Co-ordination of Benefits

Health Care Plan

In general, if you are covered under both the NAV CANADA Health Care Plan and another group health plan, you may claim for eligible medical expenses under both plans. However, the combined reimbursement under both plans cannot exceed the total expenses incurred. The following scenarios illustrate your entitlements:

Scenario 1:

You are a NAV CANADA employee covered under the Health Care Plan, and you are also covered as a member of another group health plan. Your spouse does not have any medical coverage.

In this situation, it is likely that you are covered under one plan as an active full-time employee, and under the other plan, as either a retiree or a part-time employee. A claim for your own expenses must first be submitted to the plan that covers you as a full-time employee. If your spouse and/or children are also covered under both of your health plans, then a claim for expenses that they incur must first be submitted to the plan covering you as a full-time employee.

Scenario 2:

You are a NAV CANADA employee covered under the Health Care Plan, your spouse is a member of another group health plan, and you (and your children) are covered as dependants under that plan.

In this situation, a claim for your own expenses must first be submitted to the NAV CANADA Health Care Plan, and your spouse must submit a claim first to his or her own plan. Once a claim has been settled by the first plan, you and your spouse may then claim any eligible expenses from the other plan for the unpaid balance. If there are expenses for your children, and if both of you cover your children under your respective plans, then a claim for the children's expenses must be first submitted to the plan of the parent having the birthday that falls first in the year. For example, if you were born in January, and your spouse was born in June, you would always first claim against your plan for the children's expenses.

Scenario 3:

You and your spouse are both NAV CANADA employees covered under the Health Care Plan. The co-ordination of benefits for medical expenses is NOT possible between your two plans at NAV CANADA. You and your spouse can opt for single coverage and each claim for your own expenses or one of you can opt for family coverage and claim for the expenses for the family.

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Dental Care Plan

Your entitlement under the Dental Care plan is the same as under the Health Care Plan, for scenarios 1 and 2. However if both you and your spouse are NAV CANADA employees, you can do the co-ordination of benefits for your dental expenses. Scenario 2 would apply in that case.

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Health and Dental Care Plans

The NAV CANADA Health Care plan includes a dental benefit. It covers only expenses for specified oral surgical procedures, and for certain dental treatment required as a result of an accident.

Benefits for accidental dental injury which are eligible under both the Health Care plan and the Dental Care plan will be determined under the Health Care plan first.

Benefits for oral surgery which are eligible under both the Health Care plan and the Dental Care plan will be determined under the Dental Care plan first.

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Definition of a child

The definition of a child is the following under the Health and the Dental Care Plans:

An unmarried natural child, step-child or adopted child of the employee or of the employee's spouse or a foster child for whom the employee stands in loco parentis, excluding a child who has attained age 21 (age 25 in the case of a full-time student).

A child who attains the limiting age, is incapable of supporting himself due to physical or mental disability and remains unmarried is deemed to continue to be a child for as long as these two conditions exist. This continuation is subject to the Plan Administrator receiving proof of the above conditions after the child attains the limiting age. Proof that the above conditions continue may be required periodically.

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