How to coordinate benefits between your plan and your spouse's plan

Are you and your spouse covered by separate benefit plans? Then you may be able to enjoy reimbursement for up to 100% of eligible claims through Coordination of Benefits (COB).

How it works

Is the claim for you?

Submit your claim to Manitoba Blue Cross first, then provide a copy of the Explanation of Benefits (EOB) statement to your spouse’s insurer.

EXAMPLE

John has a Manitoba Blue Cross plan through his employer, while his wife Beth’s employer-sponsored plan is with another insurer. John claims $100 from Manitoba Blue Cross for a dental checkup. He receives an 80% reimbursement ($80). Along with his reimbursement, he receives an EOB statement explaining the eligible claim portion paid. He sends his EOB statement, along with a copy of the original claim, to Beth’s plan.

Beth receives a payment for the eligible amount of the unpaid balance from her plan. John receives up to 100% reimbursement for the cost of his checkup.

Is the claim for your spouse?

Have your spouse submit the claim to their insurer first, then provide a copy of the EOB statement to Manitoba Blue Cross.

EXAMPLE

Beth claims $200 from her employer-sponsored plan for eyeglasses. She receives an 80% reimbursement ($160). Along with her reimbursement, she receives an EOB statement explaining the eligible claim portion paid. She sends her EOB statement, along with a copy of the original claim, to Manitoba Blue Cross.

John receives a payment for the eligible amount of the unpaid balance from Manitoba Blue Cross. Beth receives up to 100% reimbursement for the cost of her glasses.

Is the claim for your children?

First, submit to the insurer of the parent whose birthday comes earlier in the calendar year (based on month, not year or age). If you share the same birthday, submit in alphabetical order of first name. Then provide a copy of the EOB statement to the other parent's insurer.

EXAMPLE

John and Beth’s daughter claims prescription drugs. Beth's birthday is in May and John’s is in July— so the claim is sent to Beth’s plan first, and later to Manitoba Blue Cross for reimbursement of the remaining balance.

Are both plans with Manitoba Blue Cross?

If you are covered under more than one plan with Manitoba Blue Cross, we will automatically coordinate your family’s claims on an ongoing basis provided you have indicated upon enrollment (or contacted us to let us know) that you are covered under more than one Manitoba Blue Cross plan.

You only have to submit one claim for reimbursement and the balance of your claim will automatically process through your spouse’s plan for coordination of benefits.

For further COB guidelines, including blended family rules, please visit the Canadian Life and Health Insurance Association.