Children covered under multiple employer benefits

F

failed@life

Member
Does anyone have something like this going on? If both parents and both step parents each have separate benefits covered by their employers, can a child be covered by all four plans?


For example my child may need braces. My benefits don't cover them, assume child's mother's benefits don't either. But child's step mother's benefits would cover them at least partially if the child was added to her plan. Is that at all possible?
 
Yes you can, it can be a pain in the backside. All by date of birth.

DaD in march, insurance first, Mom in June next insurance, Step-dad september his next and step mom december this one last.

Good luck.
 
Having the kids on a step parents plan benefits everyone as the costs are reduced. In your case, if you both dont have benefits you would be splitting $4000 in expenses. If the step parents have benefits that cover $2000, you would then split the remaining net cost.

Almost all benefit companies now cover step children as they consider your spouse your “dependent” therefore the children are too. I was able to put my partners kids on my benefits even though we arent married.

You should check with your benefits provider on how they apply them though. Depending on custody situation (and its written clearly in my partners benefits book, dont correct me) if goes custodial parent first, access parent, custodial spouse, access parent spouse.
 
I have had this in place for a while, my kids were covered through both their father and stepfather but it did take quite a while for them to figure out the order of benefits for COB due to shared custody situation... Now that DD is 21 (graduated & overage) for one plan, trying to update info for the plan that goes to 22 is proving to be a challenge.
 
My kid is also covered under 3 insurance plans. Mine, my ex's and my wife's. It hits my ex's first, then what isn't covered goes to mine, then my wife's.


My wife had family benefits for years as my work insurance was expensive, so she was the only one with coverage for a while. Then my work covered 100% family insurance, and my ex got a new position with better benefits. It works out best for the kid and helps my pocket book at the end of the day.
 
The way insurance pays when there are multiple insurance involved is the same for all insurance across Canada. This is dictated by the Canadian Life and Health Insurance Association’s (CLHIA)
1- SHARE CUSTODY When both parents have plans and their children are covered under both asdependents, the plan of the parent with the earlier birth date in the calendaryear pays first.
Example 1:• Father’s birthday – October 11• Mother’s birthday – September 21Therefore - Mother’s plan pays first - Mother’s birthdate comes before Father’s inthe calendar year.


If both parents have the same birth date, the plan paying first is based on theparent’s given name that occurs first in the alphabet.


Example 2:• Mom’s given name is Jane• Dad’s given name is StephenTherefore - Jane’s plan pays first - the name Jane comes first alphabetically.


In cases of Single Custody i.e., when one parent has custody of the child(ren),
The plan of the parent with whom the child resides, i.e., the plan of the parent withcustody, pays first.
The plan of the spouse of the parent with custody pays second.
The plan of the parent not having custody pays third.


Example 3:A child lives with mother and her new spouse.Therefore - Mother’s plan pays first.
Mother’s spouse’s plan pays second.
Father’s plan pays third.


In a case of sole custody, it's not the DOB that are important, it's mom then partner (if applicable) then dad, then partner (if applicable)


See this link for complete document:
Brochure_Guide_To_CoOrdinationBenefits_ENG.pdf (clhia.ca)
 
Parents with joint custody :

1. Plan of the parent with joint custody with the earlier birth date
2. Plan of the parent with joint custody with the later birth date.
3. The plan of the spouse of the parent in #1
4. The plan of the spouse of the parent in #2
 
Alpinist said:
Parents with joint custody :

1. Plan of the parent with joint custody with the earlier birth date
2. Plan of the parent with joint custody with the later birth date.
3. The plan of the spouse of the parent in #1
4. The plan of the spouse of the parent in #2
Click to expand...



yeap exactly.. goes back and forth
 
enchantedowl said:
Are the step-parent's plan premiums for the children's coverage considered a section 7 expense then?
Click to expand...


Most plans don’t charge for kids but if the step parent has to pay for benefits then it isn’t required to have them. However, if it works out to say less than $10 a month and their spouse will have to pay $500 a year for things like braces out of pocket, that $120 is a good investment.


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Alpinist said:
Parents with joint custody :

1. Plan of the parent with joint custody with the earlier birth date
2. Plan of the parent with joint custody with the later birth date.
3. The plan of the spouse of the parent in #1
4. The plan of the spouse of the parent in #2
Click to expand...


Beware of this scenario:

Parent 1 is primary insurance
Parent 2 is covered under spouse’s plan (step-parent) and does not have their own plan
Children are covered under Parent 1 and step-parent (4 on this list).


