In-Home Nursing & Personal Support Workers
What is covered?
- 100% of the reasonable and customary (R&C) limit, up to $100,000 every year (January 1 to December 31)
Eligible services
Graduate Registered Nurse (RN) or Registered Practical Nurse (RPN) who is:
- Prescribed by a physician
- Not a relative
- Currently registered
GreenShield conducts an independent nursing service assessment for coordination with government programs.
Personal Support Worker (PSW) who is:
- Prescribed by a physician
- Not a relative
- PSW certified from an accredited program
- Employed by a recognized health care provider
- Bonded or carries insurance
GreenShield can help coordinate with government assistance programs.
Reasonable and customary (R&C) limit for in-home nursing/PSWs
To ensure members are not overcharged, every year GreenShield sets a reasonable and customary (R&C) limit for the cost of in-home nursing/PSW services. Every time you receive service, the R&C limit is applied.
However…
Some providers charge more than the R&C limit.
And…
The R&C limit is the maximum amount your plan will cover for in-home nursing/PSWs…
That means…
If your provider charges more than the R&C limit, you will have to pay the remaining amount out of your own pocket.
You can check your eligibility and coverage limits by logging in to your account at greenshield.ca, emailing GreenShield at customer.service@greenshield.ca or by calling GreenShield at 1-877-266-5494 to use their interactive voice system. You will then see if your estimated payments are fully covered or not.
For Example:
Lorraine’s PSW charges $45 each hour. The R&C limit at the time for this service is $35 each hour, which is the maximum amount your plan will pay.
Since Lorraine will be $10/hour out of pocket, she has two choices:
- Pay the remaining $10/hour out of pocket; OR
- Look for a provider that charges less; OR
- Use her Health Care Spending Account (HCSA) to help cover her cost—in full or in part.
If you are reaching the annual maximum coverage
If you are reaching the annual maximum, you can continue in-home nursing care at two hours per day with a Registered Nurse (RN).
Who to contact for in-home nursing or PSW support
GreenShield: Contact GreenShield at 1-877-266-5494 to get the process started, such as accessing required authorization forms and information. GreenShield can also help with coordinating with government programs.
CarePath: If you are looking for in-home nursing or PSW support, contact CarePath at 1-866-883-5956. You will be connected to a Nurse Case Manager who will provide assistance in navigating the healthcare system. After an initial consultation, your Nurse Case Manager will develop a customized plan of care based on your concerns and preferences.
