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Benefits fraud occurs, according to the Canadian Life and Health Insurance Association (CLHIA), when someone “intentionally submits false or misleading information to an insurance provider for the purpose of financial gain. It can take many forms. Examples include (but are not limited to): Billing for health or dental services that were never received Submitting the same claim to multiple insurers to double your reimbursement Letting someone not covered by your plan use “your benefits.” A [...]

Canada Revenue Agency (CRA) is the revenue service of the government of Canada. It collects taxes, administers tax law and policy. It also delivers benefit programs and tax credits for the federal government, as well as most provincial and territorial governments. The CRA also oversees the registration of charities in Canada.

Canadian Chiropractic Guideline Initiative (CCGI) develops evidence-based clinical practice guidelines and best practice recommendations. It also facilitates their dissemination and implementation within the chiropractic profession.

Canadian Life and Health Insurance Association (CLHIA) is a not-for-profit membership-based organization that represents 99 percent of Canada’s life and health insurance companies and benefits administrators.

College of Chiropractors of Ontario (CCO) is the governing body established by the provincial government to regulate chiropractors in Ontario. Every practicing chiropractor must be registered with the CCO.

Coordination of benefits refers to a provision that determines the sequencing of coverage when employees and their dependents (plan members) are eligible for benefits under more than one private health care plan. For example, coordination of benefits allows two people with health care plan coverage, who are married or in a common-law relationship, to be covered as dependents by each other’s plans. The children or dependents of spouses who both have health care coverage may [...]

Cost containment is the business practice of maintaining expense levels to prevent unnecessary spending or otherwise attempting to reduce expenses. Its goal is to improve profitability without damaging the long-term success of the company.

Co-payment is part of an insurance claim that you must pay out of pocket when you make a claim before the insurer will reimburse you the remaining insured portion of the claim. Some benefit plans include deductibles and/or co-payments as part of their design. An insurer generally applies a deductible once per benefit renewal period. However, an insurer usually charges co-payments on a per-product or service basis at each visit. For example, if a patient [...]

Deductible is a payment that you must pay out of pocket when you make an insurance claim before the insurer reimburses your claim. Some benefit plans include deductibles and/or co-payments as part of their design. Unlike a co-payment, which is generally charged on a per-product or service basis, a deductible is typically charged once per benefit period (e.g. annually). For example, if a plan has a $25 deductible for paramedical claims this means that a one-time [...]