Cost Plus Information Package

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1 Cost Plus Information Package P.O. Box 1569, Street, Fairview, AB T0H 1L0 Phone: Fax: Updated: 05/27/2015

2 COST PLUS BENEFIT PLAN INFORMATION PACKAGE Cost Plus is a Private Health Services Plan (PHSP) that provides 100% health and dental and vision coverage. This plan can be a stand alone plan or can be used to supplement existing health and dental plans. Cost Plus is a pay as you go plan. Premiums are not charged monthly but on a per claim basis. Cost Plus covers all health-related expenses eligible as defined under Subsection 118.2(2) of the Income Tax Act (or IT 519R2). The employer sets the level of coverage for the employees. This can be based on position with the company, length of employment, etc. This limit can be changed yearly. There is no statutory limit for the amount of medical/dental expenses that can be reimbursed but must be reasonable in order to be deductible. You pay for your health and dental expenses as you normally would. This plan only accepts paid receipts. Your business then pays Canwest Group Benefits Inc (plan administrator) payment to cover the health and dental expense plus a 10% administration fee (both of which are tax deductible). Canwest Group Benefits Inc then provides the claimant with a tax free reimbursement of the health and dental expenses incurred. Employees manage this plan themselves they decide which health and dental benefits they want to claim through the plan up to their annual maximum. Once they have used up their annual maximum, claims cannot be carried over to the following year. There is no enrollment fee or monthly premiums to pay. 2

3 LIST OF ELIGIBLE EXPENSES WHAT IS COVERED The list of Eligible Expenses is not comprehensive and is subject to change at any time without notice. This information does not supersede information or decisions rendered by Canada Customs and Revenue Agency (Canada Revenue Agency). Please visit Canada Revenue Agency s website, or the direct link, for the active list of eligible expenses. Under the Cost Plus plan, participants can be reimbursed for medical related expenses not covered by provincial health care or an employee's health and dental plan. Any medical related expense which could be used to meet requirements for deductibility on a participant's personal income tax return (in accordance with the Income Tax Act) is eligible for reimbursement. The expenses must qualify for reimbursement for an eligible medical expense as defined under subsection 118.2(2) of the Income Tax Act (or IT 519R2), which includes many items not covered by most traditional medical and dental insurance plans. Note: Premiums for Alberta Health Care (AHC) or any other Provincial Health Care Plan are not eligible expenses. PREMIUMS FOR HEALTH CARE PLANS Premiums paid to any non-governmental medical, dental or hospital care plans. Example: Alberta Blue Cross, Great West Life, Canada Life, etc PROFESSIONAL SERVICES Any service performed by a licensed qualified medical practitioner, including, but not limited to the following: Acupuncturist Naturopath Physiotherapist Chiropodist Neurologist Podiatrist Chiropractor Opthamologist Psychiatrist Dentist Optometrist Psychologist Dental Hygienist Orthodontist Registered Nurse (RN) Dietician Osteopath Speech Therapist Gynecologist Physician Surgeon Note: A qualified medical practitioner means a person who is authorized to practice in accordance to the laws of the province and is certified according to the practitioner's governing body. 3

4 DENTAL SERVICES Any service performed by a qualified licensed practitioner, including but not limited to the following: Dental X-Rays Extracting Teeth Orthodontic Treatment Denture Repairs Filling Teeth Crowns & Bridgework Denture Replacement Gum Treatment Dental Implants Dental Examinations Oral Surgery Dentures LABORATORY EXAMINATIONS, TESTS AND HOSPITAL SERVICES Any service performed by a licensed medical practitioner, including but not limited to the following: Blood Tests Metabolism Tests Use of Operating Room Cardiographs Prescription Drugs Vaccines Diagnostic Fees Spinal Fluid Tests X-Rays & Lab Fees MEDICINES & MEDICAL TREATMENTS Must be prescribed by a licensed medical practitioner and dispensed by a licensed pharmacist or licensed medical practitioner as part of their medical services: All Prescription Drugs Insulin & Insulin Supplies Oxygen & Equipment Blood Transfusion Radiation Therapy Audiology Tests & Treatment Vein Removal Organ Transplants Nursing Services by RN PRESCRIBED MEDICAL MATERIALS & APPARATUS Must be prescribed by a licensed medical practitioner and dispensed by a licensed pharmacist or licensed medical practitioner as part of their medical services: Breast prosthesis Birth Control Pills Orthopedic Shoes & Boots Extremity Pumps Hospital Beds at Home Infusion Pumps Devices to Mobility Impairment Oxygen Synthetic Speech Systems & Braille Printers Wigs required as a result of medical treatment 4

