Get Fraud Smart

Each year, an estimated $5 billion is lost in Canada to health care benefits fraud and abuse.

What is benefits fraud?

Benefits fraud is an intentional deception or misrepresentation, by an individual or entity, with respect to a claim that results in payment for an ineligible benefit under the benefit plan.

What is benefits abuse?

Benefits abuse occurs from practices that, although not usually considered fraudulent, are inconsistent with accepted, sound, medical, dental, or business practices. Examples of abuse include overtreatment, excessive billing, and billing for services that are not medically necessary.

Why do benefits fraud and benefits abuse matter to you?

Benefits fraud and benefits abuse can have a direct impact on your benefits coverage. When fraud and abuse occurs, coverage levels can be at risk because UBC is required to pay more for benefits coverage.

Here are some tips to help protect you against benefits fraud/abuse:

  • Keep your benefits information confidential. Your benefits information is valuable. Keep your drug card and certificate/member ID confidential and in a secure place.
  • Submit claims online whenever possible. Online claims submission and direct deposit is the most secure form of claims processing (using www.mysunlife.ca or Sun Life’s mobile app). Remember to keep your access ID and password confidential, even from your service provider.
  • Check your receipts. Ensure your receipts are correct and reflect the services you actually received. If your provider submits claims electronically for you, cross-check your copy of this information with the claim statement you get from Sun Life to confirm they both reflect what you actually received.
  • Never sign claims forms in advance. Sign one completed claim form at a time – never pre-sign blank forms.
  • Report suspicious activity. If you are suspicious of any activity or request from a service provider or medical equipment supplier – such as actions that provide little or no benefit to you but maximize payments to the provider or supplier based on your coverage – please call Sun Life’s Fraud Hotline, toll free at 1-888-882-2221. Your confidentiality will be protected.

Tips for Preventing Fraud

  • Know your plan. Understand the treatments, products, medications and services that are covered by your plan – and the limits that apply. Ask your professional health service provider any questions if you’re unclear about their specific services.
  • Don’t substitute products or services. If a service provider suggests substituting one covered product or service for something that isn’t covered, decline the offer. Examples can include a facial or spa services instead of a therapeutic massage, or teeth whitening instead of regular dental care.
  • Review Sun Life’s delisted providers list. Take the time to review Sun Life’s “delisted providers” list so that you don’t unknowingly use a delisted provider, which would result in your claim being declined.

To view the delisted providers, log onto www.mysunlife.ca or use the Sun Life mobile app. Select the message for delisted providers found on the left-hand side of the screen. You will need to ensure you have pop-up blockers turned off. This list is updated periodically.

Sun Life’s Role in Fighting Fraud

Sun Life has a comprehensive fraud prevention, detection and investigation program – with a team of professionals dedicated to these tasks. Sun Life sometimes finds it necessary to disallow claims from certain health care service providers, clinics, facilities or medical suppliers to better protect your plan. When Sun Life delists a provider, this means that they will not process or pay for claims from that provider.

If you have any questions regarding a provider, please contact Sun Life’s Fraud Hotline, toll free at 1-888-882-2221 directly.

Sun Life Launches Bright Minds Community

Bright Minds is a private online insights community made up of Sun Life plan members which allows Sun Life to create an ongoing dialogue with plan members and gain valuable feedback from them.

What plan members can expect:

  • At the end of May, Sun Life sent out an email invitation to plan members to the email address you used when setting up your online Sun Life account at www.mysunlife.ca.
  • Sun Life plan members who are interested will opt-in to join the community through the email invitation from Sun Life.
  • Participation is voluntary and Sun Life plan members can opt-out at any time.
  • Plan members’ participation in the community and any information they share with Sun Life will be treated with the strictest of confidence. Individual responses will not be identified and will be combined with those from other plan members in the community.
  • Community members will be given the opportunity to participate in a variety of engaging qualitative and quantitative research studies and be entered into periodic draws for prizes to thank them for participating.
  • Community members are encouraged to contact Sun Life (1-800-361-6212) should they have any questions or concerns.

