Coordination of Benefits

Your health plan benefits may be coordinated 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 coordinated or reduced by any amount payable under a government plan.

Coordinating With Your Spouse’s Plan

If your spouse or dependents have coverage under another benefit plan, benefit coverage will be coordinated when claims are submitted. Alternately, you can contact Green Shield Canada to update coordination of benefits information.

If you are both MHP members:

GSC will automatically coordinate to cover the total benefit

Your coordination of benefits information is updated automatically by Green Shield Canada when you submit claims, or you can to update over the phone.

If you and your spouse have different plans:

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. Benefits cannot be paid 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.

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 GSC if you separate or divorce so that the correct order for payment of benefits can be determined. If not, GSC will assume the first payor is the plan of the parent who has the earlier birthday in the calendar year.

Coordination 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 coordination provisions. It is subject to any applicable deductibles, reimbursement levels and maximums under this Plan.