Employee(s) get to know the plan - Q & A's

What if I have additional questions?

Please e-mail us at phsp@puhlemployeebenefits.com

The following questions are the most frequently asked by employees:

How is a traditional plan different than the PHSPCANADA Plan?

In concept, the traditional plan is like a size 10.5 shoe. Everyone gets a pair of 10.5 shoes – one size fits all. A few employees have high arches.

The PHSPCANADA Plan gives the ability to as to as close as possible, allow you to pick your own shoe size and be able to adjust the shoe size when your feet change – many sizes based on your life circumstances.

How does the PHSPCANADA plan work?

Please visit out video link to see your options. Employee Choices

Your PHSPCANADA account is like a bank account. You start each plan year with a certain number of credits / dollars in your account. Then, throughout the year, you use those credits / dollars to pay for medical, vision & dental expenses (that aren’t covered elsewhere) as well as premiums for complemental health and dental plans.

The purpose is to provide flexibility and choice in the delivery of employee benefits, tax-free.  Provides reimbursement of eligible “medically necessary” medical & dental expenses as defined by CRA rules & regulations.

Your employer allocates a pre-determined dollar benefit to you through your PHSPCANADA account. You then decide how & when to spend your health care dollars based on your personal and family needs.

Login to the Employee Portal at MyInsurance Store – Top Right Corner

How does a claim receipt need to satisfy CRA Government Requirements?

Each receipt submitted in a claim submission needs to abide by CRA’s (Canada Revenue Agency) guidelines and requirements. Receipt(s) are required to have the following:

  1. Date of service
  2. Cost of service
  3. Proof of payment
  4. Identification of the service rendered / drug purchased
  5. Patient name / who the service was for 

Please note:

*Cashier / till receipts are not an eligible form of receipt, due to the above noted required CRA – Government criteria for each receipt submitted.

*You may assist the adjudication process by circling the 5 CRA required points.

Medical practitioners authorized to practice in accordance with the above laws can include (depending on the applicable province or jurisdiction, as the case may be) the following:

    • an osteopath;
    • a chiropractor;
    • a naturopath;
    • a therapeutics (or therapist);
    • a physiotherapist;
    • a chiropodist (or podiatrist);
    • a Christian Science practitioner;
    • a psychoanalyst who is a member of the Canadian Institute of Psychoanalysis or a member of the Quebec Association of Jungian Psychoanalysts;
    • a psychologist;
    • a qualified speech-language pathologist or audiologist such as, for example, a person who is certified as such by The Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) or a provincial affiliate of that organization;
    • an occupational therapist who is a member of the Canadian Association of Occupational Therapists;
    • an acupuncturist;
    • a dietician; and
    • a dental hygienist.

Additionally, a “nurse” includes a practical nurse whose full-time occupation is nursing as well as a Christian Science nurse authorized to practice according to the relevant laws referred to in subsection 118.4(2).

What is an acceptable CRA receipt?

IT-519R2 – Medical Expense and Disability Tax Credits and Attendant Care Expense Deduction (# 68) states:

Proper receipts must support all amounts being claimed as qualified medical expenses (including travel expenses).  A proper receipt should indicate the purpose of the payment, the date of the payment, the patient for whom the payment was made and, if applicable, the medical practitioner, dentist, pharmacist, nurse, or optometrist who prescribed the purchase or delivered the service.

A cancelled cheque is not an acceptable substitute for a proper receipt.  If required forms, receipts or other supporting documents are not filed with the income tax return, such as when the return is electronically filed (E-filed), they should nevertheless be retained and readily available as they may subsequently be requested as proof of the claims being made or in support of the information being reported.

If the Rx drug or product I am buying has a Drug Identification Number (DIN), can I use my Health Spending Account to cover the costs?

The CRA requires that all health, dental & vision care expenses must be medically necessary in order to be paid with HSA funds.  This is the key; proving from two sources that the Rx drugs are / were medically necessary.

The CRA is satisfied if a third party medical professional has provided in writing the prescription for the DIN (Drug Identification Number) Rx drug and if it has been dispensed and recorded by a pharmacist.  The cost of a physician’s prescription drug that is recorded by a pharmacist will be reimbursed to you with tax-free dollars from your Health Spending Account.

So, if you can buy the Rx drug with a DIN over the counter, it will not be allowed by CRA Rules as a medical need because the pharmacist has not recorded the transaction.