Sun Life Mobile App Photo Submission

Making claims is faster and easier than ever.

With my Sun Life Mobile app’s new photo submission feature, you can now submit a range of supporting claim documents, such as a doctor’s referral, and it’s as simple as snapping a photo.

Photo submission is available on Android and Apple devices such as iPhones, iPads and iPod Touch. Note that this feature is not available on the Sun Life Plan Member Services website.

Check out and download the latest version of the my Sun Life Mobile app for Android or Apple devices from Google Play or the
App Store.

Answers to frequently asked questions about the my Sun Life Mobile app can be found at www.mysunlife.ca and selecting ‘Download my Sun Life Mobile’.

Prior Authorization Program Reminder

For those enrolled in the Extended Health benefits plans 2 and 3, effective April 1, 2017, Sun Life added the prior authorization program. Prior authorization requires that coverage for certain drug therapies be pre-approved based on certain criteria. The prior
authorization’s aim is to focus on monitoring claims for specialty drugs or treatments and ensure that plan members are getting
reimbursement for the right drugs when needed.

If the drug your doctor prescribes for you needs prior authorization, send Sun Life a completed prior authorization form before
filling your prescription. You can visit www.mysunlife.ca/priorauthorization and enter your group contract number (020605) for a
list of included drugs and forms.

If you were reimbursed for one of the drugs included in the prior authorization program within 120 days prior to April 1, 2017, you do not have to apply for authorization; you’ll be considered pre-approved for reimbursement. Adding prior authorization to your group benefits plan will help manage drug plan costs and ensures extended health care is affordable for plan members into the future.

Carrot App

Provided by the BC Ministry of Health, the Carrot Rewards app is a free mobile app that rewards you for living healthier. You can earn reward points from your choice of four brand-name loyalty reward partners: Aeroplan®, SCENE®, Petro-Points™, and More Rewards®.

There are two easy ways to earn reward points with the Carrot Rewards app:

  • Take part in quizzes to learn about the many ways you can take care of your health.
  • Brought to you by Sun Life and the Canadian Diabetes Association, the Steps Challenge is as easy as tracking your daily steps and then working to increase your step count over time.

Don’t have the Carrot Rewards app?

Download the app on your phone from Google Play or the App Store and set up your account to participate and receive additional reward points.

For more information, visit www.carrotrewards.ca/faq/.

Disclaimer: The information you provide while using the Carrot Rewards app is not shared with anyone, including your former employer, UBC.

Sun Life Rate Changes

Each year, the Sun Life Extended Health and Dental Care plans are reviewed with UBC’s Benefits
Consultants to determine the appropriate premium rates to support claim costs expected for
the upcoming year.

The following tables outline the required rate adjustments to the Extended Health and Dental
Care plans, effective January 1, 2017. The renewal rates are based on analyzing 12 months of
past claims experience (July 1, 2015 – June 30, 2016) while incorporating ongoing inflation.

Dental Plan Current 2016 Monthly Rates New 2017 Monthly Rates
Effective Jan. 1, 2017
Adjustment
Single $42.42 $45.81 + 8.0%
Couple $85.10 $91.91 + 8.0%
Family $126.17 $136.26 + 8.0%
Extended Health Plan Current 2016 Monthly Rates New 2017 Monthly Rates
Effective Jan. 1, 2017
Adjustment
Plan 1 (LTM* $15,000)
Single $51.89 $60.19 + 16.0%
Couple $103.79 $120.40 + 16.0%
Family $103.79 $120.40 + 16.0%
Plan 2 (LTM* $50,000)
Single $100.93 $92.48 – 8.5%
Couple $203.87 $186.81 – 8.5%
Family $203.87 $186.81 – 8.5%
Plan 3 (LTM* $200,000)
Single $70.02 $63.75 – 9.1%
Couple $140.07 $127.53 – 9.1%
Family $140.07 $127.53 – 9.1%

* LTM – Lifetime Maximum