Coordinating Claims

If both you and your spouse have health and/or dental coverage under a group benefit program, you can coordinate your claims.

In other words, you may be able to claim payment for health or dental expenses under both plans (provided you have Level II, III, Life Member or Enhanced Life Member coverage, which includes family coverage).

Any personal claims for yourself must be submitted through the DGC Benefits Plan first. Any unpaid expenses can then be submitted through your spouse’s plan;
Your spouse must submit personal claims through their company plan first. If that plan doesn’t cover the full cost of the service or procedure, you can claim the remaining expense through the DGC Benefits Plan if you have family coverage; or
Claims for dependant children should be submitted first to the plan of the parent whose birthday falls earlier in the year. For example, if you were born in March and your spouse was born in July, you would submit claims to the DGC Benefits Plan first. Again, any uncovered expenses could, in turn, be submitted to your spouse’s plan as a secondary payer (assuming your spouse has family coverage).

In situations where you and your spouse are separated or divorced you should make claims for children in the following order:

The plan of the parent with custody of the child;
The plan of the spouse of the parent with custody;
The plan of the parent without custody; or
The plan of the spouse of the parent without custody.

In situations where you belong to two or more different group plans (e.g., you are an employee at two organizations and have coverage at both), your claims should be submitted in the following order:

The plan where you are an active full-time employee;
The plan where you are an active part-time employee; or
The plan where you are a retiree.

If you have the same status (i.e., full-time employee, part-time employee, retiree) in two group plans, the order of payment should be:

The plan where you have had coverage the longest; or
The other plan.

In no case can the total reimbursement you (and your spouse) receive exceed 100% of the actual expenses incurred.

How to Submit a Claim

Coordinating Claims

Coverage and Plan Details

How the Plan Works

How to Submit a Claim