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Coordinate Your Benefits with Ease

When you, your spouse, and your dependents are covered under more than one plan, claiming under both plans can mean greater reimbursement of medical and dental expenses, minimizing your out-of-pocket expenses.

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Coordination of Benefits (COB)

If you have health or dental coverage under another plan, you can coordinate with your UA Local 67 Benefits Plan for up to 100% reimbursement. Here’s how it works.

For Your Claims
  1. Submit your claims to your UA Local 67 Benefits Plan first.
  2. After receiving reimbursement from GreenShield, submit any unpaid balance to your spouse’s benefits plan.
  3. Then (if applicable), submit remaining unpaid amounts to your HCSA.
  4. Finally (if applicable), submit any remaining unpaid amounts to your spouse’s HCSA.

If you are a member of another benefits plan, such as another employer or retiree plan, contact UA Local 67 Benefits and we’ll help you navigate the order to submit your claims.

If you are over 65 and covered by the Ontario Drug Benefit Program (ODB), drug claims must be submitted to ODB first. You can then submit any out-of-pocket amount (e.g. the ODB deductible) to the UA Local 67 Benefits Plan. If a medication is not covered by ODB, you may need to submit a prior approval request to GreenShield for approval.

For Your Spouse’s Claims
  1. Submit your spouse’s claims to their benefits plan first.
  2. After receiving reimbursement from your spouse’s insurer, submit any unpaid balance to your UA Local 67 Benefits Plan.
  3. Then (if applicable) submit remaining unpaid amounts to your spouse’s HCSA.
  4. Finally (if applicable), submit any remaining unpaid amounts to your HCSA.
For Eligible Dependent Children’s Claims

Who has the earliest birthday in the year – you or your spouse? If you share the same birthday, whose first name comes first in the alphabet?

  • If it’s you, submit your children’s claims to the UA Local 67 Benefits Plan first.
  • If it’s your spouse, submit your children’s claims to your spouse’s plan first.

Then submit any unpaid balance to the other plan, and finally to your/your spouse’s HCSA (if applicable).

For Separated or Divorced Parents

Where parents have joint custody, claims should be submitted in the same order described above (to the plan of the parent with the earliest birthdate in the year first, then to the other parent’s plan). Where one parent has sole custody, claims go to the plan of the custodial parent and their spouse first, then to the non-custodial parent’s plan.

Important Notes:

  • Motor Vehicle Accidents: Claims from injuries due to car accidents should be submitted to the auto insurance company first.
  • Work-Related Injuries: Claims from work-related injuries should be directed to the Workplace Safety and Insurance Board (WSIB) as the first payor.

By coordinating your benefits effectively, you can maximize your coverage and ensure that you and your family receive the support you need.

Have a Claim for Reimbursement?

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