5 MEDICAL MATERIALS & APPARATUS NOT REQUIRING PRESCRIPTION Any materials or apparatus paid to a doctor, nurse or hospital Any materials or apparatus paid to a doctor, nurse or hospital Artificial Limbs Braces Blood Sugar Measuring Devices Catheters Crutches Colostomy / Illestomy Pads Hearing Aids, Audible Telephone Systems Wheelchairs VISION COVERAGE Must be prescribed by a licensed medical practitioner and dispensed by a licensed pharmacist or licensed medical practitioner as part of their medical services: Eye Glasses Frames & Fittings Contact Lenses Eye Exams Laser Eye Surgery OTHER EXPENSES Must be prescribed by a licensed medical practitioner and dispensed by a licensed pharmacist or licensed medical practitioner as part of their medical services: Ambulance Charges Home Maker Services & Home Care (No Relatives ) Prescription Birth Control Pills Specially Trained Dogs for Blind / Deaf / Impaired Co-Insurance and Deductibles for medical expenses not paid or reimbursed by Employee Benefit Plans MEDICAL TRAVEL EXPENSES If you had to travel at least 40 kilometres (one way) from your home to obtain medical services, you may be able to claim the transportation expenses you paid as medical expenses. If you had to travel at least 80 kilometres (one way) from your home to obtain medical services, you may be able to claim accommodation, meal, and parking expenses in addition to your transportation expenses as medical expenses. To claim transportation and travel expenses, the following conditions must be met: - substantially equivalent medical services were not available near your home; - you took a reasonably direct travelling route; and - it is reasonable, under the circumstances, for you to have travelled to that place for those medical services. 5

6 WHAT IS NOT COVERED Air Conditioner, Humidifiers, Dehumidifiers, Air Cleaners Antiseptic Diaper Services Cost of Missed Appointment EXPENSES INCURREDFOR PURELY COSMETIC PROCEDURES (including related services and other expenses such as travel). This generally includes surgical and non-surgical procedures purely focused on enhancing one s appearance such as liposuction, hair replacement procedures, Botox injections, and teeth whitening Health / Fitness Programs offered by Resort Hotels or Health / Fitness Clubs Homeopathic Medicaments and Herbal Supplements Illegal Operations, treatment or drugs Maternity Clothes Medical Expenses reimbursed from other benefit plans Non prescription birth control devices Non prescription sunglasses / clip-ons Personal Fitness Trainers / Gym Memberships Reiki practitioner Rolf Therapy Scales for weighing food Special Foods unless for treatment of medical condition and prescribed by a medical practitioner Take home bleaching kits (dental) Toothpaste Umbilical Cord Blood Extraction and Storage PROVINCIAL HEALTH CARE PREMIUMS ARE NOT ELIGIBLE SPECIAL NOTE: This is not a complete list of all eligible expenses, it is intended to provide a guideline and examples of commonly claimed medical expenses. Please visit CRA's website for the complete list of which expenses are and are not eligible to be claimed. The final authority for Income Tax purposes is Canada Customs & Revenue Agency - (CCRA). Please refer to Section 118.2(2) of the Income Tax Act for a complete list of expense coverage or go to: 6

7 WHO IS ELIGIBLE? Shareholders are eligible if they are actively employed by the company and the benefit is paid in their capacity as an employee, not a shareholder. In order for the benefits to qualify the shareholder must be actively engaged in the business activities of the corporation, although not necessarily collecting a salary. the benefits must be reasonable, and be consistent with what would be offered to an arm s length employee providing similar services Employees for an individual to receive tax free health and dental benefits from an employer, Revenue Canada must define them as an employee. If one of the following answers to the questions below is yes, then the person is an employee. 1. Does the individual collect a wage, salary, fees or bonus? 2. Does the corporation (employer) remit payroll taxes (income tax and CPP) on behalf of the individual? 3. Are payments made to the individual deductible from the corporation s (employer s) income? (IE. management fees, wages, salaries, bonuses) UNINCORPORATED BUSINESSES If you are unincorporated (self-employed individual or partnership) you may qualify for a Cost Plus plan, if you are actively engaged in the business on a regular and continuous basis, or your total income from the year from other sources does not exceed $10,

8 PLAN SETUP: A Cost Plus plan can be designed in many different ways. When designing the plan, different classes with set limits can be created according to: Single vs family Responsibility in the company (manager vs employee) Length of service with the company For example an employee that is a Manager could have a higher limit than a full time employee. Or an employee that has been with the company 5 years could have a higher limit than employee that s only been there one year. This would also work as an incentive for the employees that once they reach the next level (ie five years) they could look at an increase in their Cost Plus. One thing to keep in mind is that employers MUST offer their employees some type of benefit plan. Employers can t set themselves up with a $20,000 Cost Plus plan and offer nothing to the employees. At the same time, they need to set up their Classes with reasonable and customary limits. For example, the employer shouldn t have a $50, limit and give their employees a $ limit. The limit set is an annual limit. There is no carry forward of unused amounts. Use it or lose it. If a plan member sends in a claim from last year and hasn t used up his/her annual limit for that year, the claim will be honored. For Cost Plus plans that have their employees enrolled, the employee would send in a claim form along with receipts. Canwest adjudicates the claim to ensure eligibility. Once the claim has been processed, the employer will receive an Invoice for the amount owing. In order to protect the employee s privacy, the employer does not see the receipts or is given any information regarding the details of the claim. All receipts submitted must be PAID by the individual in order to qualify for reimbursement. This is a reimbursement plan only. This ensures the reimbursement back to the employee is tax free. Before implementing a Cost Plus program, we strongly encourage you to consult with your professional tax advisor. You want to be sure that you are eligible to implement a Cost Plus program; and before any expenses are submitted for reimbursement, you need to be sure that these expenses are eligible. For a complete list of eligible medical expenses (form IT-519) you can visit Revenue Canada s website at or by calling

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