Policy range 2

These forms are for group plan members with out-of-country healthcare coverage, with a group plan number that falls outside these number ranges:

  • 55440
  • 56000 to 56300 (exception policy 56048)
  • 56461 to 56599
  • 56891
  • 57134
  • 250000 to 256499
  • 330000 to 339999 (exceptions: policy 330864 and policy 335206)
  • 340000 to 344999

If your group plan number does fall within the above numbers, use the out-of-country claim forms in the policy range 1 section instead.

If you are unsure of which forms you should use, have any questions or need help completing these forms call our Out-of-Country claims department at 1-800-957-9777.

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 authorization forms be completed, in full, by the person who incurred the medical expense.

Select your home province: