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Submit a claim to more than one plan

Also called coordination of benefits or COB

 

Covered by more than one benefit plan? You can send the same claim to all the plans. You could get back the full amount you claim.

Keep copies of your statement and receipts – including drug receipts. Each plan will tell you what you need to send with your claim. Also, if you need a copy of your claim statement in future, they’re available online, after you sign in to your plan on the website. Once signed in, your Claims history presents itself on the screen. Click on  the “Statement” icon (on the right beside a specific claim) to find the statement for that claim.

Under some plans, you don't have to use your benefits first. You can use your health care spending account, wellness account, taxable spending account, or lifestyle account first. Then you can have your benefits pay any unpaid balance. Check your benefits guide to see if your plan offers that choice.

 

Who is the claim for?

For you

  1. First send the claim to your plan.
  2. Then send the claim to your spouse's plan (if your plan didn't pay the full amount).
  3. Send the claim back to your plan if there's still an unpaid amount and you want to see if your health care spending account (HCSA) can help pay for it. (You may also be able to use your wellness account, taxable spending account, or lifestyle account.)
  4. Then you can send it to your spouse's HCSA or other account.

Not all plans offer health care spending, wellness accounts, taxable spending, or lifestyle accounts. If not, you can skip that step.

Retired or have another job?

  • If you have two full-time jobs
    Send the claim to the job you started first. Then send it to your other plan. Then to your spouse's plan.
  • If you have a full-time and a part-time job
    Send the claim to your full-time job's plan first. Then to your part-time job's plan. Then to your spouse's plan.
  • If you're retired with a full- or part-time job
    Send the claim to your full-time job's plan first. Then to your part-time job's plan. Then to your retiree plan. And then to your spouse's plan.

For your spouse

Your spouse can be someone you're legally married to, or living with in a common-law relationship. Or someone who meets your plan's definition of spouse.

  1. First your spouse needs to send their claim to their plan.
  2. Then you can send the claim to your plan (if their plan didn't pay the full amount).
  3. If there's still an unpaid amount, a health care spending account (HCSA) may help pay for it. Send the claim back to your spouse's plan. (You may also be able to use a wellness account, taxable spending account, or lifestyle account.)
  4. Then you can send it to your HCSA or other account.

Not all plans offer health care spending, wellness accounts, taxable spending, or lifestyle accounts. If not, you can skip that step.

For your child

  1. First send the claim to the plan of the parent with the birthday that comes first in the year.
  2. Then send it to the other parent's plan (if the first plan didn't pay the full amount).
  3. If there's still an unpaid amount, a health care spending account (HCSA) may help pay for it. Send the claim back to the first plan's HCSA. (You may also be able to use a wellness account, taxable spending account, or lifestyle account.)
  4. Then send it to the second plan's HCSA or other account.

Not all plans offer health care spending, wellness accounts, taxable spending, or lifestyle accounts. If not, you can skip that step.

(Shared custody – separation, divorce, re-marriage, living in a new common-law relationship)

  1. First send the claim to the plan of the parent whose birthday is first in the year.
  2. Then send it to the plan of the parent with the birthday that's second.
  3. Then send it to the plan of the spouse of the parent whose birthday was first.
  4. Then send it to the plan of the spouse of the parent whose birthday was second.
  5. If there's still an unpaid amount, you may be able to claim it under a health care spending or other account. (You may also be able to use a wellness account, taxable spending account, or lifestyle account.) Send the claim to the HCSA or other account, in the same order as above.

Not all plans offer health care spending, wellness accounts, taxable spending, or lifestyle accounts. If not, you can skip that step.
  1. First send the claim to your child's college or university benefits plan.
  2. Then send the claim to any other plans. (Use the same order as above.)
  1. For drugs covered under Quebec's public drug plan (RAMQ) – First send the claim to your child's other plan(s). (Use the same order as above.)
  2. Then send the drug claim to the college or university plan.
  3. For non-drug claims – Use the same order shown above under College/university students.
Which plan pays your child's claim first?

Is your birthday closer to January 1st than your spouse's birthday? If it is, your plan pays first. If not, your spouse's plan pays first.
Same birthday?

If both parents have the same birthday, use the first initial of your first names. Whichever initial comes first in the alphabet is the parent whose plan pays first. Example: If your name starts with 'A' and the other parent's first name starts with 'S', send claims to your plan first.

Job change?

If you or your spouse recently changed jobs, it may be time to update your benefits.

Questions?

Your plan administrator can answer questions about your specific group benefits plan. Your benefits booklet may be available after you sign in to the Plan Member Secure Site (under Coverage, located at the top of the left navigation, click on Your Benefits. Then click on View Benefits Booklet). There you’ll also find information about eligibility, coverages, and more. If a View Benefits Booklet tab does not appear under Your Benefits, please contact your Plan Sponsor to obtain a copy.

Need to submit a claim?

Submit your benefits claims online or with the app. Get started now.