Coordinating Benefits with Multiple Plans
When you or one of your dependants has Extended Health Care (Drugs, Other Medical Services and Supplies and Travel Emergency benefits), Dental Care and Vision Care coverage through two or more group benefit plans, coordinating benefits between your plans becomes a step in your claiming process. This process allows you to receive up to the maximum eligible reimbursement for your claims. Total payment on any claim cannot exceed the actual cost of the service or supply.
If you have any questions, need clarity or additional information on coordinating benefits with multiple plans, your situation is complicated or if your spousal situation changes please contact us.
Determine your Coordination of Benefits Coverage
You and Your Spouse
- If the claim is for you, and you are an ASEBP covered member, ASEBP pays first and your spouse’s plan pays second.
- If the claim is for your spouse, your spouse’s plan pays first and ASEBP pays second.
You Have More Than One Group Plan
- If you have a full-time job, your full-time job's plan pays first.
- If you also have a part-time job, your part-time job's plan pays second.
- If you have coverage as a retiree, your retiree plan pays third.
You Have Two Part-Time Jobs or Two Retiree Plans
- If you have two part-time jobs or two retiree plans, the plan for which you have been a part-time employee or retiree for the longest pays first.
- The coverage from your second part-time or retiree job pays second.
Your Dependant Children
- If the claim is for your dependant children—whether you have a spouse, are separated or divorced—determine which parent’s birthday occurs in the calendar year first. Please note that age is not a factor.
- For example, if the father’s birth date is October 19 and the mother’s is October 8, claims for dependant children go to the mother’s plan first and the father’s plan second.
Your Dependant Children in Sole Custody Situations
- If you have sole custody or a complicated custody situation, contact us for more information.
You and Your Spouse are 65+
- Claims for eligible expenses for all family members should first be submitted Alberta Coverage for Seniors Plan (your provincial health care insurance plan).
- Claims for any eligible balance should then be submitted to ASEBP, along with a copy of the Explanation of Benefits statement from the plan that paid first.
You are Coordinating with Government Sponsored Programs and Dependants
- Government-sponsored programs pay first, unless otherwise stated by legislation.
- This also applies to your spouse who is 65+ and is included in a government-sponsored program.
You are Coordinating with an Individual Plan
- Coordination of benefits rules for individual plans may differ. Please contact us if you or your spouse has an individual benefit plan with another provider that you coordinate benefits with.
- For example, if your spouse is self-employed and has purchased individual health coverage through another insurance provider, coordination of benefits rules may differ.
How does Claiming with Multiple Plans Work?
- If you’re submitting a claim to the plan that pays first, be sure to submit your original receipts, if applicable, (and photocopy your receipts to claim with the second plan) and indicate that you have coverage under another plan where necessary. Check to make sure you've met all of the claim requirements of the plan that pays first (e.g. providing a written physician's order where necessary).
- Once you receive your Explanation of Benefits statement from the plan that pays first—mailed to you after submitting your first claim, detailing whether the claim is paid or declined by your primary provider—you may submit your claim to the second plan. If your claim was declined because you didn't meet all of the first plan's claim requirements, please note that ASEBP, as the second plan, will not pay the claim, either.
- When you submit your claim to the plan that pays second, you’re required to include the Explanation of Benefits statement and copies of your original receipts, if applicable.
See Submitting a Claim for more information on all the ways you can claim.