Combine your plans

Since you may have more than one insurance plan, it is important to notify your insurers. The total amount paid under all group plans you have for a given item, service received, or care claimed cannot exceed 100% of eligible expenses. In some cases, the total amounts paid by all group plans may be less than the costs incurred for a given item, service received, or care claimed.

Failure, whether intentional or not, to provide all the information necessary for the proper analysis of your file could result in the termination of your coverage plan.

Here is the procedure to follow in order to coordinate the benefits offered by your student association’s plan with those offered by your employer’s plan:

1. Submit your health or dental claim to the insurance company associated with your employer’s group plan, making sure to keep a copy of your receipts if you are mailing your claim.

2. Once your claim has been processed, you will receive a “statement of benefits” from this insurance company.

3. Submit your claim to Plan Major along with a copy of your health or dental receipts, the appropriate form, and the “statement of benefits.”

4. You will receive the eligible reimbursement from Plan Major and will be able to download your second “statement of benefits” from the Plan Major web interface.

Here is the procedure to follow in order to coordinate the benefits offered by your student association’s plan with those offered by your parents’ or spouse’s plan:

1. Submit your health or dental claim to Plan Major, making sure to keep a copy of your receipts if you are mailing your claim.

2. Once your claim has been processed, download your “benefits statement” from the Plan Major web interface.

3. Submit your claim to the insurance company associated with your parents’ or spouse’s group plan, along with a copy of your health or dental receipts, the appropriate form, and the “statement of benefits.”

4. You will receive the eligible reimbursement along with a second “statement of benefits” from that insurance company.

You may be studying at two (2) educational institutions and have supplementary insurance coverage at each of them. If this is the case, the procedure for coordinating the benefits offered by your two student associations varies depending on whether you are a full-time or part-time student. Full-time or part-time student status is determined by your educational institution.

You have FULL-TIME student status at one of your educational institutions and PART-TIME student status at the other:

1. Submit your health or dental claim to the insurance company associated with the group plan of the educational institution where you have FULL-TIME status, making sure to keep a copy of your receipts if you mail your claim.
2. Once your claim has been processed, you will receive a “statement of benefits” from that insurance company.
3. Submit your claim to the insurance company associated with the group plan of the educational institution where you have PART-TIME status, along with a copy of your healthcare or dental receipts, the appropriate form, and the “statement of benefits.”
4. You will receive the eligible reimbursement along with a second “statement of benefits” from this insurance company.

You have the same student status at all your educational institutions FULL-TIME/FULL-TIME or PART-TIME/PART-TIME:

The rule for determining the first payer when your student status is the same at both educational institutions is based on the plan with the earliest coverage start date. Here is the procedure to follow to coordinate benefits:

1. Submit your health or dental claim to the insurance company associated with the group plan of the educational institution with the earliest plan coverage start date, making sure to keep a copy of your receipts if you mail your claim.
2. Once your claim has been processed, you will receive a “benefits statement” from that insurance company.
3. Submit your claim to the insurance company associated with your second group plan, along with a copy of your health or dental receipts, the appropriate form, and the “statement of benefits.”
4. You will receive the eligible reimbursement along with a second “statement of benefits” from that insurance company.

If the first-payer rule cannot be established, your payment will be calculated on a pro rata basis, meaning that the benefits paid by the group plans will be calculated in proportion to the amounts that would be paid by each plan if it were the first payer. Please contact our customer service department for more information on this subject.

EXAMPLE: Eligible dental expenses $70
Plan A (70% coinsurance): Liability as first payer $49
Plan B (60% coinsurance): Liability as first payer $42

Adding the amounts that would be paid by each plan as the first payer, we get: $49 + $42 = $91. However, the total amount paid under both plans cannot exceed the total eligible expenses of $70.

Plan A (proportional calculation: $49 divided by $91 = 53.85%): Benefit paid $37.70
Plan B (proportional calculation: $42 divided by $91 = 46.15%): Benefit paid $32.30