DEFRAUDING
THE PLAN(S)
Unfortunately,
from time to time, persons who are not entitled have obtained benefits from one
or other of the Plan(s). In each of these instances, someone has attempted to
obtain money or a valuable service which otherwise would have been available
for you.
In
order to protect your Plans from this kind of conduct, security measures have
been established. For instance: the Health and Security processes thousands of
claims within the course of a year: each claim is scrutinized to determine its
validity, as part of our routine claims processing procedure. If the
Administrator will notify the Plan suspects that a claim submitted on behalf of
an eligible member or eligible dependent is fraudulent, the member,, in writing
and an explanation will be required. If it is determined that fraud has been
committed, restitution will be required and the Plan may also suspend future
benefits for an appropriate period.
Sometimes
the Plan discovers that through an administrative error, a claim was paid
incorrectly. Given this situation, the Administrator of the Plan will notify
the member, in writing, informing him/her of the specific overpayment and
request a refund. If the refund is not made as required, the Plan will suspend
future benefits until payment is made. The benefits will be reinstated when the
money is repaid, or an acceptable repayment arrangement has been agreed upon.
Each
of the Plans has a security system and repayment policy similar to that
described above. You may rest assured, however, that if an issue arises with
respect to a security question, the affected person will be given a full
opportunity to explain their particular circumstances before any action is
taken.
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