Retiree Benefit Update: Drug Card Q&A's

Below are a number of frequently asked questions about the new Drug Card which was mailed to OPS Retirees in the month of November 2007 by Great West Life. Specific questions on this card should be directed to Geat West Life at 1-800-874-5899. We will continue to post Q&A's to this site when they are of general interest to QCC members.

Q. Can I use my drug card in any pharmacy throughout Ontario and Canada?

A. Yes, 99% of pharmacies in Canada recognize pay-direct drug plans.

Q. Will I have to pay anything at the drugstore?

A. The drug card will provide for direct payment of prescription drugs, subject to the plan limitations, at the point of purchase. However, you will still be required to pay the $3.00 deductible that is applied to each prescription plus the balance of the 90% reimbursement percentage that is not covered by the plan.

Q. Can I use my drug card for medical costs other than drugs?

A. No. You can only use your drug card for eligible drug purchases. You will still have to submit claims to Great-West Life for medical costs other than prescription drugs.

Q. Who do I contact about a lost or stolen drug card?

A. To report a lost or stolen card, please contact Great-West Life at 1-800-874-5899 or at www.greatwestlife.com

Q. Who do I contact to make changes to dependent information?

A. You must contact your pension plan administrator. They will help you update your information.

Ontario Pension Board: 1-800-668-6203
OPSEU Pension Trust: 1-800-637-0024

Q. I will be travelling out of Ontario for 6 months. Will I be able to fill prescriptions for my medication to cover this time-frame using my drug card?

A. If you or your spouse is over 65 years of age check with your pharmacist to see what additional supply of your medications may be covered via the Ontario Drug Benefit plan (ODB). However, if you are under 65 and using the drug card, any purchase for more than 3 months will be denied. For those items that are covered by Great-West Life, you will need to contact them and request a vacation supply extension. This will enable you to purchase up to a 6-month supply via your drug card.

Q. How do I coordinate drug benefit claims with my spouse?

A. Coordinating benefits for drug claims will continue to apply the same way as your other health plan benefits; there is no change to the current process of coordinating benefits.

• To make a claim for your own drugs: Use your drug card at the pharmacy, pay the portion not covered by insurance and have your spouse claim the difference on his or her plan.
• To make a claim for a spouse’s drugs: The spouse must make this claim on his or her plan first. He or she will pay the portion not covered by his or her insurance plan, and you can claim reimbursement for that portion on your plan by submitting a paper claim for reimbursement.
• To make a claim for a child’s drugs: The claim must be made on the plan of the Parent whose birth date falls the earliest in the year. Reimbursement for the portion not covered in that parent’s plan can be claimed from the other parent’s plan.
• If both parents have drug cards: Direct payment is available using both cards. Cards need to be used in the sequence described above.
• If only one parent has a card and the other has coverage through their employer but no card: If the cardholder’s birth date falls earlier than the cardholder’s spouse’s birth date, the card can be used for the cardholder’s own prescriptions and for a child’s prescription. The other parent will have to pay for his or her prescriptions and then submit a paper claim for reimbursement.

Q. Can my coverage under the Ontario Drug Benefit and Great-West Life be co-ordinated using my drug card?

A. Yes. The system will automatically bill ODB as the first payer and then Great-West Life as the second payer. You will be required to pay the $3 deductible.

If you or your spouse are not yet 65, be sure to advise the pharmacist when you turn 65 to avoid inconvenience to yourself and to facilitate the ODB/Great-West Life payments at point of sale.

Q. I have not received a card. I understand Ontario Public Service retirees will be receiving a pay-direct drug card. Am I eligible to receive a drug card?

A. As a result of an agreement, the Ontario Government is providing pay-direct drug cards to eligible pensioners and their dependents. If you currently have health coverage under the OPS retirees’ plan but fall under the following groups of retirees, you are not eligible to receive a drug card:

• Retired Judges
• Retired Justices of the Peace
• Retired members of the OPPA already receive drug cards.

Q. I forgot to mail in my accumulated 2006 health claims before the drug card was issued. Is it too late to send them in to Great-West Life?

A. The deadline for submitting your 2006 health and dental claims is 4:30 pm, Monday, December 31, 2007, the last working day of the year. All claims must be received by the insurance carrier – not just mailed – on or before 4:30 pm on this date. Claims mailed before the deadline but received in the New Year will be denied. We recommend that you file your claims as you incur them.

Q. Do I have to use the card? I don’t want to use it. I would rather pay for my drugs with my credit card – I get loyalty points/airmiles using my card.

A. The drug card will provide for immediate, direct payment of eligible drug costs at the point of purchase and may eliminate the need to submit paper claims to the insurance carrier. You have received a drug card as a result of an agreement reached with pensioners relating to health benefits. However, if you wish to use a credit card to pay the pharmacist for your purchases, the choice is yours. You can continue to submit paper claims for the cost incurred and await reimbursement, just as you do now.

Although drug card use is not mandatory, you are still required to provide Great-West Life with dependent information to identify your eligible dependents under the OPS pensioners’ health and dental plans. You can do this by contacting the Ontario Pension Board or the OPSEU Pension Trust. This will facilitate more efficient processing of eligible claims for your dependents’ health and dental treatment costs.

Q. How are drugs that require prior authorization from Great-West Life processed when using my drug card?

A. Some prescription drugs are subject to prior approval. Should you be prescribed one of these drugs, your pharmacist will advise you to contact your insurance carrier – Great-West Life, to obtain approval for the purchase. Call Great-West Life at 1-800-874-5899 and you will be provided with a form that you will need to complete and return to them. If you have internet access, you can obtain this form by going to www.greatwestlife.com