Window Newsletter – Fall 2025 Edition

Health and dental benefit fraud and abuse is on the rise. We want to make sure our member’s are knowledgeable about what to look out for to prevent any inaccurate claims.

What are some examples of fraud and abuse by providers?

• Changed procedure codes and dates of service for previously declined claims
• Excessive and unusual invoice submissions
• Submission of services that patients never received
• Submission of inflated fees for financial gain
• Offering inappropriate incentives

What is the impact of fraud and abuse on benefit plans?
Higher insurance premiums and loss of benefits can occur because it can increase the cost of plan premiums and could threaten group plan sustainability.

Example 1
Some providers or vendors of medical equipment will promote incentives to encourage purchases, such as giving free merchandise (such as shoes, glasses, bags, gift cards or cash back), and will inflate the cost of the medical device or service to cover the cost of the incentive.

Example 2
Substitution is another example of fraud. This occurs when a provider gives a patient a product that isn’t covered (like non-prescription glasses) but bills the insurance company for a covered item (like prescription lenses).

How to Protect Yourself and Your Benefits Plan Against Fraud and Abuse 
1. Check your coverage to understand what amounts you will pay that aren’t reimbursed under the benefits plan. Check your claim’s history and explanation of your benefits regularly.

2. Check your explanation or breakdown of the service provided to ensure the service or products you received were claimed accurately, never sign a blank claim form, and keep your receipts for at least one year.

3. Report service providers and vendors who offer to waive amounts not covered by the benefit plan, or who offer inappropriate incentives.

If you suspect fraud or benefit plan abuse, please report it to Sun Life.
Email:
Phone: 1-888-882-2221

With the majority of resources now being digital, it is sometimes nice to have a printer friendly option at hand. Here are some resources available to print for Members, Treasurers, Presbytery Clerks, other employers, or those in your congregation serving in this capacity. 

Retirement Planning
Planning your retirement is one of the most anticipated stages of your life, and the Pension and Benefits department wants to help make the planning process as easy as possible for our members. This Retirement Planning Q&A guide provides answers to our most frequently asked questions regarding the retirement planning process, from health and dental coverage at retirement to steps on how to plan for the big day!

Your Pension Plan Booklet offers information on the Presbyterian Church in Canada’s defined benefit pension plan for our clergy and employees, including up-to-date rates, step-by-step guides to calculating your pension, information about retirement and more!

For Plan Members
Your Group Benefits Booklet, whether you are a Congregational Employee or a Professional Church worker, this is your go-to resource regarding your benefits. This includes Prescription Drug Coverage, Paramedical Services, Vision Care, Dental Care and more! You can also check your benefit plan by
logging into your mysunlife.ca account.

For Treasurers
Formally known as the Treasurer’s Bulletin, the Quick Reference Guide for Treasurers, Congregations and Other Employers is a printable resource that provides quick information on day-to-day jobs and tasks that treasurers, congregations and other employers complete. This includes a checklist of important dates and deadlines, Health and Dental plan information, FAQ’s and more!

The Treasurer’s Guide to Pension and Benefits is an information package for Treasurers that provides up-to-date resources, including: Maximum Qualifying Income (MQI), Pension and Benefit Rates, Minimum Stipend and Allowance Schedule, Remittance forms and more.

DID YOU KNOW?
You can find all these resources and more online! Simply visit presbyterian.ca/pensionandbenefits/helpful-resources

Ethical and eco-friendly replacements for everyday products are not just easily available, they’re diverse, accessible, and effective! From the kitchen to the closet, our daily routines are littered with products that may be convenient, but can be costly and contribute significantly to environmental issues. Below are examples of alternative products that can be used to save money, reduce waste and avoid unwanted chemicals.

1. Bottled liquid detergent -> switch to -> Detergent sheets

2. Plastic food wrap -> switch to -> Beeswax wrap

3. Bottled liquid shampoo -> switch to -> Shampoo bars

4. Dryer sheets -> switch to -> Wool dryer balls

Keeping Your Records Up-to-date…

Life moves fast and making changes to your information can often slip your mind. To help make sure you are always informed and to keep your records updated, we ask that you contact us with any changes to your information.

This includes:

• Changes to your address, phone number or email
• Life events that include marital status changes, birth, adoption or death
• A second contact or Power of Attorney
• Any changes that may include your Beneficiaries
• Plans to retire (a minimum of 4 months notice is required for processing)

Presbyterian Church – Pension and Benefits Department
50 Wynford Drive
Toronto, ON M3C 1J7
Phone: 1-800-619-7301
www.presbyterian.ca

Sun Life Customer Care Centre
Phone: 1-800-361-6212
www.mysunlife.ca
App: MySunLife

ComPsych Guidance Resources Program
Phone: 1-866-641-3847
TDD: 1-877-373-4763
www.guidanceresources.com
App: GuidanceResources Now

Download a PDF copy of the newsletter here!