When plan members are covered by more than one drug plan, benefits from both plans can be coordinated at the pharmacy counter when a prescription is filled for a patient. To take advantage of electronic coordination of benefits, plan members need to provide their drug card to the pharmacist. The pharmacist may then submit both the primary and secondary claim electronically at the point of sale. Once processed, plan members need only pay the remaining amount not covered by the various drug plans. This means minimal out-of-pocket expense for the patient at the pharmacy, while controls on claims reimbursement are exercised.

Two types of coordination of benefits exist: private coordination and provincial coordination.

Private Coordination of Benefits

When a plan member presents their drug card at the pharmacy counter to electronically process their prescription claim, the employee's benefits can be coordinated with their spouse's drug insurance benefits according to the CLHIA (Canadian Life and Health Insurance Association) guidelines.

At the time of enrollment, each employee must declare if his/her spouse has other drug coverage with another insurer. This information is registered in the spouse's file to ensure that claims submitted to Emergis for processing are processed as a second payor. All claims for spouses and children are validated electronically according to "first or second payor" status and are declined if not submitted properly. Some groups may not allow electronic Coordination of Benefits, in which case, the employee needs to submit a paper claim to their insurance company.

Provincial Coordination of Benefits

The drug card also coordinates the benefits of private plans with all provincial government plans in real-time, through electronic processing. The pharmacist processes the prescription for payment and receives an electronic response of the amount covered by the province. The portion of the claim not covered is immediately submitted electronically to the appropriate insurance company for processing. Plan members need only pay the remaining amount not covered.

Any balance of claim submitted to the government is processed according to various provincial coverage options which are determined according to each of the provincial plans in place, where applicable.

The option offered by the Quebec drug insurance plan (RAMQ), allowing persons who are covered by a private plan to opt out of the RAMQ, is subject to rigorous controls to ensure that Emergis accepts a "first payor" role only for employees where this disengagement has been accepted an authorized by the plan's administrators.