Coordinating Benefits with Multiple Plans
When you, your spouse or your family have more than one benefit plan, you can combine or share them to maximize your coverage. This means you can receive up to the maximum amount of coverage when you claim Drugs, Other Medical Services & Supplies, Travel Emergencies, Dental Care and Vision Care. This process is called Coordination of Benefits, or COB, and it’s a standard practice for benefit providers across Canada.
How Does it Work?
When a claim is submitted, you’ll receive an Explanation of Benefits (EOB) statement—available on My ASEBP—which outlines how much your plan covers. You can then submit the EOB statement with your claim to your other benefits provider (e.g. spouse’s plan or your second plan) for the remaining eligible amount.
Which Plan Pays First?
Before you can determine which plan to submit your claims to first, you need to identify which plan is your primary plan and which is your secondary plan. The primary plan always pays first. You use your secondary plan to cover the outstanding amount that was not covered by your primary plan.Â
For Individuals
Determining the primary and secondary plans for individuals with more than one benefit plan depends on your specific situation. Whether you have more than one plan with the Alberta School Employee Benefit Plan (ASEBP), or your other plan is with a different benefits provider, you can still combine them to make the most of your coverage.Â
For example, 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 also have coverage as a retiree, your retiree plan pays third.
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.
For Couples
Your plan will be primary for you, and your spouse’s plan will be primary for them. When submitting claims, you should submit to your plan first, and the remaining amount can be submitted to your spouse’s plan. Your spouse should submit their claims to their plan first, and any remaining amounts can then be submitted to your plan.
For Families with Dependent Children
All claims for dependent children should be submitted to the primary plan first. The parent whose birthday falls earlier in the calendar year is considered the primary plan holder for any dependent children. For example, if your birthday is April 13, 1970 and your spouse’s birthday falls on April 2, 1975 your spouse is the primary plan holder—regardless of which parent is older.Â
Separation or Divorce
If parents are separated or divorced, claims for dependants will work in the same way as above in the cases of joint custody (based on which parent’s birthday falls first in the year). For sole custody situations, please contact us for more information.
You and/or your Spouse are 65+
Claims for eligible expenses for any family member over 65Â should first be submitted to 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.
Submitting Claims with Coordinating Benefits
Here are some things to consider when you’re submitting claims and you have more than one benefit plan:
- If your plan pays first, you must allow the claim to be submitted to all plans before you submit any unpaid amounts to your Health Spending Account (HSA).
- Your My ASEBP account will only show claims made to your ASEBP plan—not your spouse’s plan. If your plan pays first, your account will not show any claims (full or partial payment) paid by another plan. My ASEBP or the My ASEBP Mobile App may 'allow' you to submit extra claim amounts to your HSA because we aren’t able to gather data on other payments that happen on a claim after it’s submitted to your ASEBP plan. If your claim shows an eligible amount to transfer on My ASEBP or the My ASEBP Mobile App, please check first to see if the remainder was already covered by another plan. If it hasn’t been covered by another plan (or if it’s only been partially covered and there’s still an amount remaining) you can then submit all or a portion of the remaining amount to your HSA.
- Note: if you submit expenses to your HSA account that were already claimed by another plan, you’ll have to reimburse ASEBP.
Setting up and Making Changes to your COB
If you haven’t set up COB yet, have multiple plans or are unsure which plan is primary, contact us and let us know that you’d like to coordinate benefits and we’ll help get things set up properly.
If you have any changes to your marital or dependant status, or if your coverage situation changes, you'll need to inform ASEBP to ensure your claims continue to be processed properly. You can fill out the Coordination of Benefits Information form and send it to us, or call us with your plan number(s) and information. To update your file, we’ll need to know the following about the other benefits provider: the name of the provider, the effective date of your coverage, what type of coverage you have and if all of your dependants are included in that coverage.Â