If you have coverage elsewhere
If you have a spouse and your spouse also has a dental plan:
- certain expenses not covered by your spouse's plan may be fully or partially covered by the Concordia Dental Plan;
- you may be entitled to a full or partial reimbursement from your spouse's plan for your own expenses that are not covered under the Concordia plan.
Where there is duplicate coverage, payment is coordinated as follows. In any event, the combined benefits from the 2 plans may not exceed the expenses actually incurred. - Eligible expenses that you incur are reimbursed first by the Concordia Dental Plan, followed by your spouse's plan, if a balance remains.
- Eligible expenses that your spouse incurs are reimbursed first by your spouse's plan, and then by the Concordia Dental Plan, if a balance remains.
- Eligible expenses that your covered dependent children incur are first reimbursed by the plan of the parent whose birthday falls earlier in the benefit year. Any balance remaining should then be submitted to the other spouse's plan for payment.
| If the eligible expenses were incurred by... | Submit your claims to the various plans in the following order for reimbursement: |
| You |
|
| Your spouse |
|
| Your dependent children |
If your marital relationship has ended and you have dependent children from this relationship:
If priority cannot be established this way, benefits will be prorated between or among the plans in proportion to the amounts that would have been paid under each plan had there been coverage by just that plan. |
Please note:
- If you are an active part-time employee under more than one plan
In this case, priority will be given to the plan for which you work the highest number of hours per week. - If your spouse's plan does not coordinate the payment of benefits with other plans
In this case, your spouse's plan is the first payer and the Concordia Dental Plan the second payer. - If another plan pays benefits that the Concordia Dental Plan should have paid
In this case, Desjardins Financial Security has the right, exercisable alone and in its sole discretion, to pay to the other party that paid those benefits in the first place any amount that it sees fit to satisfy the intent of this coordination of benefits provision.
Such amounts will be deemed to be benefits paid under the Concordia Dental Plan. Also, to the extent of such payments, Desjardins Financial Security will be fully discharged from liability under the Concordia Dental Plan. - Insurer's right to receive and release information on insured persons
Desjardins Financial Security may, with proper authorization, release to or obtain from any party any information, with respect to any insured person, that Desjardins Financial Security deems necessary to coordinate benefits. Any individual claiming benefits under this policy must provide Desjardins Financial Security with the necessary information. - Insurer's right to recover excess benefit payments
If Desjardins Financial Security has exceeded the maximum payment needed to satisfy the intent of the coordination of benefits provision, it has the right to recover such excess payment from any individuals to or for whom such payments were made, from any other insurance company or from any other organization.
