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.

If you apply for a medically underwritten plan (ZONE 4, 5, 6 or 7), please keep in mind that prescription drug coverage is subject to medical underwriting and drug categories may be excluded from coverage if you have a pre-existing health condition. Prescription drugs are subject to reasonable and customary charges, to the co-pay and maximum of the plan you select.

GreenShield Insurance 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.)

If you apply for a medically underwritten plan (ZONE 4, 5, 6 or 7), please keep in mind that prescription drug coverage is subject to medical underwriting and drug categories may be excluded from coverage if you have a pre-existing health condition. Prescription drugs are subject to reasonable and customary charges, to the co-pay and maximum of the plan you select.

GreenShield Insurance 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 rates for GreenShield 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.

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, 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 4, 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, 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!)

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.

GreenShield 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.