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