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Since it is possible that you are already covered by another insurance plan, your association offers you a supplemental insurance plan that allows the coordination of benefits for which you are eligible. Coordination of benefits allows you to combine the benefits and services from your student plan with those received from your parents’, your spouse’s, or your employer’s plan. It is important to confirm existence of other coverages and to compare them. Claims for reimbursement can be made to multiple plans, however, the total sums received under all claims may not exceed 100% of the costs incurred. For this reason, it is important to determine the order in which claims should be submitted to your various group plans in order to coordinate benefits.
The order in which claims are submitted to multiple group plans is determined by your coverage type.
The procedure to coordinate your student association’s plan with your employer’s plan is as follows:
The procedure to coordinate your student association’s plan with your parents’ or spouse’s plan is as follows:
You may be studying in two (2) educational institutions and benefit from a supplemental insurance plan for both. If this is the case, the procedure to coordinate both of your student association’s plans may vary according to your student status (full-time or part-time). Full-time or part-time student status is established by your educational institution.
If you have full-time student status with one of your educational institutions, and part-time status with the other:
If you have the same student status in all your educational institutions (full-time/full-time or part-time/part-time):
When your student status is the same in both of your educational institutions, the order of precedence for the 1st payer is determined according to the coverage start date of the oldest plan.
If the precedence of the first payer cannot be established, your claim will be subject to a proration of the benefits, meaning that the benefits paid by the insurance plans are calculated according to the amount that would be paid by each plan if it was 1st payer. For more information, contact customer service.
E.g.: Eligible dental costs $70
Plan A (Co-insurance 70%): Liability as 1st payer $49
Plan B (Co-insurance 60%): Liability as 1st payer $42
By adding the sums that would be paid by both plans as 1st payer, we get: $48 + $42 = $91 But the total sums received under both plans may not exceed the eligible costs of $70.
Plan A (proration: $49 divided by $91 = 53.85%): Benefit paid $37.70
Plan B (proration $42 divided by $91 = 46.15%): Benefit paid $32.30
Since it is possible that you are covered by more than one insurance plan, it is important that you inform your insurance companies of this. The total sums received under all your plans for a given item, service received, or care claimed may not exceed 100% of the eligible costs. In some cases, the total sums received under all your plans may be lower than the costs incurred for a given item, service received, or care claimed.
Failure to provide all the information required for the proper assessment of your file, whether intentional or not, may result in the termination of your coverage plan.