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Could it be… fraud?
Fraud Prevention Month is an annual public awareness campaign that helps Canadians recognize, reject, and report fraud attempts.
Benefits fraud costs millions of dollars each year in Canada.
Your ONE-T benefits plan is affected by fraud, too. When false claims are submitted, the entire plan suffers the consequences, including higher fees and less affordable benefits coverage.
The best way to help protect your ONE-T benefits plan is to remain vigilant, keep an eye out for questionable behaviour, and report any suspicious activities to Canada Life using the confidential tip line: 1-866-810-TIPS or confide@canadalife.com.
What is benefits fraud?
Benefits fraud involves intentionally tampering with information during the claims process for financial or personal gain. Fraud is not always easy to detect, but it carries serious consequences, including the possibility of being charged and convicted.
Some examples of fraud:
• Submitting a claim for services that never occurred
• Using benefits from one person to pay for a service that someone else
received
• Service providers falsifying medical conditions to provide treatments or
services that aren’t needed
Imagine the following scenario – your partner got a new pair of glasses last year for $400, but the glasses broke, and they need new ones as soon as possible. With the ONE-T benefits plan, you and your eligible dependents are covered for up to $500 every 24 months. The optician suggests splitting the fee for a new pair of glasses between your coverage and your partner’s coverage, to cover the full cost.
This may not seem like a big deal, but it does happen and is an example of fraud. Transferring unused benefits to others is fraud and could end up costing a lot more than the price of a pair of glasses.
Recognizing benefits fraud
Sometimes, service providers will rely on a lack of knowledge from their customers and submit fictitious or inflated claims. This is why it’s important to educate yourself on the warning signs of fraud, so you don’t unwittingly participate in it.
Some common signs of fraud
A service provider who:
• Asks for your password to the Canada Life website
• Doesn’t accurately reflect the service you received on your receipt
• Seems more concerned with how much your plan covers than
providing the right service
• Offers you cash or other incentives in exchange for your plan policy
information
• Encourages you to purchase additional services or products that you
don’t need
Imagine the following scenario – you need to buy compression stockings and your service provider asks how much your benefits plan will cover. With the ONE-T benefits plan, you and your eligible dependents are covered for two pairs every 12 rolling months, to a maximum of $750. Once the provider hears this, they suggest that you pay for two pairs (but receive only one), submit the receipt, and be reimbursed in full by your plan.
This may seem far-fetched, but situations like this have been known to occur. If something feels off and you suspect that any of your service providers, retailers, or even other ONE-T plan members are submitting fraudulent claims, report it to Canada Life right away using the confidential tip line: 1-866-810-TIPS or confide@canadalife.com.
Canada Life’s list of ineligible providers
If a service provider has been fraudulent, they can be de-listed, which means you will not be reimbursed by Canada Life for any services or products they provide to you.
If you’re visiting a new service provider, check Canada Life’s website first to make sure they are not on the ineligible provider list. Here’s how:
On the website >
a. Go to https://www.canadalife.com/sign-in.html and sign in.
b. From the left menu, select Resources, then Find a provider.
c. In the section Ineligible providers, you can either scroll through the
list or search for your provider’s name.
On the app >
a. Log in.
b. From the top of the screen, select Find a provider.
c. Select Ineligible providers, and either scroll through the list or search
for your provider’s name.
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© 2022 Ontario Non-union Education Trust