1. CAN MEDICAL EXPENSES FROM PREVIOUS YEARS PRIOR TO THE HEALTH PLAN BEING ESTABLISHED BE USED?

In some situations, The Health Plan contract may be back dated. Typically they are situations that involve a corporation and in these situations The Health Plan may begin as far back as the beginning of the current corporate tax year. For proprietors, The Health Plan can be dated back to the beginning of the current calendar year.

2. WHAT FAMILY MEMBERS CAN BE INCLUDED UNDER THE HEALTH PLAN?

Regardless of the type of program, corporate or proprietor, all family members of the covered employee household may all be included.

3. IS THE HEALTH PLAN APPLICABLE FOR A SELF-EMPLOYED INDIVIDUAL (PROPRIETOR) WITH EMPLOYEES?

Yes, but for your expenses to be deductible, your coverage must be no greater than the benefits provided to your arm’s length employees.

4. FOR A CORPORATION, MUST ALL EMPLOYEES BE COVERED UNDER THE HEALTH PLAN AND MUST THEY RECEIVE THE SAME BENEFIT?

No, all employees must be given the opportunity to participate. Those not wanting to participate must sign an Opt-Out Form. Those employees that participate can be grouped according to job classification. Benefit levels can vary by job classification but all employees within a particular classification must receive the same benefit.

5. WHAT MUST BE SUBMITTED TO THE HEALTH PLAN IN ORDER TO MAKE A CLAIM?

The original receipts for the expenses must be submitted along with a cheque paid by the Policyholder in the amount of the expenses plus the 10% administration fee plus applicable taxes.

6. ARE THE ADMINISTRATION FEES AND THE INITIAL POLICY FEE DEDUCTIBLE?

Yes, both the initial policy fee and the ongoing administration fees are deductible to the self-employed individual or the corporation.

7. ARE THE REIMBURSED ELIGIBLE MEDICAL EXPENSES CONSIDERED A TAXABLE BENEFIT TO THE INDIVIDUAL OR EMPLOYEE?

No, eligible medical expenses paid through a private health services plan in respect of employment on behalf of a self-employed individual or an employee are not considered a taxable benefit.

8. WHAT IS THE MAXIMUM ANNUAL BENEFIT A SELF-EMPLOYED INDIVIDUAL MAY SELECT UNDER THE HEALTH PLAN?

The maximum annual benefit that the self-employed individual can select is $1500. The same amount applies to the spouse while dependent children are only eligible for $750.

9. WHAT IS THE MAXIMUM ANNUAL BENEFIT AN EMPLOYEE OF A CORPORATION MAY HAVE ACCESS TO WITHIN THE HEALTH PLAN?

The maximum annual benefit set within a corporately sponsored program as potentially higher then that available for self-employed proprietors. Corporations may elect to set limits that are reasonable for the income a circumstance of the class of employee they are choosing to provide the benefit for. Differing classes can have different limits. For more information on this please contact a representative of The Health Plan to discuss your application.

10. CAN THE MAXIMUM ANNUAL BENEFIT BE CHANGED AT ANY TIME IN THE FUTURE?

Yes, the limits may be changed at any time in the future but The Health Plan requires a letter from the corporation or self-insured individual requesting the change. Since the limit establishes an element of insurance within The Health Plan, and this element of insurance is needed for The Health Plan to qualify under the Income Tax Act, arbitrary changes should not occur frequently.

11. DOES THE COST OF THE BENEFITS PAID UNDER THE HEALTH PLAN APPEAR AS AN EXPENSE ITEM OR A CAPITAL EXPENDITURE?

Any costs paid through a Private Health Services Plan are considered a business expense listed as employee benefits and is not a capital expenditure.

12. HOW DOES THE HEALTH PLAN INCORPORATE AN ELEMENT OF INSURANCE (NECESSARY FOR THE HEALTH PLAN TO QUALIFY AS A PRIVATE HEALTH SERVICES PLAN) INTO ITS CONTRACT?

The CCRA permits either the carry forward of unused account balances for one year or the carry forward of unclaimed expenses for one year. Claims incurred in the second year are paid from the prior year’s balance, thus reducing the chance that the balance is lost.

Secondly, the insurance or risk element is also incorporated into the contract by means of the benefit maximum. Should the benefit maximum be reached by any Eligible Member in a given year, the Eligible Member is then at risk to cover the costs over the maximum. Should it not be reached in a given year, there is always the risk that the benefit may be lost in the second year.

13. CAN ELIGIBLE PARTICIPANTS OPT OUT OF THE HEALTH PLAN?

Yes, as long as they complete an Opt Out Form indicating they were offered the opportunity to participate but elected not to.

14. WHAT IS THE TURN AROUND TIMES FOR THE FOLLOWING: CONTRACT ISSUANCE, CLAIMS?

The Health Plan strives to guarantee the following turnaround times:
Contract Issuance: 7 Business Days
Claim Cheque: 5 Business Days