Making a Claim

Coordination of Benefits With Other Insurance Programs

Step 1

If you or your spouse/partner has coverage with another insurance company, you should send your claims to that insurer for payment. However, if you are a dependant under your spouse/partner’s coverage, your claim must be sent to AFBS first. Usually, claims for insured dependant children must be submitted to the plan of the parent whose birth day and month falls first within the calendar year. When administering coordination of benefits AFBS follows the guidelines established by the Canadian Life and Health Insurance Association (CLHIA).

Step 2

After settling a claim with the primary insurer, any portion not paid by the other insurance company will be reported on the Explanation of Benefits (EOB) statement. Submit this explanation to AFBS along with a completed Extended Health Care claim form and copies of your original receipts.

Step 3

AFBS will adjudicate the remaining amount that was not paid by the primary insurer. You will be reimbursed up to your benefit level or 100% of the eligible health or dental expenses unpaid by the other insurer.

When you are coordinating claims between insurance companies, you will be required to provide copies of your receipts to the second insurer in order to be reimbursed by them.