Emergency Travel Assistance Services

For emergency assistance and advance approval of major medical treatments while travelling

Before entering a hospital or being treated for a medical emergency, immediately call, or have someone call on your behalf, one of the following numbers:

• in Canada or the United States, call 1-800-527-0218
• outside Canada or the United States, place a collect call to Baltimore, USA at (410) 453-6330

These numbers appear on your PlanDirect Emergency Travel Assistance card, which you should carry with you when traveling.

Your benefit amount may be reduced if you do not call before being treated. In addition to helping you find appropriate medical care, the Assistance Centre will obtain Great-West's prior approval for medical services and supplies and assistance services, where required, and will arrange to have hospital and doctor bills sent directly to us for payment.

Before travelling

You should contact your provincial health plan before leaving the country to determine the extent of their coverage. Many provincial health plans have time limits for submitting claims. These time limits will apply to your PlanDirect claim as well.

If your provincial health plan refuses payment, you may be asked to reimburse Great-West for any amount we have already paid on their behalf.

To submit Emergency Travel Assistance claims

If you have paid a medical provider for emergency medical services while travelling, contact our Individual Health Unit when you return home. We will send you the necessary forms and assist you in preparing and submitting a claim.

For eligible claims, Great-West will pay your provincial health plan's share of the claim for you, on the province's behalf (except for residents of Manitoba, where the province pays its share of the claim directly). The provincial health plan requires that you sign a release permitting them to reimburse Great-West for their portion of the claim.

Provincial Third-Party Agreement Forms

Along with your Out-of-Country Benefits Claim Form, you may also be required to submit a provincial third-party agreement form.

Great-West has entered into third-party agreements with most Canadian provinces. If your province of residence has a third-party agreement with Great-West, we may submit your Out-of-Country medical expenses to your provincial healthcare plan on your behalf. To do so, the provincial healthcare plans require specific Provincial Authorization and Release forms to be completed, in full, by the person who incurred the medical expense. You must submit the provincial authorization form with your completed Out-of-Country Benefits Claim Form.

If you have any questions or need help in completing these forms, contact our Individual Health Unit.

For the appropriate authorization form, choose your province of residence below.

• Alberta
• British Columbia
• Manitoba
• New Brunswick
• Newfoundland and Labrador
• Northwest Territories
• Nova Scotia
• Nunavut
• Ontario
• Prince Edward Island
• Quebec
• Saskatchewan
• Yukon Territory

Alberta

Complete both claim forms in full and submit them to Great-West.

• Statement of Claim – Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5503

Alberta Health requires all claim documents be received within 12 months from the date the medical treatment was provided.

British Columbia

Complete all claim forms in full and submit them to Great-West.

• Statement of Claim – Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5502

• The Medical Services Plan of British Columbia requires all claim documents be received within 90 days from the date of service, except for in-patient hospital services, which must be received within 6 months from the date the medical treatment was provided.

Note: British Columbia residents are also required to provide a completed British Columbia Ministry of Health Out-of-Country Claim Form. This form is available at www.health.gov.bc.ca/exforms/msp/2814.pdf

Manitoba

• Effective April 1, 2008 – Great-West and the Manitoba Health Services Commission (MHSC) have a third-party agreement in place.
  
  Complete all claim forms in full and submit them to Great-West.

• Statement of Claim — Out-of-Country Expenses M5432(HO)
• Provincial Authorization and Assignment form M6824 BIL

• The Medical Services Plan of Manitoba requires all claim documents be received within 6 months from the date the medical treatment was provided.

• Expenses before April 1, 2008 – you must first submit your out-of-country medical expenses to MHSC. The required forms are available at www.gov.mb.ca/health/mhsip/forms.html
  
  Once MHSC has completed their assessment, submit a copy of your bills/receipts to Great-West with the MHSC payment/denial statement, together with a completed Great-West Life Statement of Claim – Out-of-Country Expenses form M5432(MB) [PDF].

New Brunswick

Complete both claim forms in full and submit them to Great-West.

• Statement of Claim – Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5616 BIL

The New Brunswick Medicare Plan requires all claim documents be received within 12 months from the date the medical treatment was provided.

Newfoundland and Labrador

Complete all 3 forms in full and submit them to Great-West.

• Statement of Claim - Out-of-Country Expenses M5432(HO)

• Provincial third-party agreement form M5615 BIL [PDF]
  Newfoundland and Labrador requires all claim documents be received within 12 months from the date the medical treatment was provided.
• Out of Province Claim form, available from the Government of Newfoundland and Labrador website at www.health.gov.nl.ca/mcp/forms/Out_of_Province_Claim.pdf

Northwest Territories

• Great-West and the Northwest Territories do not currently have a third-party agreement. You must first submit your out-of-country medical expenses to the NWT Healthcare plan. Information about submitting expenses to the NWT Healthcare plan is available at www.hlthss.gov.nt.ca/english/services/health_care_plan/students/default.htm
• Once NWT has completed their assessment, submit a copy of your bills/receipts with their payment/denial statement, together with a completed Great-West Life Statement of Claim – Out-of-Country Expenses form M5432(MB) [PDF], to Great-West.

Nova Scotia

Complete both claim forms in full and submit them to Great-West.

• Statement of Claim — Out-of-County Expenses M5432(HO)
• Provincial third-party agreement form M5614 BIL

The Nova Scotia Medical Services Insurance Plan requires all claim documents be received within 6 months from the date the medical treatment was provided.

Nunavut

• Great-West and Nunavut do not currently have a third-party agreement. You must first submit your out-of-country medical expenses to the Nunavut Healthcare plan. For more information about submitting expenses to the Nunavut Healthcare plan, call 867-975-5700 and ask to speak with an out-of-country representative.
• Once they have completed their assessment, submit a copy of your bills/receipts with their payment/denial statement, together with a completed Great-West Life Statement of Claim — Out-of-Country Expenses form M5432(MB) [PDF], to Great-West.

Ontario

Complete both claim forms in full and submit them to Great-West.

• Statement of Claim — Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5500 BIL

The Ontario Health Insurance Plan (O.H.I.P.) requires all claim documents be received within 12 months from the date the medical treatment was provided.

Prince Edward Island

Complete both claim forms in full and submit them to Great-West.

• Statement of Claim — Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5613 BIL

The Health and Community Services Agency of Prince Edward Island requires all claim documents be received within 6 months from the date the medical treatment was provided.

Quebec

Complete all claim forms in full and submit them to Great-West.

• Statement of Claim — Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5501 BIL

• The Régie de l'assurance-maladie du Québec (RAMQ) requires all claim documents be received within 1 year from the date the medical treatment was provided, except for in-patient hospital services, which must be received within 3 years from the date the medical treatment was provided.
• Application for reimbursement form - Quebec residents are also required to provide a completed Application for reimbursement form, available at:
  http://www.ramq.gouv.qc.ca/en/formulaires/documents/1896.pdf

Saskatchewan

Complete all claim forms in full and submit them to Great-West.

• Statement of Claim — Out-of-Country Expenses M5432(HO)
• Provincial third-party agreement form M5611

Saskatchewan Health requires all claim documents be received within 6 months from the date the medical treatment was provided.

Yukon Territory

• Great-West and the Yukon Territory do not currently have a third-party agreement. You must first submit your out-of-country medical expenses to the YT Healthcare plan. For more information, call 867-667-5209 and ask to speak with an out-of-country representative.
• Once YT has completed their assessment, submit a copy of your bills/receipts with their payment/denial statement, together with a completed Great-West Life Statement of Claim — Out-of-Country Expenses form M5432(MB) [PDF], to Great-West.