Who does the CRA consider a 'medical professional'?

The following IT Bulletin provides the answer.

Interpretation Bulletin 519 R2 Medical Expense covered

For more details go http://www.cra-arc.gc.ca/medical/.

References to Medical Professionals – IT 519 # 3 & # 4

This bulletin uses the terms “medical doctor,” “medical practitioner,” as well as various other terms to describe individuals involved in the medical profession, in a way that is consistent with the terms found in the Income Tax Act. The term “medical doctor” is used in section 118.3 for purposes of the disability tax credit. Section 188.2, on the other hand, uses the term “medical practitioner” for purposes of the medical expense tax credit. “Medical practitioner” encompasses a broad range of individuals in the medical profession.

For purposes of the medical expense and disability tax credits under sections 188.2 and 188.3, subsection 188.4(2) provides that a reference to a medical practitioner, dentist, pharmacist, nurse, or optometrist means a person who is authorized to practice as such according to the following laws:

  • for a service rendered to an individual, the laws of the jurisdiction in which the service is rendered;
  • for a certificate issued for an individual, the laws of the jurisdiction in which the individual resides or of a province; and
  • for a prescription issued to an individual, the laws of the jurisdiction in which the individual resides, of a province or of the jurisdiction in which the prescription is filled.
What are my choices for methods of reimbursement?

The claim process has been designed to provide the choice of reimbursement that best suits your own particular needs.  The following are the TRAC on – line System choices for processing your reimbursements:

  • You pay personally at point of sale and submit your claim receipt for electronic repayment into your personal bank account. The cash reimbursement option.
  • Let’s you negotiate cash price for service and / or products.
  • You pay with a credit card at point of sale and submit your claim for electronic repayment into your personal bank account, and then you pay off your credit card.
  • Let’s you negotiate price for service and / or products.
  • Collect travel points.
  • We pay the dentist & / or vision care provider directly if provider agrees.
  • Frees you from any hassles.

The TRAC on-line System is designed to handle your method of reimbursement choice. Statements are sent to you via e-mail confirming the reimbursement and the remaining balance in your account.

How do I submit my first claim (and all future claims)?
  • Use the Portal to submit
  • Use the claim app
  • Circle the total $ amount claiming – for easier adjudication on each receipt. 

Thank you for taking the time to be clear & accurate on your claim submission, it will most definitely speed up your claim reimbursement.

How does the PHSPCANADA Plan reimburse my money?

Our custom-designed TRAC on-line System reimburses your expenses by: 

  • Electronic payment into your personal bank account;
  • Electronic payment to your dentist.

Plus, if we have your e-mail address a claim confirmation notice is sent to you upon receipt of the claim and then again when the claim is paid showing the dollar amount of your refund and the balance left in your Health Spending Account.  This information is also sent via confidential e-mail to your employer.

Effective asap, if you have not yet registered your personal e-mail address with our TRAC on-line claim System, please submit to Puhl Employee Benefits via your portal at MyInsurance Store – Top Right Corner.

Can I get refunded by a cheque?

Yes, however a cheque run is only done on the 30th of each month.

What is the usual turn-around time for a claim?

Our goal is to have 100% of correctly submitted claims paid within six days of the Claims Dept. receiving the employer funds. If we electronically reimburse your personal bank account, the turn-around time is usually 3 to 5 days (in your account) from the day the claim was processed.

We appreciate your help in maintaining (& even improving) the turn-around time..

Do I need a chequing account to have my refund electronically paid?

No, all you need is a bank account that accepts deposits. Please e-mail the name & phone number of your bank, the bank’s transit numbers, the account type & number (it is best to have your bank provide a hard copy of the information to eliminate any errors). However, if you do have a chequing account simply scan us a voided cheque.

What is the procedure when an Employee or an Employee's spouse calls the Puhl / PHSP office?

The problem we have is that we do not know who is calling, and an easy question such as: “Have you received my claim yet?” can create frustrations on both ends.

What we need is the employee to e-mail us permission to interact with the spouse so we can have permission on record.

The Human Rights and Privacy Rules and Regulations apply in this situation. Therefore, we are requesting any questions to be e-mailed to us. We can then look at the question(s) and respond back to the sender via e-mail or call if requested by the employee.

