Your Executive Health Plan

Transcription

1 Your Executive Health Plan Administered by WellSpent, A Division of Wellknit Services Inc. This plan was arranged through:

2 Your Executive Health Plan 2 Your Executive Health Plan allows you to purchase health and dental services with tax-free benefit dollars. Your Company contributes to your special Plan but you receive the benefits tax-free! To maintain the tax-free status, your plan must be administered based on the rules established by the Federal Government through Revenue Canada. You have until the end of the plan year to spend your money: unused funds cannot be carried forward to the next year. Please note that Revenue Canada does not allow claims that were incurred prior to your effective date to be paid from this Plan. What benefits are covered under my Executive Health Plan? You can use your Executive Health Plan to cover most medical and dental expenses that would normally be included in an insured plan PLUS you can choose such things as adult orthodontics or laser eye surgery. There are two requirements to obtain reimbursement: The treatment, supply or service must be prescribed or provided by a licensed medical practitioner, The treatment, supply or service is not covered by the provincial health plan nor is it prohibited from being covered under the provincial health plan. If a claim is questionable, determination is based on Section Medical Expense Tax Credit under the Income Tax Act. If the service is deemed eligible under this Act, then it is eligible under your Executive Health Plan. For a more complete list of eligible expenses, please refer to government bulletin #IT-519R2 which is posted on our web site at Eligible services include but are not limited to: Medical Practitioners Acupuncturist Chiropodist (Podiatrist) Chiropractor Christian Science Practitioner Dental Hygienist Dentist Dietician Naturopath Nurse Occupational Therapist Optometrist Osteopath Physiotherapist Practical Nurse Psychoanalyst Psychologist Speech Therapist Therapist WellSpent, A Division of Wellknit Services Inc. 11/07

3 Your Executive Health Plan 3 Prescription Drugs NOTE: For prescription drug claims, the pharmacist must see the physician's script to fill the prescription. Antibiotics Birth Control Pills Blood Pressure Drugs Generic Drugs Fertility Drugs Heart Drugs Name Brand Drugs Smoking Cessation Drugs Ulcer Drugs Dental Services Anesthesia Check-ups Cleaning and Scaling Crowns, Bridges, Inlays, Onlays Dentures Diagnostic Services Fillings Gum Disease Treatment Orthodontic Treatment Root Canals Therapeutic care X-Rays Facilities In-home Nursing care Institutional care Licensed Private Hospital expenses Nursing home care Devices and Supplies Artificial Eye Artificial Kidney Machine Artificial Limb Crutches External Breast Prosthesis following a mastectomy Hearing Aids Hospital Bed for Home Ileostomy or Colostomy Supplies Incontinence Supplies Insulin supplies including Infusion Pump, Needles or Syringes, Test Tape

4 Your Executive Health Plan 4 Supplies Iron Lung Laryngeal Speaking Aid Limb or Spinal Brace Optical Scanner for the deaf or blind Orthopedic shoes or inserts Oxygen and Oxygen Tents Pacemaker Power operated lift but only if medically required by disabled individuals Respirator Teletypewriter Walkers Wheelchairs Wig due to medical condition Vision Care Expenses Contact Lenses Eyeglasses Prescription Sunglasses Laser Eye Surgery Other Medical Expenditures Ambulance Charges Bone Marrow and Organ Transplants Guide dogs (for both vision and hearing impairment) In-Vitro Fertilization Procedure Renovations or Alterations to Dwelling due to medical condition How do I submit a claim to my Executive Health Plan? You can submit your claim for reimbursement by sending in a completed claim form with the original receipts of your expense attached. Please make sure that the receipt includes the following information: The date of the service/supply/treatment A description of the service/supply/treatment - what was it for? Physiotherapy? Prescription Drugs? The dollar amount of each service/supply/treatment The name of the patient (please add full first name if initial is only recorded on receipt) The name of the supplier (e.g. dentist, pharmacy, medical equipment company, etc.) Claim forms are available from our web site, Please complete all areas on the claim form. Forms must be dated and signed. Please remember to provide your Certificate Number (Log on to and look in your Personal Information to find your certificate number), to avoid any unnecessary delays in processing your claim. We will adjudicate the claim and deposit your benefit in your bank account. You can always check your account balance and the details of any claims we receive by logging on to the secure section of our web site,

5 Your Executive Health Plan 5 Adjudication Your claim is submitted to an adjudication engine and evaluated based on plan and employee eligibility including your account balance and the eligibility of the service based on the requirements of the Income Tax Act. Co-ordination of Benefits If you or your spouse or dependent children are covered by a Group Insurance plan, you will probably prefer to send claims to that plan first. This way you can save the money in your account for expenses that are not covered by the other plan. There will be a question on the other company's claim form asking if you have Health, Drug or Dental insurance elsewhere. You can answer "No' to this question as the Executive Health Plan is not considered an insured plan for the purposes of "Co-ordination of Benefits". If the claim is not paid by the other plan, you can then send it to us using a paper claim form and we will process any eligible claim. So, if you think the other Plan might pay something, you may want to send the claim there first. When does my coverage begin? You are eligible for benefits on the date that your Company enrolls you in the plan. Claims incurred prior to you joining the plan are not eligible. The Personal Information section on our web site includes your effective date and the anniversary date of the current plan year. Your dependents are eligible from the date you enroll them in the Plan. Changes in dependent status can be made online at Dependent Coverage Our definition of a dependent is more flexible than traditional group insurance programs. If you claim an individual as a dependent on your Income Tax, then you can include them as an eligible dependent under this Plan. When does my coverage end? Your coverage terminates the earliest of the date your employment terminates, the date you cease to be in a class of employees eligible for this benefit, or the date the Company terminates the contract. When your coverage terminates, you have 60 days to submit any claims that were incurred before your termination date. Amounts remaining in your account, after the 60 days, will be returned to the Company. Your dependents' coverage terminates when your coverage terminates or when you report that they are no longer your dependents. What are the Claims Processing costs? Claim payments can be as frequent as twice a month, however most often claims are only submitted a couple of times a year. There is a processing fee of $10.00 per claim; however this fee is waived for the first two submissions in the year. If a fee is required it is charged directly to your Executive Health Plan. A claim is defined as any Drug, Dental or Health expense for you or any family member, submitted at the same time. Account Amount You earn your benefits on a monthly basis, however your Company will advance funds up to your annual maximum. You can use the advanced funds however, should you leave the Company and have used funds you

6 Your Executive Health Plan 6 have not earned, the Company has the right to recover the unearned portion of the payments. Details of your personal account are available at Want more information? For more information about WellSpent and the benefits of tax-free Health Accounts, please go to our web site,