Employees are responsible to claim their own eligible Extended Health Care expenses by submitting claims through one of the following methods:
- Online claims via the employee’s claims portal (eProfile or myGroupSource) accessed on our website: www.groupsource.ca, or
- Electronic claims via the Mobile App, or
- Paper claims using the Extended Health Care Claim Form and mailing it with original receipts for reimbursement, or
- Providers can submit claims directly to GroupSource for reimbursement.
The timeline for Claims processing varies depending on the method chosen. Online claims via the online claims portal are adjudicated in real time, whereas Mobile App or mailed claims will be processed in the order received, according to the current GroupSource Claims Department workflow.
Claims should be submitted within 90 days after the end of the calendar year in which expenses were incurred. If coverage has been terminated for any reason, employees have 90 days from their termination date to submit any eligible claims, or as defined in your Booklet.
Pay-Direct Drugs
If your plan includes a Pay Direct Drug Card, expenses for prescription drugs will be paid directly to the pharmacy so there is no need for the employees to submit Extended Health claims. The member simply shows the pharmacist their Pay Direct Drug Card and the pharmacist will charge them only for amounts not covered by the card (e.g. deductibles, if applicable).
- OneCards are automatically re-issued if an employee’s last name, coverage levels, or ID number changes.
- Pay-Direct drugs can only be accessed within Canada.
Tip!
- If an employee’s drug card is declined at the pharmacy, advise the employee to verify the spelling of his/her name and the date of birth entered by the pharmacy, as this information must match the GroupSource system in order for the claim to be paid.
- If an employee’s oneCard is lost or stolen a replacement can be obtained from the List All Enrolled Employees screen in WEBS™.
Telus Health – Direct Billing
Health service providers that are registered with Telus Health direct billing can submit expenses to GroupSource on behalf of the employees reducing the need for the employees to pay out of pocket.
Claims Audit
Online claims submitted through the Member Portal may be selected for audit. This can be due to random audit guidelines, or adding a new provider or other plan changes. If a claim is selected for audit, the member will be required to upload the invoices and receipts, and claims payment may be delayed by up to 8 days.