Benefits Info

Green Shield (HHS)– If you can’t take a Generic Medication there is a “Generic Drug Exception” form that your Doctor can fill out. Common Paramedical Services Covered under Green Shield Benefits April 25, 2012 Hamilton Health Sciences, ON. Paramedical services are health services that are performed by medical practitioners other than physicians. Paramedical practitioner coverage at HHS differs depending on your employee group. If applicable to you, coverage may include chiropractic therapy, massage therapy, physiotherapy.

 

 

Do I have coverage for all paramedical practitioners?

You may not have coverage for all paramedical practitioners. You should refer to your applicable Benefit Overview, Collective Agreement and/or Green Shield booklet available at www.greenshield.ca. You need to register as an online user to view the benefit booklet. You can also contact Green Shield Canada at 1-888-711-1119 to determine your eligibility.

It is important to note that paramedical services are only eligible when the practitioner rendering the service is licensed by their provincial association, and that association is recognized by Green Shield Canada. All practitioners must also follow the standards of practice and regulations as set by their governing body. Please contact the Green Shield Customer Service Centre to confirm eligibility of the paramedical service or practitioner when in doubt.

Who are paramedical practitioners and what do they do?

 

The following is a list of some of the more common paramedical practitioners and their related health professional services. Please note that, a physician’s authorization may be required on the initial claim. Green Shield Canada requires that a paramedical practitioner be licensed in the province in which he/she is practicing.

  • Chiropractor: A specialist in chiropractic therapy. Chiropractic therapy is a system of treating disease by manipulation of the vertebra column. This therapy is based on the theory that most diseases are caused by pressure on the nerves because of faulty alignment of bones, especially the vertebrae, and that the nerves are thus prevented from transmitting to various organs of the body the neural impulses for proper functioning. Acting on this theory, the chiropractor manipulates various parts of the spine in treating the complaint.

 

  • Massage Therapist: Massage therapy is defined as the manipulation of the soft tissues of the body, with a knowledge of anatomy, physiology, and pathology, and applied in a scientific manner in order to bring about therapeutic results. Massage is a healing art. Massage can help relieve musculoskeletal pain by breaking the pain cycle. Massage is also excellent in helping to reduce the possibility of injury. Relaxation massage does not focus on any specific problem areas.

 

  • Active Physiotherapy: The use of conventional physiotherapy modalities to rehabilitate an injured or diseased body structure or function to attempt to return to pre-injury or pre-disease levels; it continues to be considered active physiotherapy when there continues to be objective improvement (objective meaning visible or apparent on testing) in structure or function as observed by the Physiotherapist. This timeframe of when the threshold of active physiotherapy is reached varies from patient to patient and will also be based on the patient’s diagnosis.

 

  • Maintenance Physiotherapy: At such time that the point is reached where there is no further improvement (objective signs); the physiotherapy can only be considered useful to maintain the desired function and should be considered maintenance physiotherapy.
Active physiotherapy is an eligible benefit under the Green Shield program. Please be advised that maintenance physiotherapy is not eligible; therefore, claims submitted for maintenance thereapy will not be reimbursed.

Do I need a medical referral for all paramedical services?

Some paramedical services will require that you submit a medical referral from your Physician before reimbursement of eligible paramedical expenses can be paid. To ensure that you are following the correct process, you should contact Green Shield prior to obtaining services to determine eligibility and if a referral is required.

What do I need to know about my coverage for Paramedical services?

Your coverage is subject to annual maximums, commencing at the beginning of each calendar year (i.e. in January). To determine the overall maximum limits under your coverage, please refer to your Benefit Overview, Green Shield Benefit Booklet, or contact Green Shield’s Customer Service Centre at 1-888-711-1119.

It is important to note that all paramedical services are subject to “Reasonable and Customary” fee schedules set by Green Shield Canada. Please contact Green Shield’s Customer Service Centre at 1-888-711-1119 to determine your coverage before obtaining service.

How do I submit a claim?

As communicated in the intranet article dated April 11, 2012, plan members now have the option to submit Physiotherapy, Massage Therapy and Chiropractic Treatment claims online through the Green Shield website. All other paramedical claims should be manually submitted using the “Claim Form for Related Health Professional Services”, however, some practitioners will submit claims electronically on your behalf. Please refer to your practitioner for electronic claims submission eligibility. All claims must be submitted within 12 months of the date of service to be considered an eligible expense.