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Click ‘Get Form’ to open the green shield claim form for LTC 2006 in the editor.
Begin by filling out the LTC Facility Information section. Enter the facility name, provider number, address, city, province, postal code, and telephone number.
Next, complete the Patient Information section. Input the Green Shield ID number, date of birth (year, month, day), patient surname and given names, and date of admission to the long-term care facility.
Indicate the type of accommodation occupied (semi-private, standard, or private) and whether there is any other group insurance coverage. If applicable, provide details about the other insurance company.
In the Billing Information section, specify the account period and discharge date if applicable. Calculate total amounts based on co-payment rates or monthly charges as required.
Ensure that a Long-Term Care Facility Official certifies the information by signing and dating where indicated.
Finally, select your payment direction preference and provide mailing address details for reimbursement if necessary.

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (330 Votes)
2006	4 Satisfied (52 Votes)

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How long do you have to submit a claim to Green Shield?

All extended health care claims must be received by Green Shield Canada (GSC) no later than June 30 of the calendar year following the year in which the expense occurred. All dental claims must be received by GSC within 12 months of the service date.

How to submit a claim to GreenShield?

How To Make a Claim Register for GreenShield+. Submit your claim using our online claim submission process. Sign up for direct deposit to receive your funds directly, without waiting for a cheque to arrive in the mail.

What is covered under GreenShield?

GSC Health Assist ZONE plans provide coverage against the day-to-day, routine medical and dental expenses not covered by your provincial plan, as well emergency medical travel protection when youre away from home, plus coverage for unforeseen health expenses that may arise in the future.