If the Employee or an Employee’s spouse calls us, we will respond by e-mail with an answer to the proposed question(s) as we are limited on the verbal responses to questions over the telephone.

Please e-mail any questions to phsp@puhlemployeebenefits.com

How can I make the most effective use of my Plan?

Your account is designed to cover your & your family’s basic health, dental & vision care needs. You will typically be aware in advance of predictable & / or upcoming major costs, e.g. a prescription (Rx) drug needed monthly or a orthodontics expense.

These instances dictate when your personal situation becomes the most important factor when deciding where to allocate your Health Spending Account dollars.

First, schedule appointments for major expenses like vision care and dental work around November / December of each year to maximize the availability of your HSA flex credits / dollars.

Second, always shop around to maximize the value for your money. In many cases you can drastically lower Rx dispensing fees & vision care costs (Costco & Wal-Mart & your independent vision care experts provide excellent value).

Third, if your family spends over $500 / year on regular prescription drug purchases, you will probably want / need to look for additional complimentary coverage.

Please e-mail phsp@puhlemployeebenefits.com and we will assist you in your selection. For Alberta residents, the solution is the Alberta Blue Cross non – Group Rx drug plan. Each province is unique and most have a provincial Rx Prescription drug plan so please e-mail us.

Fourth, if your family goes to the dentist twice a year and is experiencing maintenance dental bills, consider purchasing our supplemental plans with your HSA employer funds.  

Dental Plan complemental plan premiums are reimbursed from your account, tax-free.

Please e-mail us at phsp@puhlemployeebenefits.com and we will assist you in your selection of dental, health & vision care supplemental plans.

Website – MyInsurance Store 

The credits / dollars in your Health Spending Account can be used to cover health, dental & vision care expenses not covered by any independent health and / or dental plans. 

Note:  If you are covered by your spouse’s plan, your Health Spending Account is usually sufficient to cover the medical products and services not covered by his / her plan.

What is my Employer's plan year?

Your company’s Plan Year is Jan 1st to Dec 31st of each year. Employee’s plan designs are based on the employee’s date of hire, which is reconciled to Dec 31st.

What is the Effective Date of Employee Coverage?

Coverage is in effect for your account the first calendar day after your company’s waiting period has been reached.

What are the 'concerns' for me about my account?

Once a year (more often for some employees), employees have to take the time to plan the best strategy for their own personal health situations.

Until now, everyone (employer and employee) has just accepted the terms, costs, and limitations of whatever an insurance company dictated. Now personal freedom of choice can be exercised to create a tailor-made plan, which will provide the coverage needed, when needed, tax-free. The employee wins.

How does the Puhl / PHSPCANADA track and report claims and balances to all concerned?

The PHSPCANADA Plan is committed to researching, developing, and implementing the latest technological innovations. This guarantees our clients will always have access to the most effective and efficient systems available.

We have developed and use the TRAC on–line System. TRAC – Technology Reporting for Administration and Claims on–line. The TRAC on–line System uses the latest on-line technology and is currently being expanded to allow direct employee interaction.

The TRAC on–line System has the capability to handle the entire claim process, including electronic notification to both employee and employer that the claim (shows exact payment to employee) has been paid and there is (shows exact balance) left in the employee’s Health Spending Account (HSA).

The TRAC on–line System tracks and reports all transactions from the first monthly contribution to notification at the end of the year of employee options and how to best maximize them. This creates stress-free management and high employee understanding and satisfaction.

The TRAC on–line System works for employees providing them accurate information when they need it. Employees can request their HSA balances at any time and in the near future they will be able to go on-line for instant up-dates.

How do I use the claim (reimbursement) form available on the web?

Login to your portal at MyInsurance Store – Top Right Corner

Are all claims confidential?

All claims are strictly confidential. Your employer knows only the dollar amount, as the employer must cut the cheque to pay for your expenses tax-free.

What are my account limits?

The employer sets employees dollar limits. Please login to your portal for your employee statement access. Login – MyInsurance Store – Top Right Corner

How do I find out how much is left in my Health Spending Account?

Log on to your employee portal and see your statement at MyInsurance Store – Top Right Corner

You are sent a notification after each claim is processed & reimbursed which shows your remaining HSA balance.

Are my dependents covered?

