March 2, 2022
Your group benefits plan is provided to you by the OSSTF Employee Life and Health Trust (ELHT) Benefits plan and was established to help cover or supplement the cost of delivering health and dental benefits to you and your family.
The OSSTF Benefits plan is responsible for ensuring that your benefits plan is managed sustainably and efficiently. The level of coverage your plan provides is directly related to the funding received by the OSSTF Benefits plan.
Benefits fraud and abuse can put the OSSTF Benefits plan at risk and has negative consequences for the sustainability of your benefits plan.
Benefits fraud and abuse can lead to higher costs, reduced coverage, or both. While some consider benefits fraud a victimless crime, it impacts every member of the OSSTF Benefits plan. It also directly impacts the ability of your OSSTF Benefits plan to provide optimum coverage amounts and maintain overall plan sustainability.
Benefits fraud vs. abuse
Fraud is the intentional submission of false or misleading information for the purpose of financial gain. Fraud is a crime, and those who are convicted may face serious consequences, including potential job loss, criminal conviction, jail time and fines. Some common examples of provider/plan member fraud include:
Abuse is when a health or dental provider or an OSSTF Benefits plan member take advantage of your OSSTF Benefits plan provisions for personal gain. This includes overuse of services, excessive billing and accessing or providing treatment when there is no proven medical need. These types of benefit abuses have a negative impact on your OSSTF Benefits plan. Some common examples of provider/plan member abuse include:
You can help protect your OSSTF Benefits plan. Here’s how.
Fraud and abuse can be committed by service providers, plan members, or both parties. Sometimes benefits fraud and/or abuse can happen without the plan members consent or knowledge. As an OSSTF Benefits plan member you can help to protect your plan, and yourself, from benefits fraud and abuse.
Every dollar paid out due to a fraudulent claim is one more dollar that is not available for legitimate dental or healthcare needs. Any claim suspected to be fraudulent is thoroughly investigated by Manulife, and claims proven to be fraudulent are reported to OSSTF Benefits for review and action in accordance with the OSSTF Benefits fraud policy. Review your anti-fraud policy.
If you suspect that someone you know or a service provider may be committing fraud, you can report it to OSSTF Benefits, OTIP, or Manulife. It is our shared responsibility to protect the plan and report fraud when we see it.
Questions? Check your benefits booklet for benefit plan terms and coverage details. You can also contact OTIP Benefits Services at 1-866-783-6847.
The information in this document is provided by OSSTF Benefits for general information only. OSSTF Benefits endeavours to have all information current and accurate. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, or suitability of the information included. All information is subject to change without notice.
The information contained in this website is for general information purposes only. The information is provided by OSSTF Benefits and while we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information, products, services, or related graphics contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk. All information on this website is subject to change without notice.