With the prevalence of healthcare spending accounts (HCSAs) on the rise, employees who are able to take advantage of coordinating health and dental benefits with a spouse are asking for clarification as to where they should submit their claims for payment, explains a recent News & Views from Morneau Shepell.

The Canadian Life and Health Insurance Association (CLHIA) sets Coordination of Benefits (COB) guidelines that give direction on determining priority in payment of claims and promote consistency across carrier, but the association has determined that an HCSA is not subject to these guidelines.

Coverage available under all group plans will be considered before coverage available under a HCSA. So how are benefits coordinated in these cases?

With HCSA only
Morneau Shepell explains that employees enrolling a spouse into their plan should indicate that the spouse has no additional coverage if the spouse’s only plan is a HCSA. The plan administrator should code the provider’s system to show there is no spousal benefits plan and therefore no COB occurring.

With a traditional plan plus HCSA
In this case, employees should indicate that their spouse does have coverage under a benefits plan. Claim reimbursement will be coordinated under both benefit plans by the provider(s) automatically. The plan administrator should code the provider’s system to show that there is a spousal benefits plan and, therefore, that COB should be occurring.

Copyright © 2019 Transcontinental Media G.P. Originally published on benefitscanada.com

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