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COORDINATION OF BENEFITS …

Rising costs concern everyone. Plan members who utilize Coordination of Benefits (COB) can recoup up to 100% of eligible health and dental expenses.

In all cases where benefits are being coordinated, the insurer will apply any deductibles, maximums or coverage limitations in accordance with the policy before payments issued.

COB is when a plan member with family coverage has a spouse with family coverage under their benefit plan as well. Industry-wide guidelines developed by the Canadian Life and Health Insurance Association (CLHIA) establish a consistent handling process for all insurance companies to follow when processing health and dental claims.

Consistent handling process

The long and short of the coverage rules are if the claim is for the plan member, the claim is submitted first through their plan and second through the spouses plan. The opposite is true for the spouse—a claim would be submitted first through their plan and second through the plan member’s benefits. When both parents have benefits, the CLHIA guidelines suggests claims for eligible dependents flow through the parent whose date of birth falls earlier in the calendar year.

In most cases, even in the event of a divorce or separation, the same dependent child rules apply.

Claims for you and your spouse

For coordination of benefits to work properly, you need to understand which insurance company you should submit claims for you and your spouse to first.

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If your spouse’s insurance plan happens to be with the same carrier, perhaps even the same company, the same rules apply. You and your spouse must refer to each other’s policy number when submitting claims, so the insurance carrier can coordinate benefits available for each plan automatically.

When COB is utilized, you make the most of coverage available through your benefit plan.


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