Life Events & Coordination of Benefits

May 26, 2016

Have you experienced a Life Event?

When you elect a Health and Dental option, you are locked in at that level until the next re-enrolment period, which is every 2 years. However, if you experience a Life Event during a plan year that affects your coverage needs, you may make changes to your benefit options without waiting until the next re-enrolment period.

Any of the following is considered a Life Event:Life Event (Baby)

  • Acquiring a spouse
  • Acquiring a child (birth, adoption or step-child)
  • Gain or involuntary loss of similar coverage through your spouse’s group benefit program (for example, because of a change in your spouse’s employment status)
  • Death of your spouse or child
  • Your spouse or child ceasing to qualify for coverage (for example, through divorce or your child’s attainment of a limiting age)

For more information, please refer to your benefits booklet.

What do you do if you experience a Life Event?

If you experience a Life Event, contact Human Resource Services with your details no later than 60 days after the Life Event occurs. If the Life Event is not reported within 60 days your opportunity to change your Flex Option will be during the next re-enrolment.

Additionally, any time you experience a Life Event resulting in a change to your family status, you should review your beneficiary designation.

For more information on your Flex Options, refer to your benefits booklet.

Coordination of Benefits

Coordination of Benefits, or COB, is a benefit claim procedure developed by the Canadian Puzzle pieces thumbs upLife and Health Insurance Association (CLHIA) for individuals covered under two or more Health and/or Dental policies.

Applying this procedure ensures that you and your dependents receive the maximum eligible benefits available from all policies under which you are covered. It also outlines the method used for determining where to submit your claims first.

An EOB (also called a payment summary) is a letter from the insurance company which is sent to you with the claim reimbursement. It outlines the amount of the expense and how much of it was reimbursed.  For drug claims paid via your drug card, your pharmacy receipt is considered your EOB.

Here is how COB works:

Your Own Expenses

  1. Submit your claim to your Great-West Life plan.
  2. If a portion of your claim is not covered by the Great-West Life plan (such as a deductible, coinsurance or an amount over a maximum), submit the EOB form from Great-West Life to your spouse’s plan (if you have family coverage) for reimbursement of the remaining portion.
  3. If a portion of the claim is still not reimbursed, you may submit the EOB form from your spouse’s insurer to your Health Care Spending Account.
  4. If your spouse has a Health Care Spending Account, this plan would be the last payor.

Your Spouse’s Expenses

  1. Your spouse will first submit their own claim to their own insurer.
  2. If a portion of their claim is not payable under their own plan, the EOB can be submitted to your Great-West Life plan, if you have family coverage.
  3. If a portion of their claim is still not payable, the remaining portion can be submitted to your spouse’s Health Care Spending Account, if applicable.
  4. The last payor for your spouse’s expenses is your Health Care Spending Account.

Your Dependent Child’s Expenses

  1. If both your Great-West Life plan and your spouse’s plan include coverage for dependent children, the claims should first be submitted to the plan of the parent whose birth date is earlier in the calendar year. For example, if your birth date is February and your spouse’s birth date is August, the claim should first be submitted to your Great-West Life plan. (In situations where you and your spouse have the same birth date, the claim should be submitted to the plan of the parent whose first name begins with the earlier letter in the alphabet.)
  2. If the first payor doesn’t cover the full expense, the EOB can be forwarded to the other parent’s plan. Regardless of the above rules, if the parents are separated or divorced, the first payor is the insurer of the parent with custody of the child, then the plan of the spouse of that parent, then the plan of the parent not having custody of the child and finally the plan of the spouse of that parent.
  3. Health Care Spending Accounts are the final payors. To determine which Health Care Spending Account the remaining portion of the expense should be submitted to first, apply the birth date rule as described in step 1.

Supporting Your Wellnessshutterstock_173113409

The LifeWorks website contains useful tools and articles to help you and your family. You even have access to seminars at www.lifeworks.com.

LifeWorks has resources to help your family thrive, regardless of your family situation. Whether you’re a single parent, a new parent or raising teenagers check out the useful resources that LifeWorks has to offer! This month the recommended Podcast is:

  • Holding a Family Meeting