Coordination of benefits

What is coordination of benefits?

If you and your dependents are covered for extended health and/or dental benefits under more than one plan, your reimbursement will be co-ordinated following insurance industry standards. The maximum amount that you can receive from all plans for eligible expenses is 100% of actual expenses. 

The plan that does not contain a co-ordiation of benefits clause is always considered to be the first payor and therefore pays benefits before a plan which includes a co-ordination of benefits clause. 

For dental accidents, extended health benefits with dental accident coverage provides reimbursement before dental benefits. 

Where both plans contain a co-ordiantion of benefits clause, claims must be submitted in the order described below. 

How does coordination of benefits work?

Claims for you and your spouse should be submitted in the following order: 

  1.  the plan where the person is covered as an employee. If the person is an employee under more than one plan, the following order applies:
  • the plan where the person is covered as an active full-time employee.
  • the plan where the person is covered as an active part-time employee. 
  • the plan where the person is cvered as a retiree.

2. the plan where the person is covered as a dependent (for exmaple, if you are covered as a dependent under your spouse's plan).

Claims for a dependent child should be submitted in the following order:

  1. the plan where the child is covered as an employee. 
  2. the plan where the child is covered under a student health or dental plan provided through an educational instituition.
  3. the plan of the parent with the earlier birth ate (month and day) in the calendar year. For example, if your birthday is May 1 and your spouse's birthday is June 5, you must claim under your plan first.
  4. the plan of the parent whose first name begins with the earlier letter in the alphabet, if the parents have the same birth date. 

Expenses not covered by the first benefit may be eligible for some reimbursement under the other benefit.

If you wish to update your coordination of benefits (i.e. spouse loses or gains coverage), please log in to Workday to update following the user guide instructions. For Retirees, please email hrhelp@uwaterloo.ca to update your coordination of benefits.