Provincial Coordination

Provincial coordination refers to the process of aligning private insurance benefits with the coverage provided by your provincial or territorial government health plan. It ensures that the public plan pays for all eligible expenses first, and your private insurance covers only the remaining costs that are not paid by the government. This coordination helps prevent duplicate payments while maximizing your overall coverage.

In Canada, each province and territory operates its own government health insurance plan (GHIP), which pays for medically necessary hospital and physician services. Private insurers coordinate benefits to cover additional healthcare expenses such as prescription drugs, medical equipment, vision care, and paramedical services. For certain treatments, such as prescription medications for seniors or low-income residents, your provincial drug plan may act as the first payer before your private plan reimburses the balance.

Example:

If your provincial health plan covers $100 of a $350 medical procedure, your private insurance will coordinate benefits to pay the remaining $250, up to the policy’s maximum.

What to Watch For:

Always present your provincial health card when receiving care and provide accurate information to both the provider and insurer. Some private insurers require proof that the government plan has paid its portion before reimbursing the balance. Rules and coverage levels vary by province, so check how your plan coordinates benefits with your provincial health plan, especially if you move between provinces or travel within Canada.