HOW TO FIND YOUR BENEFIT ID

There are two ways to find your Benefit ID:

  1. On your Great-West Life Pay Direct Drug Card
  2. On your Member's Annual Statement

1. On your Great-West Life Pay Direct Drug Card

The numbers on your Pay Direct Drug Card are arranged like this:
11 335663 0000012345 01

Here is what the numbers mean:

11 335663 0000012345 01
Is the code the Pharmacist uses to identify Great-West Life as the insurance carrier.

11 335663 0000012345 01
Is your Great-West Life Group Contract Number.

11 335663 0000012345 01
Is your unique Benefit ID, also called your certificate number.

11 335663 0000012345 01
Is the issue number. If your card is lost or stolen and you request a new card, the issue number will change to 02, etc.

2. On your Member's Annual Statement

Your Benefit ID is located under the Personal Data section of your Member's Annual Statement.

PERSONAL INFORMATION

This section provides us with the identifying information required to make changes to your records.

Benefit ID
Please enter your Benefit ID number.

First Name
Please enter your first name (the first name of the employee).

Last Name
Please enter your last name (the last name of the employee).

Date of Birth
Please enter your date of birth DD/MM/YYYY (the date of birth of the employee.

Email
Please provide an email address so we can contact you electronically if we have questions about the information you have provided on the form.

Daytime Phone Number
Please provide the telephone number where you can be reached during the day so we can contact you if we have questions about the information you have provided on the form.

ADD OR CHANGE INFORMATION ABOUT YOUR SPOUSE

This section helps you update information if your marital status has changed or if you wish to change information about your spouse. If you are making no changes in this section, please skip to the next section.

Marital Status
Please select either married, common-law relationship or single. You are in a common-law relationship if you have been co-habitating in a spousal relationship with someone for at least one year. Coverage for a same-sex spouse is available under the 3sHealth Employee Benefits Plan.

Has your Marital Status Changed?
Please select yes or no.

Spouse's First Name
Please enter the first name of the spouse you are adding to your benefit plan coverage.

Spouse's Last Name
Please enter the last name of the spouse you are adding to your benefit plan coverage.

Spouse's Gender
Please enter the gender of the spouse you are adding to your benefit plan coverage by selecting Male or Female.

Spouse's Date of Birth
Please enter the date of birth DD/MM/YYYY for the spouse you are adding to your benefit plan coverage.

Spouse Information Change Effective Date
Please enter the date DD/MM/YYYY your common-law relationship or marriage began. If you are changing your status to single, indicate the date your relationship ended.

ADD OR CHANGE INFORMATION ABOUT DEPENDENT CHILDREN

Use this section to update information about your dependent children. If you are making no changes to this section, please skip to the next section.

Definition of a Dependent Child
A dependent child is a person who is unmarried, dependent on you for financial support, and who is your natural child, your legally adopted child, a step-child or child of your common-law spouse who lives with you, or a child for whom you have been granted custody pursuant to an Order of a Court.

Dependent Child First Name
Please enter the first name of the child you are adding to your benefit plan coverage.

Dependent Child Last Name
Please enter the last name of the child you are adding to your benefit plan coverage.

Dependent Child Gender
Please enter the gender of the child you are adding to your benefit plan coverage by selecting Male or Female.

Dependent Child Date of Birth
Please enter the date of birth DD/MM/YYYY for the child you are adding to your benefit plan coverage.

Mentally/Physically Challenged
Please check this box if your dependent child is 21 years of age or older and dependent upon you for support by reason of a mental or physical disability.

Please Note: Completion of this form does not automatically ensure coverage for your over-aged dependent with a disability. In order to obtain or continue the coverage of a dependent with a disability who has attained age 21, you must complete a Disabled Dependent Information Request Form and submit it to Great-West Life. Coverage for your child is subject to approval by Great-West Life. A Disabled Dependent Information Request Form will automatically by mailed to you by 3sHealth Employee Benefits upon receipt of this completed form.

University/Post-Secondary Student
Please check this box if your dependent child is between the ages of 21 and 26 and is in full-time attendance at an accredited college or university. Please note: coverage for students under the plan terminates on the child's 26th birthday. If you have a child between the ages of 21 and 25 who is attending an accredited college or university, complete, sign and send the Dependent Verification Form to 3sHealth each calendar year. We will automatically send this form to you annually at the end of July.

Dependent Child Effective Date
Please enter the date DD/MM/YYYY that you would like your child to be added to your benefit plan coverage or the date you would like the information about your child updated.

REMOVE YOUR SPOUSE

Use this section to remove your spouse from your benefit plan coverage. If you are making no changes in this section, please skip to the next section.

Spouse's First Name
Please enter the first name of the spouse you are removing from your benefit plan coverage.

Spouse's Last Name
Please enter the last name of the spouse you are removing from your benefit plan coverage.

Spouse's Gender
Please enter the gender Male or Female of the spouse you are removing from your benefit plan coverage.

Spouse's Date of Birth
Please enter the date of birth DD/MM/YYYY for the spouse you are removing from your benefit plan coverage.

Spouse's Removal Effective Date
Please enter the date DD/MM/YYYY you are removing your (former) spouse from your benefit plan coverage.

REMOVE YOUR DEPENDENT CHILDREN

Use this section to remove your dependent child or children from your benefit plan coverage. If you are making no changes in this section proceed to the bottom.

Dependent Child First Name
Please enter the first name of the child you are removing from your benefit plan coverage.

Dependent Child Last Name
Please enter the last name of the child you are removing from your benefit plan coverage.

Dependent Child Gender
Please enter the gender Male or Female of the child you are removing from your benefit plan coverage.

Dependent Child Date of Birth
Please enter the date of birth DD/MM/YYYY for the child you are removing from your benefit plan coverage.

Dependent Child Removal Effective Date
Please enter the date DD/MM/YYYY you are removing your child from your benefit plan coverage.

SUBMIT

Please click the submit button to complete your transaction. Your completed form will be received by the 3sHealth Employee Benefits Department and processed within three business days.