Coordination of Benefits Explained: Making the Most of Two Health Plans (2026)
How coordination of benefits works when both spouses or partners have their own group health plan, the standard order insurers use to decide which plan pays first, and how to submit a coordinated claim.
What Coordination of Benefits Means
When two people in the same household, such as spouses or partners, each have their own group health plan, coordination of benefits is the process that determines how a claim gets paid across both plans, ideally getting an eligible expense reimbursed as close to 100% as possible, without paying more than the actual cost of the expense.
Which Plan Pays First
The Canadian Life and Health Insurance Association sets out a standard order that most insurers follow. For your own expenses, your own plan pays first, and your spouse's plan can be billed second for anything left over. For your spouse's expenses, their own plan pays first, with yours as the second payer.
The Birthday Rule for Dependent Children
For a dependent child's expenses, the standard is known as the birthday rule: whichever parent's birthday (month and day, not the year) falls earlier in the calendar year has their plan considered primary for the child's claims, and the other parent's plan is billed second. This rule exists specifically to give a consistent answer regardless of which parent is older or which plan has richer benefits.
How to Submit a Coordinated Claim
- Submit the claim to the primary plan first, following that plan's standard process
- Once the primary plan processes the claim, you'll receive an explanation of benefits showing what was paid and what remains
- Submit that explanation of benefits, along with the original receipt, to the second plan to claim the remaining eligible balance
- Keep a copy of every receipt until both plans have finished processing the claim
- Check whether your plans support electronic coordination, which can reduce the paperwork needed for the second submission
- Confirm both plans' definitions of the expense category, since a claim eligible under one plan isn't automatically eligible under the other
Make Sure You're Not Leaving Coverage on the Table
If your household has two health plans and you're not confident you're coordinating claims correctly, book a free, no-obligation consultation and we'll help you get the most from both.
Frequently Asked Questions
What is coordination of benefits?
It's the process of determining how a claim is paid when a person is covered by more than one health plan, so an eligible expense can be reimbursed as close to 100% as possible without exceeding the actual cost.
If my spouse and I both have group plans, whose plan pays for my own expenses?
Your own plan pays first for your own expenses; your spouse's plan can then be billed for any eligible balance left over.
What is the birthday rule?
For a dependent child's claims, the parent whose birthday (month and day) falls earlier in the calendar year has their plan considered primary, regardless of which parent is older.
How do I submit a claim to a second plan after the first one pays?
Submit the claim to the primary plan first, then send the explanation of benefits along with your original receipt to the second plan for the remaining eligible balance.
Can coordination of benefits get me more than 100% of an expense back?
No, coordination is designed to reimburse up to the actual cost of the eligible expense across both plans, not to pay out more than what was spent.
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