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WHY DOES ONE SOMETIMES INCUR SHORTFALLS ON CLAIMS?


A shortfall might be the result of the fee charged being higher that the tariff awarded. Claims are paid according to tariffs and any fees charged above the tariff award will result in a shortfall. Shortfalls also arise when a member has exhausted the benefit limit for a given membership year. Some benefits are subject to yearly limits, which when exceeded result in a shortfall. Different packages have different limits. Shortfalls can also be due to waiting periods, which mean that the member is not yet eligible to draw funds for certain benefits.


May 27, 2020
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