Claim Submission & Forms

How to guide

Hour Bank and Office Supervisory Plan

To submit a health care or dental expense, you can:

Use your pay-direct card at providers that direct bill Great-West Life
(card example shown below):

 

Submit the claim online through:
GroupNet for Plan Members

Submit a claim by email or mail to Great-West Life using a claim form:
Health Claim Form
Dental Claim Form
Assignment of Benefits Form – if you would like Great-West Life to pay eligible claims the provider directly
CPAP Form – Required for all CPAP/APAP/BPAP claims, except for residents of Manitoba, Ontario, or Saskatchewan

Paper claims can be sent to Great-West Life (with receipts) to:

MAIL: Winnipeg Benefit Payments
PO Box 3050, Winnipeg MB  R3C 0E6

For out-of-country medical, life, disability or accidental death or dismemberment claims, please contact Mercon.

How to guide

Retiree Plan

To submit a health care or dental expense, you can:

Use your pay-direct card at providers that direct bill Great-West Life (card example shown below):

 

Submit the claim online through:
GroupNet for Plan Members

Submit a claim by email or mail to Great-West Life using a claim form:
Health Claim Form
Dental Claim Form
Assignment of Benefits Form – if you would like Great-West Life to pay eligible claims the provider directly
CPAP Form – Required for all CPAP/APAP/BPAP claims, except for residents of Manitoba, Ontario, or Saskatchewan

Paper claims can be sent to Great-West Life (with receipts) to:

MAIL: Winnipeg Benefit Payments
PO Box 3050, Winnipeg MB  R3C 0E6

For out-of-country medical claims, please contact Mercon.