Coordination Of Claims

Are you covered by more than one benefit plan?

UBC’s Extended Health and Dental plans allow for double coverage. This means that if you are covered under your spouse’s plan, you can also enrol in the UBC Extended Health and Dental plans if your spouse’s plan also allows for double coverage.

If you are covered under another Extended Health and Dental benefits plan in addition to the UBC plan (for example, through your spouse’s plan), you can submit expenses under both plans to maximize your reimbursement.

This means that if your plan does not cover the full costs of service, you can submit a claim for the unpaid amount to the second benefit plan to claim any amount not covered by the first plan.

This is called coordinating your claims and there are rules for the order in which claims are paid.

How to coordinate a claim submission when you are enrolled in two plans

The Canadian Life and Health Insurance Association has established guidelines for how to coordinate claims to ensure claims are charged to the correct benefit plan. The order of claims submission is outlined below.

Submit claims for you and your spouse in the following order

  • The plan where the person is covered as an employee. If the person is an employee under more than one plan, the following order applies:
  • the plan where the person is covered as an active full-time employee
  • the plan where the person is covered as an active part-time employee
  • the plan where the person is covered as a retiree.
  • The plan where the person is covered as a dependent (for example, if you are covered as a dependent under your spouse’s plan).

Submit claims for a dependent child in the following order:

  • The plan where the dependent child is covered as an employee.
  • The plan where the dependent child is covered under a student health or dental plan provided through an educational institution.
  • The plan of the parent with the earlier birth date (month and day) in the calendar year. For example, if your birthday is May 1 and your spouse’s birthday is June 5, you must claim under your plan first.
  • The plan of the parent whose first name begins with the earlier letter in the alphabet, if the parents have the same birth date.

In situations of separation/divorce and there is no joint custody of the child, please refer to your Sun Life Benefits Booklet for the order of claims submission standards. You can download a copy of the Sun Life Benefits Booklet that applies to your employee group.

How do I submit my claim?

Remember to make copies of your receipts before you submit a claim.

Submitting a paper claim

  • Print the applicable claim form.
  • Check the ‘yes’ box on Section 2 of your paper claim form to indicate that you are also a member of another benefit plan.
  • If the second benefit plan is with Sun Life, Sun Life will process the claim under both benefit plans using a single claim form.
  • If the second benefit plan is not with Sun Life, refer to the guidelines above to determine which plan the claim should be submitted to first.
  • If the UBC plan is the first plan, complete the claim form as you normally would. Attach a copy of the Sun Life Claim Statement to the claim form of the second benefit plan, so that the other plan knows the value of the unpaid balance.
  • If the UBC plan is the second plan, attach a copy of the Claim Statement from the other plan so that Sun Life knows the value of the unpaid balance.

Submitting a claim online

You can complete a claim online through mysunlife.ca or using the Sun Life mobile app (only certain claims may be submitted over the website or mobile app). See Submitting an Extended Health or Dental claim online to see what types of claims may be submitted online.

  • If both plans are with Sun Life and the claim is eligible for online submission, you can submit your claim online with one single transaction.
    • Indicate that you want to submit a Coordination of Benefits claim and that you want to submit the unpaid balance to your spouse’s plan. You will need to include the name of your spouse’s policy and certificate numbers, as well as their date of birth.
  • If the second benefit plan is not with Sun Life, refer to the guidelines above to determine which plan the claim should be submitted to first.
    • If the UBC plan is the first plan, submit your claim online as you normally would. Print a copy of the Sun Life Claim Statement and attach it to the claim form of the other benefit plan, so that the other plan knows the value of the unpaid balance.
    • If the UBC plan is the second plan, submit your claim online for the unpaid balance. Indicate that you want to submit a Coordination of Benefits claim and that you do not want to submit the unpaid balance to your spouse’s plan. Mark that you want to submit the unpaid balance to Sun Life and fill in the amount that the other plan reimbursed you for on the claims information page. You can find this amount on the Claim Statement received from the other plan (be sure to keep a copy of this Statement in case Sun Life audits your claim).

Claims submitted directly by your dentist or health-care provider

In some cases, your health-care provider may submit the claim on your behalf when they provide treatment or service. This can include prescription drug claims (when you use your Sun Life pay-direct drug card), claims for dental services as well as vision care and paramedical services if your provider is registered with the TELUS Health eClaims Network, in which case your health-care provider will submit the claim on your behalf.

For prescription drug claims, provide the pharmacist the details of both benefit plans so the pharmacist can send the claim to both plans in the right order. If both you and your spouse have drug cards under your individual benefit plans, the pharmacist can coordinate your benefits right at the pharmacy counter.

You will need to provide your dental office with the details of both your benefit plans so the office can send claims to both plans in the right order.

If you no longer wish to coordinate your claims

Inform Sun Life (1-800-361-6212) if you are no longer coordinating your extended health and dental benefits. If you do not inform Sun Life of the change, Sun Life may delay processing your claims. Note that UBC does not collect or report coordination of benefits information to Sun Life.