Transcription
Assure CardMaking the most of yourbenefits – for planmembers and theirdependants
Welcome toAssure ClaimsPaying for your prescriptionshas never been so easyThe Assure Card is an electronicpayment system that provideson-the-spot submission ofprescription drug claims atalmost any pharmacy in Canada.It’s a convenient, easy-to-usealternative to submitting paperclaim forms. Your personalizedAssure Card is provided to you aspart of your Great-West groupcoverage, and is administered byour pharmacy benefits manager(PBM) experts.
Using your Assure CardWhen filling prescriptions, provide your Assure Cardto the pharmacist – before the prescription is filled.The pharmacist will require the following information: nameaddress and postal codetelephone numberdate of birthrelationship to the plan memberplan sponsor name (e.g. your employer)plan numberplan member ID numberBased on this information, the pharmacist is able toconfirm your eligibility and drug coverage. Our PBMelectronically pays the pharmacist the amountcovered by your plan. You pay the pharmacist onlythe portion not covered by your plan, if any.Always provide your card whenfilling a prescriptionFor security reasons, pharmacies generally don’t sharecomputer systems, even if they’re part of the samechain. If you forget your car d, you can still get yourprescription filled. However, you will have to pay thefull amount of your prescription up front and submita paper Assure Card Claim Form with the r eceipt forreimbursement.Keep your information currentAll of your dependants must be r egistered with yourplan sponsor to be covered through your AssureCard. Only you can register dependants or updateinformation. Be sure to advise your plan administratorof any changes to your addr ess or your marital status,if you adopt or have a baby, or if any of your childr enare attending university. Inform the pharmacist of anychanges to your benefits, or if you have been issueda new Assure Card.
Co-ordinating your familycoverageIf you and your spouse both have drug coverageunder separate plans, but neither plan pays the fullcost for prescription drugs, you may be able tosubmit claims to both plans and have the totalcost covered.If your spouse’s plan offers a drug cardProvide both drug cards to the pharmacist whenfilling your prescriptions. If the prescription is for: you – ask the pharmacist to submit the claim toyour plan first. your spouse – ask the pharmacist to submit theclaim to your spouse’s plan first. your dependant – ask the pharmacist to submitthe claim first to the plan of the car dholderwhose birthday occurs first in the calendar year .If your spouse’s plan does not offer adrug cardPrescriptions for you: provide your drug card tothe pharmacist when you have your pr escriptionsfilled. Your claim will be submitted electr onicallyto Great-West. Pay the pharmacist the amount notcovered by your plan, and submit a claim form andthe receipt to your spouse’s plan for the balance ofthe prescription cost.Prescriptions for your spouse: submit the claimto your spouse’s plan in the usual manner. Submitthe receipt and a completed Assure Card Claim Formto your plan for the balance of the pr escription cost.
Prescriptions for a dependant: If your spouse’s month of birth occurs first in thecalendar year – submit a claim for your dependant’sprescription to your spouse’s plan first. Then submitthe receipt and a completed Assure Card ClaimForm to your plan for r eimbursement of the balanceof the prescription cost. If your month of birth occurs first in the calendaryear – provide your Assure Card to thepharmacist when filling prescriptions for yourdependant. The pharmacist will automatically bepaid the portion of the cost cover ed by yourplan. Pay the pharmacist the amount not cover edby your plan, and submit a claim form with thereceipt to your spouse’s plan for the balance ofthe prescription cost.The Assure Card Claim Forms are availablefrom your plan administrator or under ClientServices – group benefits plan member –Forms – Standard claim for ms on theGreat-West website at www.greatwestlife.com
Assure Claims DrugUtilization ReviewProgramIt is not always practical or possible to visit the samepharmacist to have your prescriptions filled; however,it is important for the pharmacist filling yourprescriptions to be aware of your recent drug history.This helps ensure the safety of you and your family ,when prescriptions are filled.That’s why your Great-West prescription drug planprovides you and the pharmacist with access to theAssure Claims Drug Utilization Review Pr ogram.The Assure Claims Drug Utilization Review Pr ogrampromotes safe and effective use of prescription drugs byreviewing the prescription being filled to help ensur e itagrees with the drug manufacturer’s recommendeduse, and will not interfere with other prescriptions youhave purchased with your Assure Card.If a risk is detected, the Assur e Claims Network issues awarning to the pharmacist indicating the natur e of theconcern. The pharmacist is then able to discuss the riskwith you and, if necessary, consult your physician.Common questionsCan I use my card at any pharmacy?The majority of pharmacies in Canada ar e linked toour PBM and the Assure Card is recognized at any ofthese pharmacies. When filling prescriptions at apharmacy that is not electronically linked to our PBM,pay the full amount of your pr escription up front andsubmit a paper Assure Card Claim Form with yourreceipt to your plan.What if I forget my card?You will still be covered by your plan if you for getyour card. Pay for your prescription in full, and thensubmit your receipt and a completed Assure CardClaim Form to your plan.
