Questions about Canada Smart Plan's alternative to health insurance  

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Who can qualify under Canada Smart Plan?

Businesses:

  1. Your business must be registered in any Canadian Province (except Quebec)
  2. If your business is incorporated but you have no additional employees, you qualify.
  3. If your business is a proprietorship or you are self employed, as long as you do not have $10,000 or more in income from another source, you qualify.
  4. If you have any number of additional employees on payroll – 1 to 100 or more, you qualify.

 

Employees:

The employer has complete control over which employees are covered under the plan and the annual benefit amount they receive. They can be added or deleted from the plan at any time.

How often do I have to contribute to the plan?

PAY AS YOU GO! Our cutting edge system is designed to only withdraw from the Employer bank account when claims are made. Company money should stay in company bank accounts, not ours.

Do I have to prefund?

No, we only withdraw money from the company account, when their employees (or you) make claims.

How much does it cost? Zero. Nada. Zilch!

Canada Smart plan is FREE to set up, unlike other services, who charge up to $400 to get started (Most of which is paid out in broker commission… we know from experience!)

Our professional claims adjudication fee is 10% of the claim amount (industry standard).  When you use the plan, you save money – usually 30-40%.  Our 10% administration fee is only applied when you actually benefit from our service!

There are NO monthly Fees

There are NO fees for adding or deleting employees

Can the company set limits on the claims?

 Yes, plans are set up in the following ways:

  • The company establishes a pre-determined annual maximum amount for medical claims, dental claims, and vision claims and/or Health Spending Account (includes ALL types of claims).
  • These pre-determined annual maximums are shown as “available” in the employee’s plan online account. The employee can only submit claims up to the amount that is shown available at the time of claim.  As claims are reimbursed the available limit is reduced, until the budget is exhausted.  Once at zero, the employee cannot submit more claims until the new annual benefit is available.

 What happens when an employee leaves the company?

 The company’s plan administrator can “terminate” any employee from the plan within the admin control panel! 

There might an be unused benefit amount in the employee’s plan, but remember that we do not require pre-funding so there is technically NO money that has been exchanged.

 The terminated employee could only makes claims that had service dates prior to their termination date. Any claims dated after the termination date cannot be put through.  Only the amount that is shown available at the time of claim, for eligible claims can be processed

Can unused contributions be carried over?

Yes, if your business is incorporated or if you have an unincorporated business with additional employees on payroll at the end of a ‘Canada Smart Plan benefit year’ if the employee has not used all of their available contributions, they may be carried over for one additional year. At the end of the second year, contributions made in the first year and carried over are no longer available to the employee.

If your business is unincorporated sole proprietorship (with no additional employees on payroll) you cannot rollover unused benefit amounts.  Your annual amount resets January 1st, to a pooled amount based on your family structure:  $1500 per year, per family member over 18, $750 per family member under 18 years.

EG:  Mom, Dad, 2 young kids: Family annual benefit of $4500 per year.

Can employees make a claim online?

Yes, with Canada Smart Plan, all claims are made online. By simply logging into the account, adding in a few details about the claim and uploading a copy of the receipt, employees can make a claim and get reimbursed in a matter of days!

Additionally, claims can be made from any smart phone or device.  For iPhone and IOS devices, and Android devices we have easy to use APPS so you can submit claims from anywhere.  To upload receipts you are given the option to “take a picture” and submit or choose an existing image of the receipt on our phone.

IMAGINE THIS..You are still in the office of your health practitioner and have just received a receipt for your payment.  Before you even leave their office, you can open your Claims APP on your phone, capture an image of the receipt and submit it for reimbursement INSTANTLY!

Quick.  Efficient. Done!

Our Claims APP compatible with your iPhone, iPad and Android devices is available under the name of “myHSA”! Go to your apps source from your smart device and download the app. Tap. Snap. Send. Claims Anywhere! Learn more and DOWNLOAD THE APP HERE!

What types of expenses are covered?

The employee may claim for any medical expenses that are allowable under the income tax act. This is a very wide range of uses and will include many items that are not typically allowed under a normal group benefits plan. (See the list)  

Canada Smart Plan has made this very simple. When making an online claim your only options for claim types are CRA ELIGIBLE EXPENSES, so you cannot submit something that is not an Allowable Expense.  Our claims adjudicators verify the receipts submitted to confirm eligibility.

Life insurance or disability insurance premiums are not eligible, nor are business or educational expenses. Only medical-related expenses may be claimed. Use of funds for any other reason may invalidate the deductibility of even medical expenses.

Can we get additional benefits?

Yes, you can! Canada Smart Plan can provide complete Emergency Travel Medical and Catastrophic protection which will protect the employee for all out-of country trips. In addition, this coverage includes Catastrophic Claim protection.  The annual fee is just $105 per employee (family included). Please see details at our “Add Ons ” page.

This insurance is optional to incorporated businesses, but by CRA rules, mandatory for sole proprietorships.  If required or elected, this coverage is added to your plan and paid AFTER the online enrollment is completed, and plan is set up.

How are claims reimbursed?

As mentioned before all claims are made online. An employee makes a claim and it sits at pending until it gets the final adjudication. Adjudication will run every Tuesday and Thursday. After approval the reimbursed amount is directly deposited into the employees account.

How does an employee find out their ‘account balance’?

Every employee is given a login to their personal online account. There is 1 page to keep it simple. On the page you can:

  • See your balance
  • Change contact information
  • Change banking information
  • Change dependent information
  • MAKE CLAIMS
  • See what claims are pending and approved
  • Chat live with Canada Smart Plan “live help” who can answer any questions about the  system or plans, 24/7/365.

Can we claim medical expenses from before we started the plan?

Yes! This is one of the most exciting benefits to a new enrollment!  CCRA rules allow you to claim medical expenses incurred before the plan was established.   How far back you can claim is determined by your business structure and when your business began.

If you have additional employees on the plan, you set the start date for eligible expenses.

Incorporated:   If your business is incorporated, you may go back your previous corporate year end or the start date of your business, if your business is new. This is something that you would normally restrict to owners or key management personnel. However, it may be offered to any employee.

**You cannot, however claim expenses dated earlier than the incorporation date of the business.

Your Canada Smart Plan can be set up to have a start date 1 year prior to the date they set up the plan initially. This would mean that the employee could make claims for any services after the start date.

For example, If today’s date is March 1, 2012. If a new client has receipts that date back to July 2011 that he would like to claim through the plan, we would set the START date of their plan to July 1, 2011. This means that he can submit any claims after July 1, 2011 through his company’s HSA. His benefit year would then run from July 1, 2011 – June 30th, 2012. An new allocation would be made June 30, 2012 for the new benefit year that will run from July 1, 2012 – June 30, 2013.

Proprietorship:   For proprietors or self employed professionals, you can claim expenses back to January1st of the current year, or the start of your business if your business started within the current year.

**You cannot claim expenses dated earlier than the beginning of your proprietorship. 

How Do We Get Start with Canada Smart Plan?

  1. Complete the online enrollment form (Click on the “get started” link below)
  2. You’ll receive your account login details to begin claiming and/or adding additional employee

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