This is referred to as Coordination of Benefits (COB), which means payment of an eligible benefit is coordinated between your plan and your spouse's plan. Payment is pro-rated so the total coverage amount available doesn't exceed 100% of allowable expenses.
You and your spouse must submit claims to your own plan first. Children must submit their claims to the plan of the parent with the earlier birth date in the calendar year.

To submit a COB claim take the following steps:

• Photocopy your claim and receipts
• Submit your claim to your insurer based on the above criteria.
• Once you receive your cheque and statement, complete a new claim form with the coordinating plan numbers (yours and your spouse's). Attach the statement received with photocopies of your original claim and receipts.

• Report the loss immediately to your Benefits Administrator.
• A replacement card will be issued within 7 working days (plus time for delivery).
• You will need to pay for your prescription at the pharmacy and submit your receipt as a paper claim for reimbursement if you require a prescription in the interim.

Notify your Benefits Administrator of new dependants, changes in your marital status, etc.

• Forms are available from your Benefits Administrator or dental office.
• Instructions for completing claim forms are included in your Introductory Package.

Provincial dental associations establish and publish a Dental Fee Guide. The guide serves as a reference for dentists to set their rates.Insurers use these guides to help in the management of their dental plans and provide consistent charges within provinces.

If the practitioners and others (naturopath, psychologist, speech therapist, etc.) are registered with the appropriate provincial association in which they are practicing your plan may cover these expenses. On your claim submission you will require evidence of these practitioners' credentials and their appropriate registration numbers.

• No. You cannot make direct payment to these types of providers as paramedical practitioners fall under supplemental health care providers.
• Your financial obligation is directly to your employer.

If you are comfortable dealing with the insurance carrier directly you may do so. If you wish, however, to keep an arms length from these issues or if an issue goes unresolved, please don't hesitate to contact us. Talon Benefits Consulting Group Ltd. will strive to address any unresolved issues or concerns that you or your employees may have. We are always more than happy to contact the insurance carrier on your behalf.

Yes. We are more than happy to address any questions or concerns you may have. Please don't hesitate to contact us give us a call or send us an email.

It is very important for all plan members to keep a copy of all receipts and forms submitted. Copies should be discarded only once the claim has been paid or the change processed. This may avoid potential delays and confusion.

Pay Direct Drug Cards and Drug Formularies should be investigated to determine their particular impact. Most major insurers have chosen to outsource their facility for extended health care drug coverage re-imbursement to either the Assure Health Network, or Eclipse Network. This system enables an employee to approach a pharmacy for medications with merely an "Interac" type card, which contains the necessary information to conduct a transaction directly at the till of the pharmacy. The card contains coverage level information as well as positive enrolment verification, and permits the pharmacist to ensure payment for his prescription without having the customer pay an up front cost. The customer would only pay an annual deductible or a per prescription charge (if applicable).

This convenience factor is normally combined with a restrictive drug formulary which permits only the B.C. reference based pricing for pharmaceuticals or another limited level of eligible generic drugs. The proper method to ensure that the cost containment feature is actually achieved is to co-ordinate an increased convenience with a more restrictive schedule of eligible pharmaceuticals.

Naturally, the more traditional methods of cost containment are also available, and those merely include the options of reducing the co-insurance formulas, adding larger deductibles to the equation, capping benefit levels or integrating a formula for either integration of premium sharing arrangements or a diminishing schedule of available benefits. The most obvious hurdle to incorporating any of these traditional methods is the actual physical detraction from the current level of coverage in the existing plan.

While the market survey could indicate that a potential savings could occur merely by changing the insurance carrier, other product enhancements or changes in levels could also be incorporated in your plan to minimize costs and maximize the employee perception of a viable benefits program. It is largely dependent upon the desire of the company management to define the final plan design that is implemented, however, some credence should be given to the employee group as a whole to properly gauge what levels of coverage will be workable and acceptable. The experience necessary to evaluate and implement a plan design in this manner may not be a normal function of your human resources personnel, but in concert with your benefits consultant, this can be achieved.