Prevent and denounce fraud
What is insurance fraud?
Fraud is any deliberate action that enables individual insureds or suppliers to obtain a reimbursement of expenses to which they are not entitled.
The consequences of fraud
Group insurance premiums are calculated based on group consumption, among other things. When benefits are paid following the submission of inappropriate claims, the premiums may be increased.
If the group insurance plan costs increase, the policyholder could decide to decrease or withdraw certain services.
The administration of unnecessary care represents a health risk. Moreover, false treatments burden a patient’s file needlessly. They could also compound the difficulty associated with underwriting a private insurance plan (particularly for life and disability insurance).
If fraud is demonstrated, the employer may apply sanctions against the employee, to the extent of suspension or dismissal.
How to protect yourself
Protect your personal and confidential information.
Review your claim history online regularly.
Store your plan documents (booklet and service card) in a secure location.
If you have any questions concerning a supplier, contact La Capitale.
Check your receipts to ensure that all the treatment items indicated were indeed administered.
Do not sign any claim forms in advance, and report any supplier who asks you to do so.