Adjudicator: “Adjudicators or claim adjusters investigate, negotiate, and process claims filed by policyholders.”
Admin Fee: “An administration fee is charged to process claims. Benepeak charges no more than 10% of the claim amount as our admin fee.”
Advisor: “Advisors assist clients with plan design and provide knowledgeable advice on investment in various insurance schemes.”
Arm’s-Length Employee: “For most small-businesses, workers are arm’s-length employees unless they are the owner or a member of the owner’s family. However, the business owner is a non-arm’s-length employee.”
Best Benefit Plan: “This plan is designed for employers who want their employees to receive maximum benefits and plan flexibility without increasing the company’s expenses. These plans give employees the choice of spending their benefit amount on an HSA benefit or a WSA benefit.
1st Person BBP: “I prefer that employees receive the maximum amount of benefits without increasing the company’s expenses.”
Business Owner Plan: “This plan is designed with business owners who receive a salary from the company. This plan reduces personal tax payments by making health and dental expenses business expenses.”
Carry Over (short and long definitions):
“If the employer allows carry over, plan-holders can carry unused funds over into the next plan year. This amount isn’t available to the employee if not used within the carry over year or forfeited to the employees and stays in the company account.”
Contribution Amount (for Employers and Employees):
Employees:
Employers: “You can set the contribution amount for individual plans and assign different amounts for each employee group once you’ve chosen your plan.”
Contribution schedule (Employers and Employees):
Employers: “Employers choose a contribution schedule to release a portion of plan funds for employees to use towards their claims. These are typically yearly, semi-yearly, quarterly, and monthly— most employers choose yearly. Your employees will receive a portion of their funds at the beginning of each set period.”
Employees: “Employers choose a contribution schedule to release a portion of plan funds for you to use towards claims. These are typically yearly, semi-yearly, quarterly, and monthly. You’ll receive a portion of these funds at the beginning of each set period.”
Essential Plan: “This plan helps employers limit their costs as much as possible while providing essential health and dental benefits to their employees. The best part is that the entire benefit amount is a non-taxable benefit for employees.”
1st Person EP: “I prefer to cover essential healthcare while decreasing business costs.”
Grace period: “Employees can submit any outstanding claims from the prior benefit year within the grace period you set.”
Health Spending Account (HSA): “A Health Spending Account (HSA) is a non-taxable pre-determined allowance that employees may spend on personalized health and dental needs. This puts cost control in the employer’s hands while allowing employees to individualise their benefits.”
HSA coverage categories:
- Drug
- Cost of prescription by a licensed pharmacist (not over the counter)
- Medicine, drugs, and devices prescribed by a medical practitioner or dentist including:
- Prescription birth control pills
- Tapes or tablets for diabetic sugar content tests
- Vitamin B12
- Medicinal marijuana
- Liver extract
- Insulin or substitutes
- Oxygen
- Dental
- Orthodontic Treatment prescribed by a medical practitioner or dentist (cosmetic procedures are ineligible)
- Preventative Services
- Cleaning, polishing, fluoride treatments
- Oral surgery
- Diagnostic Services
- Dental examination
- X-rays
- Dentist / Denturist appointments
- Restorative Services
- Dentures, repair & replacement
- Procedures (bridge, implant, inlay, etc.)
- Gum treatment
- Vision
- Laser eye surgery – coverage up to the amount paid to a medical practitioner or licensed hospital (either public or private)
- Artificial eye
- Prescription eyeglasses or contact lens
- Appointments with:
- Oculist
- Ophthalmologist
- Optician
- Optometrist (OD)
- Health
- Medicinally necessary or prescribed treatments, therapies and tests
- Medical devices and equipment
- Miscellaneous medical expenses
- Appointments with licensed
- Acupuncturist (R.Ac.)
