D.A. Townley.  -  Plan Administrators      



Health Benefit FAQs

The following are the most commonly asked questions by Members regarding the Health Benefit Plan. If you would like detailed information on any of these topics, please consult the Group Insurance Plan Booklet. If you still have questions after reading this information, please contact the Plan Administrator.

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.


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