If you have coverage elsewhere

If you have a spouse and your spouse also has a health plan:

• certain expenses not covered by your spouse’s plan may be fully or partially covered by the Concordia Health 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; and
• the drug card will work for your spouse provided he or she has a drug card (from his or her plan) that is also part of the ESI network. You must, however, show both cards to the pharmacist; and
• your dependent children are covered under both your plan and your spouse’s plan but your spouse does not have a drug card that is part of the ESI network, the drug card under the Concordia plan will work for your dependent children provided your birthday is before your spouse’s birthday, in the benefit year.

Note: Your drug card will work for your spouse if he or she also works at Concordia and you both have family coverage. In this case, you must show both cards to the pharmacist.

Where there is duplicate coverage, payment is coordinated as follows. In any event, the combined benefits from the two plans may not exceed the expenses actually incurred.

• Eligible expenses that you incur are reimbursed first by the Concordia Health 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 Health 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.

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 Health Plan the second payer.
• If another plan pays benefits that the Concordia Health 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 Health Plan. Also, to the extent of such payments, Desjardins Financial Security will be fully discharged from liability under the Concordia Health 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.