coordination of benefits

for green shield canada (gsc) benefits:

if a plan member is covered for extended health and dental benefits under more than one plan, their benefits under this plan will be coordinated with the other plan so that they may be reimbursed up to 100% of the eligible expense incurred.

for eligibility purposes, use the following guidelines to identify the primary and secondary plans.

gsc plan member

if you have benefits under two group plans, priority goes in the following order:

  1. the plan where you are a full-time plan member
  2. the plan where you are a part-time plan member
  3. the plan where you are a retiree

spouse

if your spouse is a plan member under another benefit plan (regardless if that benefit plan is a gsc plan or with a different benefit provider), gsc coverage is always secondary for your spouse.

children

when dependent children are covered under both your gsc plan and the spouse’s benefit plan, use the following to determine the order of eligibility:

  1. the plan of the parent whose birth date (month and day) occurs earlier in the calendar year
  2. the plan of the parent whose first name begins with the earlier letter of the alphabet, if the parents have the same birth date
  3. in cases of separation or divorce with multiple benefit plans for the children, the following order applies:
  • the benefit plan of the parent who has custody of the dependent child
  • the plan of the spouse of the parent who has custody of the dependent child
  • the plan of the parent who does not have custody of the dependent child
  • the plan of the spouse of the parent who does not have custody of the dependent child

if your family has other benefit coverage, it will be coordinated according to industry standards. for more information on industry standards, please visit the canadian life and health insurance association at https://www.clhia.ca/.