GROUP INSURANCE FRAUD
Why benefits fraud matters to you:
Fraud increases the cost of benefits plans and it leads to higher premiums for all of us. The cost of our group insurance benefits is part of our compensation and the more money that is needed for maintaining our group insurance benefits means less money that is available for salary/wages. Fraud can have serious repercussions to the colleges and employees and can result in:
- increased cost to colleges and to you
- criminal charges
- breach of ethics that may result in loss of employment
What is benefits fraud?
Benefits fraud is intentional deception or misrepresentation resulting in the payment of ineligible benefits. This includes ineligible payments claimed on behalf of yourself and your dependent(s).
Tip for preventing unintended fraud
Ø Get to know your plan
- understand the treatments, products, medications and services that are covered by your plan and the limits that apply
Ø Do not substitute products or services
- if a service provider suggests substituting covered item for something that isn’t covered, decline the offer. Common substitutions include:
o receiving a facial or spa treatment instead of a therapeutic massage
o receiving running shoes for orthotics
o receiving designer sunglasses instead of prescription eyewear to correct vision impairment
o receive teeth whitening instead of regular dental care
How you can help
If you or your dependents suspect fraud may be occurring, please contact Sun Life’s toll free line, available throughout North America, at 1-888-882-2221. It is our plan, we all have a responsibility to protect it.