What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to
receive similar benefits simultaneously under the Health &
Welfare Plan or any
other group insurance plan (including Provincial Plans), to prevent over
payment, benefits payable under this Plan would be co-ordinated with the other Plan.
For example: A Member's wife is covered under her employer's plan with
family coverage. The Member, his spouse and their three children are all covered
under both Plans. To determine which Plan would be primarily responsible for
the dependent children: Between the Member and the spouse, whomever's birthday falls first in
the calendar year, their plan is responsible for the initial reimbursement of benefits
for the dependent children, then, any amounts that are not paid by that Plan are
submitted to the other parent's plan.
In the event that the Member's birthday is in April and the spouse's
birthday is in January. The spouse's plan would be primarily responsible for the spouse's
claims and the claims of the children. Any amounts not paid by the spouse's plan can be
submitted to the Member's Plan for reimbursement. Any amounts for the Member that are
not paid by the Member's Plan, can be submitted to the spouse's plan for reimbursement.