Employees & their dependents that are included on the employee enrolment form have coverage to the account member’s maximum. Coverage includes all tax dependent members; your mother could claim her health care expenses (to your dollar limit) if she is tax dependent on you.

What if my spouse has coverage?

Perfect: your account is much like a bank account. You do not have a conventional plan, you have credits / dollars. Claims go through your spouse’s plan first and then any “medically necessary” health, dental and vision care expenses not covered may be paid through your account, to your dollar limit, tax free.

How long can I hold expenses before submitting?

Expense receipts cannot be dated more than twelve months prior to submission and are payable in the year claim was incurred.       

We ask that you please hold expense receipts until $200 is reached or until year-end (December 31 of the current year). This is not a requirement but our suggestion in order to help keep administration costs low for you and your employer.

You have thirty days from date of termination or if presently employed with the company, until December 31 of the current year to submit your medically necessary health, dental & vision care expenses, that where incurred while employed.

Employee Enhancements - start date?

Enhancements can be started on January 1st of each year, or when a family situation occurs.

Example:  birth, marriage adoption etc.

What about travel coverage?

We strongly recommend purchasing travel insurance when traveling out of the country. MyInsurance Store is the site to buy travel insurance, #1 in price and product. Please check with your Company’s administrator.

Ask us about our special snowbirds travel policy.

Can I pay for travel insurance with my account credits / dollars?

Yes, can be paid with Health Spending Account tax-free credits / dollars.

Why is there no card to use for Rx drugs so I don't have to come up with the money?

Flexibility of choice: a card system restricts your coverage by the Rx Prescription drugs allowed. The purpose of the plan is to cover 100% of all costs, of all drugs & other services. Example: co-insurance, extra billing, extra charges, plus allowing you to divert your account dollars for item(s) of medical necessity.

Also, the Flexible Plan Rx prescription complimentary drug plans provide an Rx drug prescription card.

What is an optional complimentary health and dental plan?

An optional complimentary health and dental plan (which can also be called a safety net or stop-loss plan) is designed to protect employees from catastrophic claims that could deplete or exceed their Health Spending Account maximums.

A spouse’s plan or optional supplemental health and dental plan. You choose the appropriate plan for your family & the premiums are paid from your HSA, taxfree. Employee Choices

Should I buy an extra health and dental plan?

Your situation is unique to you. Our answer is yes if you have or anticipate frequent claims that are higher than the premiums you would pay for additional coverage. Use your account before-tax dollars to pay the premiums.

Please e-mail or fax us & we will facilitate your application for the additional coverage product so it can be coordinated with your account.

What do you suggest for new employees who have high Rx drug expenses?

In Alberta, employees should apply for the AB Government Blue Cross Non- Group Drug Plan, (if within 31 days from ending Blue Cross coverage with a former employer, there is no waiting period). Coverage will be seamless from the date the previous coverage terminated.

New employees with no prior coverage and high Rx pre-existing expenses should apply immediately for the AB Government Blue Cross Non-Group Rx Drug Plan, as there is a three-month waiting period during which premiums are collected and claims are disallowed. Best to apply ASAP from date of hire to minimize the waiting period.

In other Provinces and Territories employees should join their provincial Rx Prescription drug plan card then look at applying for our Sub Plan B, Level a, b or c, depending on their personal situations.

I'm worried that my dental expenses will exceed my Health Spending Account limits, what are my options?

Your First option is to book major dental work in the months of November & December each year, allowing possible access to two years of taxfree HSA funds.

Second – a supplemental dental Sub Plan can be purchased using funds from your Health Spending Account; e-mail or fax us as we coordinate these plans with your Health Spending Account, allowing tax-free payment of the premiums.

Third – all Health Spending Account coverage is at 100%, but if you anticipate a short fall – say in orthodontics – you should plan ahead and use your annual negotiation option (see Question: Can I put extra money into the Plan? for details). You have twelve months (from date of health care expense) to submit receipts.

I have 1, 2, 3, or 4 children and we each visit the dentist twice a year, what are my options?

Consider purchasing, with account funds, a complemental dental Sub Plan.

Please e-mail phsp@puhlemployeebenefits.com, we will help you.

What is the Puhl / Private Health Services Plan web address?
What if I have additional questions?

Please e-mail us at phsp@puhlemployeebenefits.com. For a quick response, it’s best to email your questions in the mornings.