The order in which claims are submitted to multiple group plans is determined by your coverage type.

•       Policy holder: your employers’ or student association’s plan.
•       Dependents: your parents’ or your spouse’s employers’ plan or student association’s plan.

The procedure to coordinate your student association’s plan with your employer’s plan is as follows:

1. Submit your health or dental claim to your employer’s plan’s insurance company, making sure to keep a copy of the receipts if submitting by mail.
2. Once the claim is processed, you will receive a “Statement of Benefits” from your employer’s insurance company.
3. Submit your claim to Major Plan along with a copy of your health care or dental receipts, the appropriate form, and the “Statement of Benefits.”
4. Major Plan will send you the eligible amount, and the second “Statement of Benefits” will be available for download from the web portal.

The procedure to coordinate your student association’s plan with your parents’ or spouse’s plan is as follows:

1. Submit your health or dental claim to Major Plan, making sure to keep a copy of the receipts if submitting by mail.
2. Once the claim is processed, download the “Statement of Benefits” from the Major Plan web portal.
3. Submit your claim to your parents’ or spouse’s plan’s insurance company along with a copy of your health care or dental receipts, the appropriate form, and the “Statement of Benefits.”
4. Your parents’ or spouse’s insurance company will send you the eligible amount along with a second “Statement of Benefits.”

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:

1. Submit your health or dental claim to the plan insurance company for the educational institution in which you have full-time student status, making sure to keep a copy of the receipts if submitting by mail.
2. Once the claim is processed, you will receive a “Statement of Benefits” from this educational institution’s insurance company.
3. Submit your claim to the plan insurance company for the educational institution in which you have part-time student status along with a copy of your health care or dental receipts, the appropriate form, and the “Statement of Benefits.”
4. The above educational institution’s insurance company will send you the eligible amount along with a second “Statement of Benefits.”

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 1^st payer is determined according to the coverage start date of the oldest plan.

1. Submit your health or dental claim to the insurance company for the educational institution whose plan’s coverage start date is the oldest, making sure to keep a copy of the receipts if submitting by mail.
2. Once the claim is processed, you will receive a “Statement of Benefits” from the educational institution’s plan insurance company.
3. Submit your claim to your second plan’s insurance company along with a copy of your health care or dental receipts, the appropriate form, and the “Statement of Benefits.”
4. The above insurance company will send you the eligible amount along with a second “Statement of Benefits.”

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 1^st payer. For more information, contact customer service.

E.g.: Eligible dental costs $70

Plan A (Co-insurance 70%): Liability as 1^st payer $49

Plan B (Co-insurance 60%): Liability as 1^st payer $42

By adding the sums that would be paid by both plans as 1^st 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.