Your health and dental expenses, and those of your family, may be covered by more than one group insurance plan. If this applies to you, you may be able to claim up to 100% of the expenses you incur by submitting separate claims to each plan. In the insurance industry, we call this
the coordination of benefits.
Different factors can influence the order in which claims should be submitted, but the first thing to consider is—who incurred the expenses?
-
-
| Situation | Order of claim submission |
|---|
| You are covered under a group insurance plan as an
active plan member AND as a
dependent under your spouse’s group plan. | - Your plan
- Your spouse’s plan
|
| You are covered under two separate group insurance plans as an
active plan member AND you are also covered as a
dependent under your spouse’s group plan. | - The plan under which you have been covered as an active plan member for the longest period of time
- The plan under which you have been covered as an active plan member for the shortest period of time
- Your spouse’s plan
|
| You are covered as an
active plan member AND a
retired plan member under two separate group insurance plans. | - The plan under which you are covered as an active plan member
- The plan under which you are covered as a retired plan member
|
| Situation | Order of claim submission |
|---|
| Your spouse is covered as a
plan member under his/her own group insurance plan AND as a
dependent under your plan. | - Their plan.
- Your plan.
|
| Situation | Order of claim submission |
|---|
You live with the parent of your children.
If your children are covered under both your plan and your spouse’s plan. | - The plan of the parent whose birthday comes first in the calendar year (the year of birth is not taken into account).
- The plan of the second parent.
Note: If both parents were born on the same day, the alphabetical order of the parents’ first names determines which plan the claim is submitted to first. |
You are separated and have shared custody of your children.
If each parent has a new spouse and your children are covered under all the following plans (up to a total reimbursement of 100% of eligible expenses). | - The plan of the parent whose birthday comes first in the calendar year (the year of birth is not taken into account).
- The plan of the second parent.
- The plan of the spouse of the parent whose birthday comes first.
- The plan of the spouse of the second parent.
|
You are separated and have sole custody of your children.
If each parent has a new spouse and your children are covered under all the following plans (up to a total reimbursement of 100% of eligible expenses). | - Your plan
- Your current spouse’s plan
- Your ex’s plan
- Your ex’s current spouse’s plan
|
Your dependent child is enrolled at an educational institution and has a part-time job.
Your child is covered through work, through school and through your group plan. |
Medical and dental expenses - Your child’s employer’s plan
- Your child’s student plan
- Your plan
Drug expenses - Your child’s employer’s plan
- Your plan
- Your child’s student plan
Note: The order may be different for expenses incurred for a medical emergency during a trip outside the insured’s province of residence. In these cases,
please contact us. |