Who Pays Insurance First?
Summary:
The Canadian Life and Health Insurance Association Inc.(CLHIA) has created a number of rules that set out the order in which claims are to be paid.
As a general rule, if you are covered as a member under a plan, that plan will always pay before a plan that covers you as a dependent. In other words, you must submit the claim to your own plan first.
Below are a few common examples of who pays first. For more examples, please read the CLHIA's "Who Pays First?" brochure available at the following link:
http://www.clhia.ca/domino/html/clhia/CLHIA_LP4W_LND_Webstation.nsf/resources/Consumer+Brochures/$file/Brochure_Guide_To_CoOrdinationBenefits_ENG.pdf
Employer Plans:
If you have coverage with your employer plan and as a dependent with your spouse’s employer plan:
- Your employer plan pays your claim first.
Your spouse’s plan pays your claim second.
Single Custody:
In cases of Single Custody i.e., when one parent has custody of the child(ren):
- The plan of the parent with whom the child resides, i.e., the plan of the parent with custody, pays first.
- The plan of the spouse of the parent with custody pays second.
- The plan of the parent not having custody pays third
A child lives with mother and her new spouse. Therefore:
-
- Mother’s plan pays first.
- Mother’s spouse’s plan pays second.
Father’s plan pays third.
Joint Custody:
When both parents have plans and their children are covered under both as dependents, the plan of the parent with the earlier birth date in the calendar year pays first.
Example:
-
- Father’s birthday – October 11
- Mother’s birthday – September 21
Therefore, the Mother’s plan pays first since the Mother’s birth date comes before Father’s in the calendar year.
Product (s): ABELDent
Category: Insurance
Classification: Private/Public
Date Created: 22 Oct 2016
Created by: Brian Neale