on or about your coverage start date (your coverage effective date), depending on the day of the week the first of the month falls. This ensures your payments (and benefits!) are secure a month in advance. Subsequent payments are taken on or around the first of every month.

Pre-existing conditions are medical conditions that you have at the time you apply, or had before you apply, or in some cases, had medical consultations about before you apply. (Examples would be asthma, diabetes, or high cholesterol – not a cold or the flu.)

There are some specific prescription medications that require assessment through GreenShield’s Special Authorization program. GreenShield’s Special Authorization process follows Health Canada guidelines with respect to drug eligibility and reasons for use.

You can download the Special Drug Authorization form from GreenShield Online Services. Take it to your physician to be completed. Once completed, you simply forward the documentation to us. The GreenShield Special Drug Authorization team will review and communicate approval (as applicable). Once your authorization for that medication is approved, it will be kept on file so all future claims for that drug can be submitted directly through the pharmacy.

GreenShield has a Preferred Pharmacy Network (PPN). Depending on the special authorization drug, you may need to fill the prescription at an approved pharmacy in the PPN. GreenShield can help you find an approved pharmacy in your area, and we can arrange to have the prescription forwarded to the approved pharmacy you choose.

Absolutely! If you’re self-employed, a small business-owner, contract worker or freelancer, your SureHealth payments may be a tax-deductible expense. (We recommend speaking to your financial advisor for exact details pertaining to your situation.) A SureHealth insurance plan also has advantages for your cash flow situation. How? By giving you the confidence that comes from knowing you’re protected against routine and unexpected, out-of-pocket health care expenses not covered by your government plan – things like prescription drugs, dental care, vision care, and more.

If you've signed up for direct deposit services, you'll receive an email letting you know a deposit has been made. Otherwise, your cheque will arrive by mail.

Birth control pills are eligible for coverage at time of prescription renewal -- provided they are approved by Health Canada for contraceptive purposes, they are being used for contraception, and the plan you choose has prescription drug coverage. Understandably, you can't claim them if the prescription was paid for BEFORE your coverage effective date.

Amazingly, most prescription drug, dental, extended healthcare and vision claims can be processed instantly using your GreenShield ID card, right at your health care provider’s office. How convenient is that! Other insurance claims may be reimbursed quickly via direct deposit banking.

When you've received your money! Either you'll receive an email confirming a direct deposit has been made to your bank account, or we'll drop a cheque in the mail one to two day(s) after processing. Couldn't be easier.

There are a couple of ways. You can have your health care provider bill us directly, you can submit a claim through GreenShield online services or the mobile app, or you can print off a claim form and send it in via Canada Post. (Keep in mind that if you choose to submit your own claim, you will need to pay for your services up front.)

Life is busy, which is why GreenShield generally gives you 12 months to submit a claim after the date of service (unless otherwise stated in your SureHealth Policy).

The 'effective date' is the day your coverage begins. It’s generally the first of the month following approval of your application. (You can request to postpone your coverage effective date for a month or two, if you’re applying earlier than you need your coverage to start.)

SureHealth insurance plans offer coverage for therapy provided by registered Acupuncturists, Chiropractors, Chiropodists, Podiatrists, Dietitians, Massage Therapists, Naturopaths, Osteopaths, Physiotherapists, Psychologists, Registered Social Workers and Speech Therapists. The practitioner must be licensed, certified and registered with their provincial regulatory agency or be a registered member of a professional association that is recognized by GreenShield.

Physician referrals are not required for registered professionals and therapists.

Yes, absolutely!  SureHealth plans include coverage for 4 virtual visits every year.  You can use the visits for yourself, or for a family member who lives with you. You set up the Maple account and list the family members who can use it.  Then, through the Maple platform, you (or your family member) will be connected to general health care practitioners via your smartphone, tablet or desktop, through text, audio or video.   If you use Maple for more than 4 virtual visits during the year, you’ll receive GreenShield preferred pricing.

SureHealth plans don't include coverage towards medications that treat infertility or erectile dysfunction.

If you apply for a medically underwritten plan like ZONE 5, 6 or 7, you’re required to complete a health questionnaire. GreenShield evaluates your health info. If you have any medical conditions, GreenShield will send you a counter-offer. The counter-offer includes options: a) The medically underwritten plan applied for, excluding prescription medications that treat pre-existing medical conditions; and b) alternative plans that provide coverage for pre-existing conditions for you to consider.

SureHealth plans can equal lifetime protection. Once your application is approved, your SureHealth benefits will continue, regardless of your age, as long as your premiums are paid. You won’t have to apply again, even if your health changes in the future.

Your prescription drug claims need to be submitted to RAMQ first. When RAMQ reimburses a portion of the drug cost, unpaid balances (including co-payments and deductibles) will be co-ordinated so that you may be reimbursed up to 100% of the eligible expense incurred. (If the drug is not covered by RAMQ and is covered by your SureHealth plan, the standard co-pay applies.)

While kids these days never seem to grow up, children can be included on your plan until the age of 21. (Unfortunately, we can’t guarantee they’ll have left your basement by then.)

Yes! Unlike regional insurance companies with supplemental health insurance plans tied to your province of residence, Green Shield Canada is a national benefits specialist. That means SureHealth plans offer national coverage – wherever you go in Canada, your plan goes with you. Whether you move for work, retirement or any other reason, once you’re approved for a SureHealth plan, it’s yours for life – wherever life in Canada might take you.

You must have valid provincial health insurance plan coverage. For example, residents of Ontario must have OHIP, BC residents need to have MSP, Nova Scotia residents must have MSI plan coverage and Quebec residents must have RAMQ.