- Anaesthesiologist
- Athletic Therapist
- Audiologist
- Chiropodist
- Chiropractor (DC)
- Clinical Counsellor (Provincially registered)
- Dermatologist
- Dietitian (registered)
- Gynecologist (Ob. Gyn)
- Kinesiology
- Masseuse (Provincially registered)
- Naturopaths
- Neurologist
- Obstetrician
- Occupational Therapist
- Osteopath
- Pediatrician
- Physician
- Physiotherapist
- Plastic Surgeon (medically required procedures with doctor certification)
- Podiatrist (DPM)
- Practical Nurse (LPN) and Registered Nurse (RN)
- Psychiatrist
- Psychoanalyst
- Psychologist (PsyD)
- Registered Midwife
- Social Workers (RSW, RCC, MFT)
- Speech Therapist (SLP)
- Surgeon
- X Ray Technician
Monthly Payment: “Benefits can be distributed as set-monthly payments like an annuity. Employers can ensure their plans are as cost effective as possible by reviewing claim reports.”
Non-Arm’s-Length Employee (Business Owner Employee): “For most small-businesses, the business owner is a non-arm’s-length employee while workers are arm’s-length employees (unless they are an owner or a member of the owner’s family).”
Pay as you go: “This option allows you to meet claim costs as they arise or set an allowance for a service before it is used.”
Payment method: “The method you use to pay for a transaction. The most basic are cash and credit.”
Plan Classification (Short and Long Definitions):
“Classifications help you organize and create different groups of employees for benefits. Classification factors typically include seniority, salary, and tenure. The employer defines the specific, allocated, coverage amount for each employee and can determine how these employees designate their funds. Classification helps you retain loyal employees while saving money.”
Plan Start Date: “The plan start date marks the beginning of your yearly benefit coverage. This date may be different from the beginning of the fiscal year.”
Plan Eligibility Date: “The plan eligibility date marks the date when employees are eligible to begin using their coverage.”
Renewal Date: “The renewal date marks the end of one year of benefit coverage and the beginning of the next if renewed. Employees may change and set their plan design for the coming year on the renewal date.”
Titles: Company Details, Plan Info, Plan Type, Banking Info, Plan Administration, Advisor Fee Structure
Wellness Spending Account (WSA): “A Wellness Spending Account (WSA) is a personalized health program which allows employees to spend a pre-determined, taxable, allowance on wellness-related activities and products. This puts cost control in the employer’s hands while being flexible for employee spending.”
WSA intro for employee app: “A Wellness Spending Account (WSA) is your personalized health program. Once your employer sets your coverage amount, you can spend this taxable allowance on wellness-related activities and products suited to your lifestyle.”
WSA amount coverage (Employer / Employee):
Employer:
Employees: “You can flexibly spend the WSA allowance set by your employer at the beginning of the plan year on wellness-related activities and products.”
WSA coverage categories:
- Fitness & Equipment:
- Essential equipment and footwear (excluding athleticwear and uniforms)
- Fitness equipment (treadmills, exercise bikes, universal gyms)
- Membership fees (fitness clubs, gyms, putting green)
- Registration fees (wellness events, sports leagues, etc.)
- Physical activity fees (lessons, drop-in fees, etc.)
- Personal trainers and/or fitness trackers
- Ergonomic office equipment
- Flotation therapy
- Health & Wellness:
- Bodily Health:
- Vitamins and supplements (including over the counter)
- Medic alert bracelets and/or neck chain
- Massage or TENS units
- Sun related skincare
- Smoking cessation programs
- Weight loss program
- Mental Health and Wellness:
- Yoga and guided meditation classes
- Holistic (alternative) medicine or practitioner
- Aromatherapy
- Spa services
- Reflexology
- Cleaning services
- Reiki
- Bodily Health:
- Personal Development:
- Development courses (language programs, CPR training, etc.)
- Parking and transportation (handicap/parking permits, city transit, etc.)
- Professional membership(s)
- Financial advisor fees
- Life coaching
- Cell phone
- Legal fees
- Family & Pets:
- Doula services and prenatal support
- Daycare services
- Cleaning services
- Elder care
- Veterinary fees
- Pet insurance
- Pet daycare
- Pet food
- Cosmetic:
- Cosmetic procedures (non-invasive, surgical, dermatology)
- Cosmetic dentistry and teeth whitening
- Hair replacement
- Makeup
“HSAs cover a wider range of dependents than health and dental benefits. Plan members can claim expenses for their spouse, children, and extended family members, as long as they qualify as dependents under the Canadian Income Tax Act. Visit the CRA website at www.cra-arc.gc.ca and search for Medical Expense Tax Credits in the search window for additional details.”