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General Policy

Published Date: August 01, 2011
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Coordination of Benefits

Eligibility for health benefit coverage from any other source is a factor in determining eligibility for Community and Social Services health benefits. Community and Social Services does not duplicate health benefits if another government department, or another agency is responsible to provide them. For example, First Nations persons registered under the Indian Act and certain Innu and Inuk receive comparable health benefits through the Non-Insured Health Benefits (NIHB) Program of Health Canada’s First Nations and Inuit Health Branch.

However, Community and Social Services may provide health benefits to persons whose health benefits from another source are inadequate to meet their needs. For example, a child receiving IS and covered by a Family Support for Children With Disabilities (FSCD) agreement may be eligible for Community and Social Services health benefits to cover needs not provided for in that agreement. The FSCD program generally covers only specific needs related to the child’s disability.

Clients may have health plans with partial-coverage; e.g., health plans through an employer, union or professional association. Clients are expected to inform Community and Social Services of this primary coverage, and to provide verification of both health plans to the service provider (drug store, dentist).

The benefit administrators (Alberta Blue Cross and Alberta Dental Service Corporation) bill the primary health benefit plan first for all amounts eligible under that plan. The benefit administrators then use Community and Social Services coverage as the second payer to cover deductibles or top-up the primary coverage in accordance with the agreements.