Coordination of benefits is the insurance term used to describe the process when two insurance providers split the costs of coverage.
We’ve heard from employees that it often seems like more trouble than it’s worth to go through the steps of coordinating benefits.
Your Ryerson benefits provide a high level of coverage and the university (not our insurance company) pays 100% of your eligible benefits expenses. Health and dental care costs are consistently increasing, so in order to maintain the current level of benefit coverage, it’s important Ryerson isn’t paying claims as the first payer when it is in in fact second or third payer.
By effectively coordinating benefits you’re playing an important part in ensuring that your current level of Ryerson benefits are sustained, and you could save money by having 100% of your out of pocket expenses covered.
The insurance industry in Canada has set up a procedural guide for all insurance companies that describes how benefits are calculated and which plan pays first when you make a claim to more than one group plan. You can only receive 100% of what you paid out originally.
For Ryerson employees who are also covered under their spouse’s plan, you should submit first to the Ryerson plan and then submit any unpaid balance to your spouse’s plan.
Your spouse should submit first to their employer’s plan and then submit any unpaid balance to your plan with Ryerson.
Claims are covered under the parent’s plan with the earlier birthday in the calendar year (month/day) first and then under the parent’s plan with the later birthday in the year. For example, if you are born July 24, 1970 and your spouse is born December 4, 1965, and you both have coverage, you would submit any expenses first to your plan, and then any unpaid balances to your spouse’s plan.
In sole custody arrangements, if the children live with only one parent, the date of birth rule should be applied as follows:
In joint custody situations, the date of birth rule should be applied to parents first and if there is still an outstanding balance owing, then to the step-parents as follows:
If you have questions about your coordination of benefit situation, please contact Pension and Benefits.
For more information about the specifics of your coverage, please contact Sun Life at 1-800-361-6212.
Ryerson reserves the right, at any time, to amend, change or discontinue any benefit coverage. If there is a question about coverage referred to in any portion of this benefits communication, the master contract from the insurer is the governing document.