Submitting to a secondary insurer

Coordination of benefits applies when a patient is covered under more than one plan, either with a single insurance company or with multiple insurers. Coordination rules determine which insurer or plan pays first and which one(s) pay(s) subsequently.

You can use coordination of benefits if both the primary and secondary coverage are under the same insurance company and through an insurer that supports coordination of benefits. When you submit the coordination request, only the primary is processed in real-time; the secondary claim is processed manually and sent to the recipient member. Refer to the View FAQs by insurer section of the FAQ to see which insurers support coordination of benefits when the patient has primary and secondary coverage with the same insurer. Currently, coordination of benefits is only supported for different insurers if the patient's coverage is with Canada Life and Claims Secure.

The Secondary coverage section is optional because not all patients have secondary coverage. However, if the patient does have secondary coverage, this section must be completed so that this information can be provided to the primary insurer for the purpose of claim adjudication.

Determining coverage

When both spouses have their own coverage, primary and secondary coverage are determined using the following guidelines:

  • Patients submit their claims under their own plan (policy) and identify their spouse’s plan (policy) for secondary coverage purposes.

  • If the patient is a child and is covered under both policies, the claim should be submitted under the policy of the parent whose birthday occurs earliest in the year. For example, if the father’s birthday is February 1 and the mother’s birthday is September 1, list the father’s policy as primary and the other’s policy as secondary.

Further information regarding order of coverage can be found in the guidelines issued by the Canadian Life and Health Insurance Association Inc.

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co-ordination of benefits / coordination of service