Assignment of Benefits
September 30, 2019
The assignment of benefits is an arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital, rather than pay for the services or products themselves and subsequently submit a claim to their benefit plan for reimbursement. This practice is not permitted under the PSHCP in most circumstances.
Under the PSHCP, assignments of benefits may only be permitted for hospital and emergency travel expenses. Assignments of benefits are not permitted for any other service or medical product eligible under the PSHCP, and exceptions are not permissible. Assigned claims for these other products and services will be returned to the plan member with a request to re-submit them directly to the Plan Administrator (Sun Life). While the assignment of benefits was permitted for certain drug expenses prior to the implementation of the PSHCP benefit card in 2010, the practice has been rendered irrelevant as prescription drugs are now processed instantaneously at point-of-sale.