Family coverage and coordinating payments

Family coverage - eligible dependents

You may be able to claim eligible family members as dependents under McGill's benefits plan. Click on the groups below to find out more.

Children

  • Under most circumstances, the term "child" includes:
    • your natural or legally adopted child
    • your spouse's child if living with you
    • a child for whom you are the legal guardian and who is wholly dependent on your for support
    • during the period of probation that precedes adoption, the child you are adopting.

Any child described above must be unmarried, less than 21 years of age and wholly dependent on you for support. You must also have custody and control of that child.

  • Your unmarried child under 26 years of age is also eligible, if he or she is wholly dependent on you for support and is a full-time student attending (or on vacation from) an educational institution.
  • A child who is mentally or physically disabled and wholly dependent on your support is also eligible beyond age 21.
    • Proof of the disability must be submitted within 31 days after the child reaches age 21. The form Application for Health/Dental Coverage for Overage Disabled Dependant Child must be completed in part by Human Resources (HR Service Centre) and then by your child's treating physician.  Submit the form direcly to Manulife Financial for review. Manulife will send you written confirmation of the results of their review.


NOTE: Under the Quebec Act respecting prescription drug insurance, you and your eligible family members under age 65 must join the McGill Supplemental Health Plan if drug coverage not provided under another group insurance plan.

Spouse

For purposes of your benefits plan, your "spouse" is:

  • a person of either sex with whom you have been living in a conjugal relationship for one year. The one-year cohabitation requirement does not apply when you and your spouse have a child together.
  • as defined under the applicable legislation.

Only one person at a time can be covered as your spouse under the terms of the program.


Coordinating health and dental payments

If both you and your spouse have health and/or dental coverage through your respective employers, you can claim payment for health and dental expenses under both plans. To coordinate payment, you will need to follow the following steps:

  • If you have incurred the expense: You must submit your claim through the McGill plan first. If there is an unpaid portion remaining, your spouse can submit a claim for this amount through his/her plan.
  • If your spouse has incurred the expense: Your spouse must submit his/her claim through his/her plan first. Any unpaid portion may be claimed through your McGill plan, provided you have family coverage.
  • If your child has incurred the expense and you both have family coverage: The claim must be submitted first to the plan of the parent whose birthday falls earlier in the year. Any unpaid portion can then be submitted under the other spouse's plan as the secondary payer.

For information regarding coordination of benefit scenarios, please consult the Canadian Life and Health Association's PDF icon brochure_guide_to_coordinationbenefits_eng1.pdf

Prior to sending your claim to the first insurance company, take photocopies of the completed claim form and all receipts. Once you receive payment from the first insurance company, complete a new claim form for submission to the second insurance company. Attach the statement showing the amounts considered and paid by the first insurance company with photocopies of all corresponding receipts.