If you are covered for health and dental benefits under more than one plan, your benefits will be co-ordinated based on guidelines developed by the Canadian Life & Health Insurance Association (CLHIA). This is called co-ordination of benefits (COB).
The total amount of reimbursement you receive cannot exceed 100% of the eligible expense incurred.
1. You and your spouse must first submit your claims through your own employer group plan.
2. If you are submitting the balance of ineligible expenses to another plan, you must include the original explanation of benefit (itemization of expenses) that you receive from the first submission.
3. Claims for dependent children must be submitted to the plan of the parent who has the earlier birthday in the calendar year (the year of birth is not considered), either when the parents are cohabiting or when there is a shared custody arrangement in the event of separation or divorce.
4. In the case both parents have the same birthdate, the primary carrier is the plan of the parent whose first initial comes first in the alphabet.
5. If you are separated or divorced, and have full custody of any dependent children, the plan that will pay benefits for your children will be determined in the following order:
• The plan of the parent with custody of the child.
• The plan of the spouse of the parent with custody of the child.
• The plan of the parent without custody of the child.
• The plan of the spouse of the parent without custody of the child.
6. Any remaining balances can be submitted to a Health Care Spending Account, if available.
Please feel free to contact us with questions at info@truebenefits.ca or 604.872.2866.
Rachel von Sturmer, BA, GBA, CFP
www.truebenefits.ca