Coordination of Benefits
Coordination of Benefits is a provision that determines the sequencing of coverage when Plan members and their dependents are eligible for benefits under more than one private health care plan. The PSHCP uses the benefit coordination guidelines established by the Canadian Life and Health Insurance Association (CLHIA). The specific sequencing for coordination of benefits under the PSHCP is outlined in the Member Booklet and the Plan Document.
Coordination of Benefits allows two people with PSHCP coverage who are married or in a common-law relationship to be covered as dependants by each other’s plans. Eligible expenses can be submitted under both members’ certificate numbers, providing greater reimbursement (up to 100%) to the family.
PSHCP members can also coordinate their benefits with other plans. For example, a Plan member may be eligible for individual coverage another group benefits plan, or may be covered as a dependant under their spouse or common-law partner’s plan. PSHCP benefits can also be coordinated in cases where a dependant child is covered under more than one plan.
To inform Sun Life that you would like to coordinate your benefits, you must complete Positive Enrolment. During this process, you will be asked to provide your spouse’s PSHCP certificate number or information about other private group health care plans under which you or your dependants are covered. Such information includes the type of coverage offered (e.g. drugs, medical, other), whether it is for single or family coverage, and by what relationship you or your dependant is eligible for such coverage (e.g. your child is covered through your spouse’s plan). You can add or modify your coordination of benefits information at a later date by submitting a Positive Enrolment Change Form. The Sun Life Positive Enrolment Booklet provides additional guidance on how to complete the Coordination of Benefits section.