In 2016, the Toronto Transit Commission sued its insurer for allegedly not having appropriate benefits fraud controls in place to detect unusual trends or patterns. The lawsuit was settled three years later. In the meantime, 10 people, including nine TTC employees, were convicted in relation to the scheme and more than 250 TTC staff resigned […]
In the year ahead, the Canadian Life and Health Insurance Association will continue its advocacy efforts to ensure the federal government’s proposed pharmacare plan extends coverage for those who lack benefits without disrupting workplace benefits that millions of working Canadians rely on, says Stephen Frank, the association’s president and chief executive officer. The right approach to […]
A story on how plan sponsors and insurers are considering covering weight-loss drugs as part of a broader push towards more inclusive benefits was the most-read benefits story on BenefitsCanada.com this year. Here are the 10 most popular benefits news stories of the year: 1. How plan sponsors, insurers are considering coverage of weight-loss drugs amid rising […]
An article announcing the finalists in Benefits Canada‘s 2023 Workplace Benefits Awards was the most-read story on BenefitsCanada.com over the last week. Here are the five most popular news stories of the week: 1. Who are the finalists of the 2023 Workplace Benefits Awards? 2. How employers can help prevent post-vacation burnout 3. AI tools helping insurers manage plan costs by […]
In 2022, Beneva Inc.’s fraud management department noticed unusual activity under a plan member’s account. The insurer’s artificial intelligence tool, used to analyze millions of benefits claims, flagged that a plan member and the person’s dependant had used up all their maximum coverages within a short period of time. When the plan coverage rolled over […]
An article on how the Canadian Life and Health Insurance Association is collaborating with insurers on suspected benefits fraud investigations was the most-read story on BenefitsCanada.com over the last week. Here are the five most popular news stories of the week: 1. CLHIA working with insurers on suspected benefits fraud investigations 2. AIMCo closing gender equity gap through […]
The Canadian Life and Health Insurance Association will now be working with participating insurers to collaborate on joint investigations into suspected benefits fraud schemes. This initiative builds on last year’s launch of a CLHIA-supported program that uses advanced artificial intelligence to identify fraudulent activity across a vast industry pool of claims data. “We’ve been working […]
Our industry sometimes gets a bad rap for being overly traditional and slow to change. But there’s no question we’ve seen some major shifts in employee benefits over the past 45 years. Three of those shifts will have implications for employers going forward. Greater onus on the individual to save for retirement Over the years, […]
The Canadian Life and Health Insurance Association is launching an industry initiative to pool claims data and use advanced artificial intelligence tools to enhance the detection and investigation of benefits fraud. While all Canadian insurance companies have their own internal analytics to detect fraud within their book of business, the new initiative — led by […]
Most (79 per cent) plan sponsors said they have at least one major concern about their health benefits plan, with this increasing to 89 per cent for employers with 500 or more workers, according to the 2020 Sanofi Canada health-care survey. The top concerns include drug plan sustainability (42 per cent), dental plan sustainability (39 […]