New E-claims Service
On October 1, we are introducing an exciting new electronic feature to CyberClient. Your plan members across Canada will have the opportunity to submit their claims online through our new E-claims service!
Our new E-claims service can be used for most claims that have not already been submitted electronically to Industrial Alliance by a service provider (e.g. pharmacist, dentist, etc.). It eliminates the need to submit paper forms and receipts to our Claims Department. Your plan members can enter information about their claims in CyberClient and view the status of their claims at any time. It’s quick, secure and greener than ever!
If covered under your group insurance plan, the following types of expenses can be submitted using the new E-claims service:
- Drug claims (groups without drug cards)
- Dental care (basic and preventive services only)
- Vision/Eye exam
Paramedical care including:
- Massage therapy
- Chiropractic therapy
For the time being, the new E-claims service cannot be used for the reimbursement of certain expenses such as major dental expenses, laboratory or imaging expenses, or any other expenses not listed above.
To take advantage of the E-claims service, your plan members must be enrolled for our direct deposit and e-notification services. Your plan must allow members to access CyberClient, with the option to enrol in direct deposit and e-notification.
Focused on efficiently managing our E-claims service, we have a strict and flexible monitoring system to ensure that your group's claims experience is not adversely affected. When using the new service, your plan members must agree to the terms and conditions of online claims submission and are asked to keep their original receipts for a 12-month period.
To detect inappropriate transactions, E-claims are reviewed according to the following key parameters:
Random auditThe system randomly selects a percentage of claims (for example 10%), that will require the submission of original receipts before claims payment will be processed.
Eligibility periodThe system includes an eligibility period for submitting claims (for example 12 months after the date of care received). If a claim is submitted after the eligibility period, your plan members will be asked to submit their original receipts.
The system includes transaction limits for various benefits (for example for dental care, health care and vision care). When a limit is exceeded, your plan members will be asked to submit their original receipts.
These parameters can be customized to satisfy your specific needs and the needs of Industrial Alliance.
Plan members whose claims are chosen for review will have 30 calendar days to submit their original receipts. If they fail to respond accordingly, their access to the E-claims service will be revoked.
The audit process will provide monitoring reports to allow profiling and to detect changes in plan members’ behaviour (for example the use of multiple maximums for the plan member and his or her dependents).
Note that our analysts can contact service providers at any time to verify your plan member’s information (for example the date of care received, the expenses and the member's file). Industrial Alliance also reserves the right to withdraw access to the new service to a plan member at any time.
To help you promote the E-claims service, you will receive a promotional email in September that you can forward to your plan members.
Unless you advise us otherwise, our E-claims service will be offered to your plan members effective October 1, 2011. You have the option to opt-out of this service at any time.
Please contact your benefits advisor or your Industrial Alliance group account executive, if you have any questions about this service or if you choose to decline our E-claims service for your plan members.