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The Co-operators Introduce e-Claims

The Co-operators have introduced e-Claims submission effective May 15th 2013.
E-claims is different from emailed claims in that a a claim can be sent from an internet browser.It simply requires the member to login, enter the type of claim, and amount. The Co-operators would adjudicate the claim and deposit the amount to the employee’s bank.

Think before you turn on e-claims

Drugs and dental claims are already submitted electronically. The new service applies to other health services like vision care, paramedical services, orthopedics, hearing aids, and so on.

This new service, while it is convenient, troubles us because it relies on the honor system; it does not require the employee to submit receipts for most benefits.

Benefits which will not require a receipt:

  • Dental
  • Vision
  • Paramedical

Benefits which still require a receipt:

  • Ambulance
  • Diabetic supplies
  • Emergency out of country
  • Hearing Aids
  • Nursing
  • Hospital
  • Medical equipment/supplies
  • Prescription Drugs
  • All other types not listed here or in the “not required” list above.

A forecasted increase in paramedical fraud

The Co-operators will audit 5% of claims for fraudulent submissions.

Our concern is that the services that makes convenient to submit are the very services that are currently subject to the most abuse.

It is not unheard of for an audited employee to simply “purchase” the needed paperwork.

One employer experienced a 30% increase in premiums

One of our members turned on e-claims with a different carrier a couple years ago. After the first year, the carrier wanted a 30% increase in premiums to account for the higher usage. They quickly turned it off and their rates decreased.

How to turn it on

If you wish to make the service available to your employees, here is what is required:

  • Send Beneplan an email stating positively that you want e-claims
  • Educate your employees about the change
  • Explain that fraud may lead to prosecution and a loss of employment
  • Employees must register for a ‘Benefits Now’ online account http://cooperators.ca. If they have not done so, they must call 1-800-667-8164
  • Employees log in and enter in their Direct Deposit information
  • Educate employees that emailed or faxed claims are no longer supported past September 2013

Silence on your part will indicate that you do not wish to allow e-claims.