How our integrated systems benefit plan sponsors and members

How our integrated systems benefit plan sponsors and members

Real-time communication between our administrative and adjudication systems offers quick and seamless confirmation of coverage. This means that when an eligible dependent is added to Benefits Now®, coverage is available within minutes.

Imagine you’ve recently placed a group with us. One plan member attempts to fill a prescription for her son, but the pharmacist is not able to submit the claim because her son is not listed as a dependent on the plan. The member calls our Client Service Centre from the pharmacy. As soon as the client service representative adds the dependent, the pharmacist can instantly submit the claim.

A simplified claims process

Our flexible, single-platform health, drug and dental claims system provides efficient processing and can accommodate a combined deductible for health and dental benefits. Because we operate on a single platform, there’s no need to co-ordinate multiple legacy systems during adjudication, so claims need less manual intervention and administration.

Being rules-based allows for more auto-adjudication of health and dental claims, with rules that can be as simple or as complex as the plan requires. Adjudication can be customized to co-ordinate benefits with a Health Care Spending Account.

Our capable systems and the seamless, real-time connection between them enable plan sponsors to spend less time problem solving plan members’ extended health and dental claims.