Coordination of Benefits
Coordinating Benefits With Your Spouse's Plan
When you and your dependents have coverage under more than one group benefit plan, the following rules govern the reimbursement of claims as set by the Canadian Life & Health Insurance Association (CLHIA):
When making a claim for you or your spouse:
- each of you is required to submit to your own plan first.
- any remaining expenses are then submitted to the other plan with an Explanation of Benefits (EOB) that shows what the first plan covered.
When making a claim for a dependent child:
- the spouse whose birthday (by month or day if necessary) occurs first in the calendar year submits to their own plan first.
- any remaining expenses are then submitted to the other plan with an Explanation of Benefits (EOB) that shows what the first plan covered.
- if your child does not live with you and/or is covered by more than two plans, the CLHIA-ACCAP Consumer Information brochure has more information.
The total amount received from all plans cannot exceed 100% of the eligible expenses incurred.
These provisions also apply when both spouses are employed by the university and are eligible for benefit coverage.
Coordination with the Alberta Seniors Program
The Government of Alberta provides seniors with premium-free coverage for prescription drugs and other health-related services. Alberta Blue Cross administers the Coverage for Seniors program .
- You are eligible to participate once you reach the age of 65.
- This plan will become the first payer.
- After expenses have been adjudicated by Alberta Blue Cross, any residual amount can be submitted to Sun Life for reimbursement.
Most pharmacies and dental offices can submit claims to both plans electronically on your behalf.