The benefits plan is there for you and your family, for when you need it. While your benefits plan is robust, there are limits.
Learn how to know if you might have to pay for any of your benefits out of your own pocket before you get hit with the bill.
Reasons why you might have to pay out-of-pocket
1. Your provider charges more than the reasonable and customary (R&C) limit.
We don’t expect you to know what a reasonable price is for a pair of orthotics or a visit to a chiropractor. Unfortunately, we know that sometimes these services or items are priced excessively. To ensure members are not overcharged, every year GreenShield sets a reasonable and customary (R&C) limit for certain health treatments, services, and items covered by your benefits plan.
Every time you receive these treatments and services, 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.
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.
For Example: John’s registered massage therapist (RMT) charges $135 for each appointment. The R&C limit at the time for this service is $110, which is the maximum amount your plan will pay.
2. You have reached your annual maximum coverage limit.
Some of your benefits have an annual maximum. If you reach your benefit maximum partway through the year, you won’t have any coverage available to you until the full coverage resets again on January 1.
3. The service/treatment is not covered by your plan.
Don’t be surprised and find out the health item you purchased isn’t covered under the plan – after you have bought it. For example, over-the-counter medications that don’t require a prescription, exercise equipment, and eyeglasses cases all aren’t covered.
What should you do to avoid paying out-of-pocket?
You can check the R&C limits, your personal limits based on your claims history, and the items that are covered and not covered by the plan. Log in to your account at greenshield.ca, email GreenShield at customer.service@greenshield.ca or call GreenShield at 1.877.266.5494 to use their interactive voice system.