Coverage of the child must proceed through the “coordination of benefits” between any plans. At the time of making a claim, most plans ask the question “are there any other plans covering this child?” and prompt you to indicate additional policies. If Parent 2 & step parent pays for anything out of their own pocket, all reimbursements will still go to Parent 1 because that is the primary plan (in my experience). Parent 2 or their spouse could have an earlier birthdate than Parent 1 even, but it doesn’t matter. Parent 1 is primary and gets the reimbursements.

I am out $1000 currently because of this rule. Ex just pocketed my money even though I paid for the services (for our child) I made the claim for.


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Not sure if I am understanding correctly what is going in in your scenario.

If you have paid for the total claim expense upfront (prior to any insurance payments) they should reimburse you for any amounts their insurance contributed toward that claim.
 
Ange71727 said:
Beware of this scenario:

Parent 1 is primary insurance
Parent 2 is covered under spouse’s plan (step-parent) and does not have their own plan
Children are covered under Parent 1 and step-parent (4 on this list).


Coverage of the child must proceed through the “coordination of benefits” between any plans. At the time of making a claim, most plans ask the question “are there any other plans covering this child?” and prompt you to indicate additional policies. If Parent 2 & step parent pays for anything out of their own pocket, all reimbursements will still go to Parent 1 because that is the primary plan (in my experience). Parent 2 or their spouse could have an earlier birthdate than Parent 1 even, but it doesn’t matter. Parent 1 is primary and gets the reimbursements.

I am out $1000 currently because of this rule. Ex just pocketed my money even though I paid for the services (for our child) I made the claim for.


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Click to expand...


Then he committed insurance fraud and you need to reach out to his spouse’s insurance company and report it. He should also be paying his share of the expense over and above what was covered by his wife’s plan.

But then again, your ex is a super ass who pulls these stunts. Add it to your list of abuses for the next time he cries foul.


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Rockscan is right. If you have paid for an expense and their insurance plans paid anything toward it they need to reimburse you right away.
 
Sorry it’s not super clear now that I read it.

Child gets some medical services.
Both parents pay towards this service.
We both have insurance coverage for the child - my ex through his own plan, and through my spouse’s plan (stepdad) on my end.
Receipts issued even state explicitly who paid what. We each submit through our plans.
Insurance company will only issue the reimbursement through the Primary parent’s plan (my ex).
This means he receives back his reimbursement, for funds paid out of his pocket AND my reimbursement for funds paid out of my pocket.
Insurance company considers it a done deal at this point because they’ve paid out what they’re reimbursing and don’t care to who.
At this point, a reasonable human would return the money to the party who actually paid it out.
My ex is not a reasonable human. He actually has accused ME of insurance fraud, saying I had no business “using” his benefits to cover our child. He clearly does not understand how it works.
Therefore I am currently out $1000 for two separate claims.
At one point he said he would just mail the money back to the insurance provider, but that hasn’t happened. The insurance company also told me that unless he mails it back with specific instructions to reimburse it to my husband’s policy number, that they’d not be sending me any money as it’s considered “his” right now.
This is going to just keep occurring as well.
It’s on the list of items we are hoping to address at the upcoming trial.
I am surprised I don’t hear others talking about this matter - it must occur to other people in similar situations to me.
And yes Rockscan, I know you know this would be typical of him.
As infuriating as it is though, my husband seems to think it’s going to hurt him in front of a judge to have been so uncooperative.


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It has been discussed in other threads.

In your case what should have happened is this:

You pay the money up front and submit to your benefits company. You send him the receipt and he submits to his company. You can also submit to the new spouses companies on both sides. Insurance reimbursements go back to you IN FULL and any remaining amounts are split according to section 7.

Namely, expense is $1000. Your company pays $300, his company pays $300, other companies don’t exist. You pay out the $1000 up front, he pays you the $300 and then you split the remaining $400 proportionate to income (say it’s 50/50 so he pays you $200).

I wonder if you can just get the insurance info and have the medical provider bill direct?


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So what happened is we both agreed to pay our share and each submit through our own insurance. He didn’t want to have to deal with me, and frankly I didn’t want to deal with him either. We divided up the cost proportionately and knew the full amount was going to be covered. It seemed like a win-win....
Except that when I submitted my portion through my husband’s account, I was forced to indicate there was an additional policy covering the child (ex and current husband are both with the same company). That’s fine, because it’s insurance fraud to not indicate that, but it meant that the reimbursement went through the one plan only - the primary insurance ie. ex husband’s.
He should have simply just e-transferred the amount over to me. But he chose to power trip and keep my money.
The dentist is never a problem because they direct bill and we don’t pay out first.
Any time an agency expects payment first (which is the case for many places), I am going to run into this problem.


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