How to coordinate benefits between your plan and your spouse's plan
Are you and your spouse covered by separate benefit plans? Then you may be able to enjoy reimbursement for up to 100% of eligible claims through Coordination of Benefits (COB).
How it works
Is the claim for you?
Submit your claim to Manitoba Blue Cross first, then provide a copy of the Explanation of Benefits (EOB) statement to your spouse’s insurer.
EXAMPLE
David has a Manitoba Blue Cross plan through his employer, while his spouse Anna's employer-sponsored plan is with another insurer. David claims $100 from Manitoba Blue Cross for a dental checkup. He receives an 80% reimbursement ($80). Along with his reimbursement, he receives an EOB statement explaining the eligible claim portion paid. He sends his EOB statement, along with a copy of the original claim, to Anna's plan.
Anna receives a payment for the eligible amount of the unpaid balance from her plan. David receives up to 100% reimbursement for the cost of his checkup.
Is the claim for your spouse?
Have your spouse submit the claim to their insurer first, then provide a copy of the EOB statement to Manitoba Blue Cross.
EXAMPLE
Anna claims $200 from her employer-sponsored plan for eyeglasses. She receives an 80% reimbursement ($160). Along with her reimbursement, she receives an EOB statement explaining the eligible claim portion paid. She sends her EOB statement, along with a copy of the original claim, to Manitoba Blue Cross.
David receives a payment for the eligible amount of the unpaid balance from Manitoba Blue Cross. Anna receives up to 100% reimbursement for the cost of her glasses.
Is the claim for your children?
First, submit to the insurer of the parent whose birthday comes earlier in the calendar year (based on month, not year or age). If you share the same birthday, submit in alphabetical order of first name. Then provide a copy of the EOB statement to the other parent's insurer.
EXAMPLE
David and Anna’s daughter claims prescription drugs. Anna's birthday is in May and David's is in July— so the claim is sent to Anna’s plan first, and later to Manitoba Blue Cross for reimbursement of the remaining balance.
Are both plans with Manitoba Blue Cross?
If you are covered under more than one plan with Manitoba Blue Cross, we will automatically coordinate your family’s claims on an ongoing basis provided you have indicated upon enrollment (or contacted us to let us know) that you are covered under more than one Manitoba Blue Cross plan.
You only have to submit one claim for reimbursement and the balance of your claim will automatically process through your spouse’s plan for coordination of benefits.
Do you have a health spending account?
In accordance with Canada Revenue Agency guidelines, a health spending account (HSA) must be the last payer after government, employer, individual, student and spousal plans. If you have more than one health benefits plan, all claims must be submitted through all carriers first before a health spending account claim can be made.
EXAMPLE
Maria has a claim of $110 for speech language pathology. She submits it to Manitoba Blue Cross. She has used almost all of her benefits for speech language pathology, so she receives $20. Maria submits the claim to her spouse’s employer-sponsored plan and receives a 50% reimbursement of $55. She then provides Manitoba Blue Cross with the explanation of benefits statement from the other carrier and, as she has a health spending account with an automatic claim payment plan, Manitoba Blue Cross automatically reimburses her for the remaining $35 from the health spending account.
If Maria had a health spending account with an on-request claim payment plan, she would submit a request for HSA payment to Manitoba Blue Cross using her online mybluecross® account and provide the explanation of benefits statement from the other carrier.
For further COB guidelines, including blended family rules, please visit the Canadian Life and Health Insurance Association.