Item - 2012.AU7.10

Tracking Status

  • City Council adopted this item on July 11, 2012 without amendments and without debate.
  • This item was considered by Audit Committee on July 3, 2012 and was adopted with amendments. It will be considered by City Council on July 11, 2012.

AU7.10 - Improving Reporting and Monitoring of Employee Benefits

Decision Type:
ACTION
Status:
Adopted
Wards:
All

City Council Decision

City Council on July 11, 12 and 13, 2012, adopted the following:

 

1.         City Council request the Director, Pension, Payroll and Employee Benefits, in consultation with the City Solicitor, to formally request the City’s benefit administrator to provide statistical data and reports related to suspected and actual incidents of benefit fraud by employees and/or their dependants that have been investigated by the benefit administrator.

 

2.         City Council request the Director, Pension, Payroll and Employee Benefits, give consideration to the formal documentation of an annual evaluation of the benefit administrator performance as it relates to prevention, detection and investigation of benefit fraud including fraud related to the receipt of Long Term Disability benefits.

 

3.         City Council direct that a copy of this Item be forwarded to the Employee and Labour Relations Committee.

Background Information (Committee)

(June 12, 2012) Report from the Auditor General on Improving Reporting and Monitoring of Employee Benefits
https://www.toronto.ca/legdocs/mmis/2012/au/bgrd/backgroundfile-48565.pdf
Appendix 1 - Managementís Response
https://www.toronto.ca/legdocs/mmis/2012/au/bgrd/backgroundfile-48566.pdf

AU7.10 - Improving Reporting and Monitoring of Employee Benefits

Decision Type:
ACTION
Status:
Amended
Wards:
All

Committee Recommendations

The Audit Committee recommends that:

 

1.         City Council request the Director, Pension, Payroll and Employee Benefits, in consultation with the City Solicitor, to formally request the City’s benefit administrator to provide statistical data and reports related to suspected and actual incidents of benefit fraud by employees and/or their dependants that have been investigated by the benefit administrator.

 

2.         City Council request the Director, Pension, Payroll and Employee Benefits, give consideration to the formal documentation of an annual evaluation of the benefit administrator performance as it relates to prevention, detection and investigation of benefit fraud including fraud related to the receipt of Long Term Disability benefits.

 

3.         City Council direct that a copy of this Item be forwarded to the Employee and Labour Relations Committee.

Origin

(June 12, 2012) Report from the Auditor General

Summary

The City of Toronto and its Agencies, Boards and Commissions provide employee health care benefits for its employees and retirees, as well as to their spouses and eligible dependants.  Pension, Payroll and Employee Benefits Division (PPEB) is responsible for administering the employee benefit plans including the City’s Long Term Disability program (LTD), for those individuals employed directly by the City (i.e., Toronto Public Service) employees.

 

The City provides, through its benefit administrator, Manufacturer’s Life Assurance Company (Manulife) extended health care, dental care and long term disability coverage on an Administrative Services Only basis.  The City is self insured which means the City reimburses Manulife for the actual benefit claims paid to employees and pays administrative fees for their processing and adjudication services.

 

Administration of the City’s Benefit Plans by Manulife includes prevention and detection of fraud and investigation services.

 

There is a need to improve Manulife’s reporting to the City with respect to incidents of benefit fraud by employees and their dependants, that Manulife has investigated.  Improved reporting by Manulife should include statistical data and reports to enable the City to consider trends and patterns which may indicate fraud or abuse of benefit claims.  This will also enable the City to assess the performance of the benefit administrator, as it relates to its responsibility to prevent, detect and investigate benefit fraud including fraud related to the receipt of LTD benefits.

 

This report contains two recommendations to improve the reporting and monitoring of benefit fraud, along with a management response to each of the recommendations.

Background Information

(June 12, 2012) Report from the Auditor General on Improving Reporting and Monitoring of Employee Benefits
https://www.toronto.ca/legdocs/mmis/2012/au/bgrd/backgroundfile-48565.pdf
Appendix 1 - Managementís Response
https://www.toronto.ca/legdocs/mmis/2012/au/bgrd/backgroundfile-48566.pdf

Motions

1 - Motion to Amend Item (Additional) moved by Councillor Doug Holyday (Carried)

That the Audit Committee recommend that:

 

1.         City Council direct that a copy of this Item be forwarded to the Employee and Labour Relations Committee.


2 - Motion to Adopt Item as Amended (Carried)
Source: Toronto City Clerk at www.toronto.ca/council