Coordination of Benefits

For GreenShield Canada (GSC) Benefits:

If a plan member is covered for extended health and dental benefits under more than one plan, their benefits under this plan will be coordinated with the other plan so that they may be reimbursed up to 100% of the eligible expense incurred.  

If your family has other benefit coverage, it will be coordinated according to industry standards. For more information on industry standards, please visit the Canadian Life and Health Insurance Association at https://www.clhia.ca/.

For eligibility purposes, use the following guidelines to identify the primary and secondary plans.

GSC Plan Member

If you have benefits under two group plans, priority goes in the following order:

  1. The plan where you are a full-time plan member
  2. The plan where you are a part-time plan member
  3. The plan where you are a retiree

Claiming for Your Spouse

If your spouse has other benefit coverage (regardless if that benefit plan is a GSC plan or with a different benefit provider), GSC coverage is always secondary for your spouse and claims will be paid according to Industry standards:

  1. First, your spouse must submit claims to their benefit plan (this is your spouse’s primary benefit plan).
  2. Next, submit the unpaid portion to your GSC plan (this is your spouse’s secondary plan).

Your Children’s Claims

When dependent children are covered under both your GSC plan and the spouse’s benefit plan, use the following to determine the order of eligibility:

  1. First, submit your children’s claims to the plan of the parent whose birthday falls earliest in the year regardless of the year of birth. (That’s the primary plan for your child)
    1. The plan of the parent whose first name begins with the earlier letter of the alphabet, if the parents have the same birth date
  2. Next, submit the unpaid portion to the other parent’s plan (the secondary plan for your child).

In situations of separation or divorce, the following order applies when determining which of the adults are responsible for the coverage of the children:

  1. The plan of the parent who has custody of the dependent child
  2. The plan of the spouse of the parent who has custody of the dependent child
  3. The plan of the parent who does not have custody of the dependent child
  4. The plan of the spouse of the parent who does not have custody of the dependent child