Co-ordination of Benefits
Your health plan benefits may be co-ordinated with the benefits provided by any other plan to provide coverage up to 100 percent of eligible expenses. The total amount received from all sources cannot exceed the amount of the actual expenses incurred. Benefits will automatically be co-ordinated or reduced by any amount payable under a government plan.
Co-ordinating With Your Spouse’s Plan
To implement or revise co-ordination of benefits with your spouse's group insurance plan, log in to MySTF.
You and your spouse must first submit your own claims through your own group plan, regardless of whether or not you have reached your benefit maximum. Include the original receipts and bills.
Then submit claims to the plan of the other spouse for any amount that is not paid by the first plan. Include an itemization of expenses received from the first insurer, as well as copies of your receipts and bills.
Each person will receive payment for the portion of the claim submitted to their plan, regardless of who incurred the total cost. The Members’ Health Plan cannot pay benefits to any individual or organization other than the covered individual under whose plan the claim is submitted.
Remember to keep copies of receipts and bills for your own files.
If You are Both Members of the Members’ Health Plan
You may elect to automatically co-ordinate benefits so that the total of eligible expenses are calculated first as a member and secondly as a dependent spouse at the same time. If you are using your prescription drug cards, your pharmacist may electronically co-ordinate for you.
Claims for Dependent Children
The parent who has the earlier birthday in the calendar year (the year of birth is not considered) submits the claim for dependent children. This applies whether the parents are cohabiting, or when there is a shared custody arrangement in the event of separation or divorce.
If You Are Separated or Divorced
If one parent has full custody of a dependent child, claims should be submitted in the following order:
- To the plan of the parent with custody of the child.
- To the plan of the spouse of the parent with custody of the child.
- To the plan of the parent without custody of the child.
- To the plan of the spouse of the parent without custody of the child.
Please advise the Members’ Health Plan if you separate or divorce so that the correct order for payment of benefits can be determined. If the Plan is not advised, it is assumed the first payor is the plan of the parent who has the earlier birthday in the calendar year.
Co-ordination With Government Plans
No payment is provided by this Plan for any portion that is covered or funded by any of the following:
- Saskatchewan Health.
- Workers’ Compensation Board.
- Saskatchewan Government Insurance.
- Saskatchewan Aids to Independent Living.
- Any other government programs and benefits provided in Saskatchewan, or in your province of residence, if other than Saskatchewan.
When reimbursement is provided by one of the above government plans, each covered expense is reduced by the amount payable under that plan. The reduced covered expense is then considered to be the covered expense under all other co-ordination provisions. It is subject to any applicable deductibles, reimbursement levels and maximums under this Plan.