To: OSSTF Members
From: Donna Morrison, Executive Director
January 24, 2023
It’s common to have access to more than one health and dental plan in families with two working adults. The two plans may have slightly different levels of coverage and provide different service options. Under COB, insurance companies share the responsibility of paying for eligible health and dental expenses by determining which of these plans is primary and which is secondary. The primary plan considers the claim first and the unpaid balance is then considered by the secondary plan. Benefits are coordinated between the two plans to ensure that you receive reimbursement for up to 100% of your eligible expenses.
The details of the COB provisions are included in your benefits booklet on the OTIP secure member site. You can also find helpful COB-related information and FAQs in the OTIP article, Co-ordination of benefits.
The CLHIA (Canadian Life and Health Insurance Association) has developed the COB Guidelines for the benefits industry to help promote consistency in determining the priority in which payments are made and to outline the minimum amount payable by each group benefits plan in situations where a covered individual can submit a claim to more than one plan. This guideline describes the order in which benefits are determined and how to coordinate payments from group plans available to the covered individual.
You can access the CLHIA guidelines on the coordination of benefits here.
What does this mean under the OSSTF Benefits Plan?
As the first payor, there are no changes under the OSSTF Benefits plan. However, if an eligible member or dependant has coverage under the OSSTF ELHT as well as another plan, if the claim goes first to the other plan, as the second claim payor the OSSTF ELHT benefits plan will pay eligible drug claims based on the reasonable and customary limits of the plan commencing February 1, 2023.
Adjustment to the COB rules between two plans will ensure that the OSSTF ELHT is not reimbursing more than intended under the OSSTF Benefits plan rules.
Questions? If you have any questions, please contact Donna Morrison, OSSTF Benefits Executive Director at donna.morrison@osstfbenefits.ca or OTIP Benefits Services at 1-866-783-6847.
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