Provincial Government Programs. Provincial government programs may contribute a portion toward the approved cost of certain devices to qualified residents. Green Shield Canada’s system is designed to co-ordinate with provincial government programs. Eligible provincial government claims must first be submitted to the provincial government health plan for payment of its portion of the approved cost, and then to Green Shield Canada for consideration of the unpaid portion.
Provincial Government Programs. Provincial government programs may contribute a portion toward the approved cost of certain devices to qualified residents. Green Shield Canada’s system is designed to co-ordinate with provincial government programs. Eligible provincial government claims must first be submitted to the provincial government health plan for payment of its portion of the approved cost, and then to Green Shield Canada for consideration of the unpaid portion. Reimbursement shall be made for expenses incurred and paid for eligible benefits provided such expenses: are incurred and paid for services or supplies which are prescribed by and given under the direction of your attending legally qualified medical or dental practitioner; are, in the opinion of Green Shield Canada, medically necessary for the treatment of an illness or injury and usual, reasonable and customary, taking all factors into account. Reimbursement shall be made by Green Shield Canada’s cheque drawn in your favour, or to the provider of services where applicable. Reimbursement shall not be made for any eligible benefits unless the premiums due have been paid in full at the time the eligible benefit was rendered. Interest shall not be payable under this Agreement. All maximums and limitations stated are in Canadian currency. Reimbursement will be made in Canadian or U.S. funds for both providers and employees, based on the country of the payee. Reimbursement for eligible benefits must be processed by Green Shield Canada within 12 months from the date the eligible benefit was incurred. Reimbursement will be made according to standard and/or basic services, supplies or treatment. Related expenses beyond the standard and/or basic services, supplies or treatment will remain the responsibility of the employee. Our contract includes provisions that authorize Green Shield Canada to determine the amount of benefits payable, giving consideration to limited procedures, services or courses of treatment that may be performed to accomplish the desired result. The attending medical Practitioner/physician/dentist and the patient have the option of which procedure to use, although payment for the procedure may be based on the "alternate/limited treatment" principle. The Alternate/Limited Benefit Clause is a financial limitation and not intended as a comment regarding any treatment recommended or performed by a medical practitioner/physician/dentist.
