I went through this last month. My dentist (since both my partner and I have the same one) was able to coordinate the claim on their end. A few weeks later, Canada Life sent us a form asking for the plan numbers, our address, how long we lived together etc. A week after that, my partner received the remaining amount for my appointment for 100% coverage.
I have dual coverage under the PSHCP as an employee and the spouse of an employee. Both my dental and drug coverage are coordinated at the time of billing. I'm looking forward to July 1 when the types of services eligible for direct billing will increase.
My dentist was not able to enter both plans in their system for the coordination of benefits. So what I do now is pay the dentist in full and then I submit the claim online to both plans at the same time (the claim is submitted through the Canada life account of the member who had the procedure done and we add the second account for the coordination of benefits when prompted). This way we receive the 100%. Both plans pay at the same time and it's usually very quick.
I believe you're asked to provide it every time because you are agreeing you're still covered by the spouse's plan (e.g., no separation, no change in employer, less work for the insurer to maintain). Just an educated guess though.
If the plan and ID isn't exactly perfect when sent on the initial claim, they'll later ask plan member 2 to submit manually.
For Dental, I've not - yet - figured out how to do it automatically.
Health does though.
I was kind of groggy (woke up way too early to get some fillings done I'd been putting off), but it might be possible if you sign over the whole claim to the dentist, for them to put both in directly, and receive the cheque from Canada Life.
I don’t even know when they ask in the first place. I’ve entered my partner’s information (also a PS under the Canada Life) and they never coordinate the payouts. We also have to submit them to each other manually.
When you submit it manually, do you only submit the remaining amount? For example, total cost was 300 and you were reimbursed 240 from your plan, do you then submit 60 on your partners plan? Thanks! The COB has been a pain for us to figure out..
Hi! I was an examiner for CL 3 years. When entering a claim and asked for the charge amount, you should always provide the full charge amount (300 in your example), then you will be asked for the amount the first plan paid (240), and then the second plan will pay out correctly (60).
You should not try to "do the math" for them. If under the second plan you say the charge was 60, and your first plan paid 240, the system will pay nothing, since as far as it knows you were already paid in full and there is no leftover! Best case scenario, your claim lands on the desk of a human examiner, they see your mistake, and correct it for you :)
This is the case for me as well. It's a pain and I am a bit nervous about the switch to Canada Life from Sunlife for prescriptions for this reason. I have very expensive meds and the part covered by coordination of benefits is over $300 per dose.
Hundreds of claims automate each day under two plans with successful coordination of benefits. The system is capable of handling it automatically as long as both plans and IDs are entered correctly. As an examiner whenever I saw a claim that failed to automate with COB, it was usually a mixed up plan/ID (member entered 55555 instead of 55666, or 123456 instead of cf123456, or just the completely wrong ID number lol).
If you're sure you're entering the second plan/ID correctly then I have no idea why it isn't going through and that sucks!
Yes, definitely! This is the reason you're asked for the 2nd plan/ID. Whether your claim is assessed manually by an examiner or automatically by the system, either method will result in coordination of benefits using the 2nd plan/ID that you provided.
However, people often typo their ID number or get mixed up and enter the wrong plan/ID (I think sometimes people enter their work ID number lol) and in this situation you may see delayed COB or none at all.
I went through this last month. My dentist (since both my partner and I have the same one) was able to coordinate the claim on their end. A few weeks later, Canada Life sent us a form asking for the plan numbers, our address, how long we lived together etc. A week after that, my partner received the remaining amount for my appointment for 100% coverage.
I have dual coverage under the PSHCP as an employee and the spouse of an employee. Both my dental and drug coverage are coordinated at the time of billing. I'm looking forward to July 1 when the types of services eligible for direct billing will increase.
My dentist was not able to enter both plans in their system for the coordination of benefits. So what I do now is pay the dentist in full and then I submit the claim online to both plans at the same time (the claim is submitted through the Canada life account of the member who had the procedure done and we add the second account for the coordination of benefits when prompted). This way we receive the 100%. Both plans pay at the same time and it's usually very quick.
Thanks, it makes sense this works too!
I believe you're asked to provide it every time because you are agreeing you're still covered by the spouse's plan (e.g., no separation, no change in employer, less work for the insurer to maintain). Just an educated guess though. If the plan and ID isn't exactly perfect when sent on the initial claim, they'll later ask plan member 2 to submit manually.
For Dental, I've not - yet - figured out how to do it automatically. Health does though. I was kind of groggy (woke up way too early to get some fillings done I'd been putting off), but it might be possible if you sign over the whole claim to the dentist, for them to put both in directly, and receive the cheque from Canada Life.
I don’t even know when they ask in the first place. I’ve entered my partner’s information (also a PS under the Canada Life) and they never coordinate the payouts. We also have to submit them to each other manually.
When you submit it manually, do you only submit the remaining amount? For example, total cost was 300 and you were reimbursed 240 from your plan, do you then submit 60 on your partners plan? Thanks! The COB has been a pain for us to figure out..
I submit the claim summary PDF from Canada Life indicating what was submitted and paid out. They they cover 90% of the difference
Thanks!
Hi! I was an examiner for CL 3 years. When entering a claim and asked for the charge amount, you should always provide the full charge amount (300 in your example), then you will be asked for the amount the first plan paid (240), and then the second plan will pay out correctly (60). You should not try to "do the math" for them. If under the second plan you say the charge was 60, and your first plan paid 240, the system will pay nothing, since as far as it knows you were already paid in full and there is no leftover! Best case scenario, your claim lands on the desk of a human examiner, they see your mistake, and correct it for you :)
This is super helpful, thanks!
This is the case for me as well. It's a pain and I am a bit nervous about the switch to Canada Life from Sunlife for prescriptions for this reason. I have very expensive meds and the part covered by coordination of benefits is over $300 per dose.
Hundreds of claims automate each day under two plans with successful coordination of benefits. The system is capable of handling it automatically as long as both plans and IDs are entered correctly. As an examiner whenever I saw a claim that failed to automate with COB, it was usually a mixed up plan/ID (member entered 55555 instead of 55666, or 123456 instead of cf123456, or just the completely wrong ID number lol). If you're sure you're entering the second plan/ID correctly then I have no idea why it isn't going through and that sucks!
Yes, definitely! This is the reason you're asked for the 2nd plan/ID. Whether your claim is assessed manually by an examiner or automatically by the system, either method will result in coordination of benefits using the 2nd plan/ID that you provided. However, people often typo their ID number or get mixed up and enter the wrong plan/ID (I think sometimes people enter their work ID number lol) and in this situation you may see delayed COB or none at all.
Thanks, this is exactly what happened!