Coordination of benefits
Maximize your benefits
Under your UNITE HERE Health and Welfare Plan you must coordinate your medical benefits and dental benefits.
It is your responsibility to keep copies of the original receipts when applying for the coordination of benefits provision.
General rules – Spouse/common law partner
My spouse has coverage with a group benefit plan that is not the UNITE HERE Health and Welfare. I am a dependent under my spouse’s plan and my spouse is a dependent under my UNITE HERE Health and Welfare Plan. How do we coordinate benefit claims between plans?
Q: If the claim is for your expense:
A: You must first submit your claim to Soben with an original claim form and original receipts. If there are any unpaid amounts, you must then send a copy of your claim Explanation of Benefit Statement and a copy of your expense receipts to your spouse’s benefit plan to claim any unpaid amounts.
Q: If the claim is for your spouse’s expense:
A: Your spouse must first submit a claim to their group benefit plan. If there are any unpaid amounts, you must then complete a claim form and send a copy of your spouse’s claim Explanation of Benefit Statement and a copy of expense receipts to Soben to claim any unpaid amounts.
General rules – Children
Q: I am covered under the UNITE HERE Health and Welfare Plan and my spouse is covered under another group benefit plan. Our dependent children are covered under both Plans. Which Plan pays first?
A: If both parents have a group benefit plan, the Plan of the parent with the earliest birth date (month/date) in the calendar year pays first. This is also the case if the parents are divorced but they have Joint Custody of the children.
If you have questions about coordination of benefits, please call Soben.