What if my card is lost or stolen?Report a lost or stolen car d to your plan administratorimmediately. For your protection, your card numberwill be cancelled and a r eplacement card will beissued. If you find your original car d after receivingyour new one, return the original card to your planadministrator.Do I have to use the card to fill my prescription?No, however, when you use your Assur e Card, yourclaim is submitted electronically when yourprescription is filled, and you get the addedadvantage of the Assure Claims Drug UtilizationReview Program.Is there a difference in the amount coveredusing the Assure Card compared withsubmitting a paper claim?Sometimes. Depending on your plan design and theamount charged by the pharmacist for dispensingand/or additional fees, you may pay mor e forprescription drugs when you submit paper claimsthan you would have if you’d used your Assur e Card.When you use your card, you will never pay mor e fora prescription than you would have if you submitteda paper claim.Is there a difference in the drugs covered usingthe Assure Card compared with submitting apaper claim?No. The drugs covered by your plan are the samewhether you use your card or submit a paper claimform. The difference is when you use your Assur eCard to fill prescriptions, your claim is submittedelectronically.
Why do I have to pay part of the cost of eachprescription?Most drug plans include a co-payment or deductible,or both. That means you and the plan shar e the costof your prescriptions. A co-payment means you pay either a flatamount on each prescription (for example, 5each time you get a pr escription filled) or apercentage of the cost of the pr escription (forexample, 20 per cent of each pr escription). A deductible means you pay the full cost of yourprescriptions up to a certain amount. Forexample, if you have a 100 deductible, you paythe first 100 of prescription costs. The planbegins paying after that.What if my claim is declined?Depending on your plan design, ther e may be certainsituations when drug claims could be declined. Your plan may not cover the dr ug beingprescribed.Often there are equally effective alternativemedications available that are covered by yourplan. You or the pharmacist may want to contactyour physician to discuss alter natives. Some drugs may require specialauthorization.Some drugs may be covered for specificconditions or circumstances only, and/or inpre-defined amounts. These drugs require specialauthorization from Great-West before they willbe covered.Prior Authorization forms are availableunder Client Services – group benefits planmember – Forms on the Great-West websiteat www.greatwestlife.com, or for moreinformation, contact Great-West’s GroupCustomer Contact Services office at1-800-957-9777. For the deaf or har d ofhearing a TTY line is available at1-800-990-6654.
Your prescription exceeds the allowablesupply.Some plans pay for a supply of medication up toa certain period of time, for example 30 or 90days. If you refill a prescription too soon, orrequest a large quantity, your claim may bedeclined. If you require a larger supply than iscovered by your plan, contact your planadministrator to find out what options ar eavailable. If your doctor increases your dosage,be sure to get a new pr escription. That way, theallowable supply will be adjusted, and your claimwill be approved.How do I change the information on my card?You should inform your plan administrator of anychanges that may affect coverage or claims payment.The most common changes include a change ofaddress, change in marital status, the addition of adependant, or the removal of a dependant who nolonger qualifies under the ter ms of your plan.Who can I contact for more information?For questions about your group benefits plan, contactyour plan administrator.If there are any problems with your Assure Card, thepharmacist should call our PBM’s toll-free number forassistance. This number is provided to the pharmaciston the Assure Claims Network.
Balancing safety withconfidentialityWith the Assure Card and Assure Claims, yourpersonal prescription information is completelyconfidential. For Drug Utilization Review purposes,our PBM will only release information about yourclaims history and war ning notices about possibledrug conflicts to the pharmacist. No informationconcerning what you are being treated for isever shared with the pharmacist.
You and your family deser vequality benefits coverage backedby excellent service, and we atGreat-West understand that.We are committed to beingyour Benefits Solutions People.www.greatwestlife.comAssure Claims is a trademark of Emer gis Inc.Great-West Life and the key design ar e trademarks of The Great-West Life Assurance Company. The Great-West Life Assurance Company (Great-West Life), all rights reserved.Any modification of this document without the expr ess written consent of Great-West Life is strictly prohibited.M5600-4/11
Assure Claims Paying for your prescriptions has never been so easy The Assure Card is an electronic payment system that provides on-the-spot submission of prescription drug claims at almost any pharmacy in Canada. It's a convenient, easy-to-use alternative to submitting paper claim forms. Your personalized Assure Card is provided to you as
