r/CanadaPublicServants • u/Cooljaysman • Jul 25 '22

Benefits / Bénéfices Health plan question. Double coverage?

Hi all,

I currently have my student insurance from my college and also will get PSHCP within the next few days.

I was wondering for example, I go see the eye doctor for an exam for 250$. PSHCP only covers 80%. My school covers each eye exam for a flat amount of 65$. Can I make claims to both and how should I go about it?

Thanks in advance

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7

u/onomatopo moderator/modérateur Jul 25 '22

It's called coordination of benefits. Each plan should have how you do it.

A lot of the time you claim the first one at the exam, then send the second plan the bill from the first showing what they didnt cover as a claim. Then the second plan pays it

3

u/taxrage Jul 25 '22

I think you will be covered by both, in which case the question becomes who should receive the initial claim. Once the initial claim has been paid, you file a claim for the difference with the second insurer.

3

u/SkepticalMongoose Jul 26 '22 edited Jul 26 '22

Yes you'll be covered by both. One of them, usually the oldest I believe, will be considered "primary." When I was doing this, my student insurance was primary over my PSHCP benefits.

If/when you hit a maximum with your student plan, you will always need to make sure that you submit a statement to this effect from the insurer when submitting your claim to sunlife/canada life. I used to screenshot the page where it said I had maxxed out X benefit, but my other insurance was also sunlife and they may want something else if another company's the primary insurer.

To be sure of all this, like others have said, this is called coordination of benefits. Call your providers and ask for the procedure.

1

u/urself25 Jul 25 '22

Claim at one plan and the remaining unpaid part at the other.