Extended Health Care Management (EHC)
ClaimSecure’s full range of web enabled extended health care claims management services, including vision care, major medical, hospital and Out of Country and Travel Assistance benefits, provides Canadian plan sponsors and plan members with accurate and efficient claims processing and payment services. We adjudicate, process and pay eligible EHC claims within five business days of receipt.
Key features:
• Rigorous Standards. ClaimSecure has developed extensive auditing procedures and guidelines that help protect clients from fraudulent claims and/or abnormally high healthcare provider service fees.
• Usual and Customary (U&C) Cost Adjudication. If required, ClaimSecure can adjudicate EHC claims according to U&C costs, to ensure fees don’t exceed “usual and customary” amounts. ClaimSecure maintains up-to-date U&C tables for various EHC services using a number of methods, including:
- Practitioner association published guidelines
- Supplier price lists
- Book of business claims experience
- Provincial assistance program guidelines
- Information sharing with industry associations and healthcare practitioners
Please speak to a ClaimSecure representative to learn more about the benefits and limitations of the U&C adjudication option.
• Flexible Plan Design Options- Tiered co-insurance per benefit class (e.g. 100% Hospital, 80% Major Medical)
- Co-insurance plus calendar maximum per benefit class – dollar or frequency (e.g. 100% Paramedical to maximum of $500 per year or 12 visits per year)
- Dollar maximums: Lifetime or Annual (per certificate, individual or benefit class)
- Benefit entitlement age maximums (for students, employees, retirees)
- Health Care Spending Account (HSSA) set up/maintenance
- Pay member/provider capabilities
- Usual and customary price verification
- Coordination of benefits – private and provincial (e.g. Assistive Devices Program)
- Front end deductibles
- Multiple trip duration options – Out of Country Insurance and Travel Assistance program
• Stop Loss Coverage
Insurance protection that limits a plan sponsor’s financial exposure in the event of catastrophic or unexpectedly high medical claims.
Download• Out of Country (OOC) Insurance and Travel Assistance Program
Emergency travel health insurance to protect plan members and their families from unexpected medical expenses while travelling.
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