Coordination of Benefits

April 29, 2019

Historically under the PSHCP, you could not be both a covered member and a dependant under the plan. Since April 1, 2006, however, if both you and your spouse are eligible for PSHCP coverage in your own right and you both elect family coverage, each of you can cover the other as well as your eligible dependant children. This means that you can coordinate eligible expenses between each other’s coverage and receive up to 100% of the expenses incurred.

For example, if you incur eligible psychological counselling expenses in the amount of $3,000, and both you and your spouse have family coverage under the PSHCP, you will submit the claim and receive a reimbursement of $1,600 (80% of the maximum eligible expense of $2,000). Your spouse can then submit a claim for the amount not reimbursed (i.e. $1,400) and receive a reimbursement of $1,400. This represents a combined reimbursement amount of $3,000 rather than the $1,600 you would have received without the coordination of benefits.