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Learn how to spot benefits fraud – and protect your plan

Benefits fraud is on the rise in Canada.
But most Canadians feel benefits fraud is no big deal.
According to the Canadian Life and Health Insurance Association Inc., 75 per cent of insured Canadians believe the consequence of benefits fraud is having to pay higher premiums or reimbursing claim payments.
The truth is, the consequences of benefits fraud are far more serious and can include the loss of benefits, loss of job, criminal charges, fines or jail time.  
What does benefits fraud look like?
Benefits fraud occurs when you intentionally submit false or misleading information to your insurance provider for the purpose of financial gain[1]. Some examples include:

  • Billing for health or dental services that were not received

  • Submitting the same claim to multiple insurers

  • Letting someone not covered by your plan use your benefits

  • Using your benefits to buy items not covered under your benefits plan, such as purchasing non-prescription sunglasses and submitting the claim as prescription eyeglasses

Benefits fraud can be committed by health or dental service providers, plan members or both.
So why should this matter to you as a plan member? Simply put, the cost.

Benefits fraud can make the cost of providing group benefits to you more expensive and may lead to higher premium payments, reduced coverage — or both.

Safeguarding your benefits will help to keep your benefits affordable, accessible and sustainable for many years to come.

If you suspect that someone you know or a service provider may be committing fraud, you can report it to your Employee Life and Health Trust, OTIP, your insurer, or anonymously.
Questions? We are here to help. Check your benefits booklet for benefit plan terms and coverage details. You can also contact OTIP Benefits Services at 1-866-783-6847 or send us an online note.

[1] Canadian Life and Health Insurance Association Inc.

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