The simple way to think of the HCSA is that at the beginning of the Plan Year, or the first day of the first month you were signed up for benefits, you have a defined amount of money to spend on health-related expenses. The range of expenses that can be covered by this amount is wide – see the sample list of eligible expenses under the Canada Agency Website. This amount can also be applied to the deductible on the Catastrophic Medical, if required.
The Catastrophic Medical was put in place to cover unexpected expenses such as hospital stays, drugs, private-duty nursing and the cost of certain practitioners (e.g. masseuse, chiropractor). It provides up to $125,000 for reimbursement of medical expenses incurred in your province of residence per calendar year for each illness or accident after the expenses exceed the Annual deductible of $2,500.
Expenses claimed in your HCSA or your Spouse’s Benefit Plan all apply towards the deductible.
The Employee’s spouse and eligible dependents are covered under this plan.
The Emergency Medical Travel covers employees who require medical services when traveling outside of Ontario – see SSQ Policy Booklet for details of expenses covered under this section. Employee’s spouses and dependents are covered under this plan as well - even if they are travelling without the employee (i.e. vacationing while the employee is at home or travelling for business). On the Emergency Medical Travel, there is no deductible.
How do I make a claim for an expense under the HCSA or claims under the Catastrophic Medical or Emergency Medical Travel policies?
You can use a Vital Health Savings Plan claim form for claims under the HCSA. Claims eligible under Catastrophic Medical are automatically monitored by Vital Health and you will be notified once the deductible has been attained. Eligible claims are then reimbursed by the Catastrophic Medical insurance policy and NOT by your HCSA.
Can I use my HCSA for expenses incurred (and not previously reimbursed or claimed on my income tax return) prior to my enrolment with Vital Health Savings Plan?
Yes. You can claim for any expenses incurred within the 12 months prior to the start date referred to as the 'Plan Year' on the health plan (not 12 months prior to your start date with the company).
I have a spouse, a child and mother-in-law – are they covered under the HCSA?
The amounts allocated to your HCSA are for all family claims, including those who are related to you by blood, marriage or adoption and are residing with you.
What if I haven’t used up all my HCSA funds by the end of my plan year?
You can carry over your HCSA funds for one year, if any amount remains outstanding and your plan permits the balance carry-forward feature. If this carried-over amount has not been used up by the end of the following year, the amount is forfeited.
What if I have an expense for $1,000 in my second month on the plan?
Vital Health will process reimbursements each month to the maximum available in your HCSA until the claim is reimbursed in full.
What if I’m no longer working for my current employer, but I have some claims that I haven’t put through yet?
An employee can still make claims for any expenses that were incurred while employed so long as the claim is submitted within 60 days of the termination period. Claims incurred after your employment date are not eligible.
What are your fees?
8% Ontario Retail Sales Tax on Paid Claims and Admin Fees
10% Administration fee for Self-Employed Plans
10% Administration fee on eligible paid claims for Incorporated Professionals
10% Administration Fee on eligible paid claims for Employer Plans with fewer than 5 people
15% Administration Fee on eligible paid claims for Employer Plans with 5 or more people
A 2% Ontario Insurance Premium Tax on the Administration Fee and eligible paid claims
13% HST in certain circumstances but we hope you get that back (only applicable to Incorporated Professional and Employer Plans)
No claim submission fees
No inactive account fees
No annual fee
What’s the cost of the Catastrophic Medical + Emergency Medical Travel insurance policy?
$145.64 per year for Single
$291.29 per year for Couple or Single Parent with 1 child
$393.10 per year for Family (couple+ 1 or more child)