Coordination of Benefits
January 27, 2023
Coodination of Benefits. How does it impact your benefits?
In some families, two adults will have a benefit plan through their employer. The coverage may be somewhat different and some of the coverage could even overlap. Insurance companies follow procedures set out by the Canadian Life and Health Insurance Association (CLHIA). The CLHIA established which plan pays first when a claim is made to more than one plan, for either a dependent child or plan member.
Who pays first?
From the CLHIA, there are a number of rules that set out who pays the claim first in a case where there is more than one plan. You will always submit a claim for yourself to your plan first. If there is an amount remaining, the rest can be put through on your spouse's plan.
For parents who have benefit plans through their employers, and their children are covered under these plans, the parent who has a date of birth earlier in the calendar year pays first. In a case of joint custody, it would be the same. For example:
Father's date of birth is March 31
Mother's date of birth is February 3
The mother's plan would pay first, as her date of birth comes first in the calendar year.
If the parents have the same date of birth, the plan that would pay first is based on the parent's given name that is first in the alphabet.
Single and Joint Custody
There may also be varying situations with custody, which will have an impact on how claims are submitted for dependent children. For example, in a single custody situation, the plan that pays first would be the plan of the parent with custody. If that parent has a spouse, that spouse's plan would be the next payor. Third payor would be the plan of the parent who does not have custody, and fourth would be that parent's spouse.
In a situation with joint custody, parent with the earlier birthdate in the year would have the claim put through on their plan first.
If you have questions about your benefits, feel free to call our customer care line at 1-800-667-7830 Monday through Friday, 8:30AM CST to 5:00PM CST.