Traditional Health Insurance Plans
Personal health insurance provides affordable coverage for:
• unexpected health expenses
• ongoing health-related services not covered by provincial plans.
Depending on your drug, dental, and supplementary health needs (such as vision care, chiropractic care or emergency travel medical), we find the plan that suits you needs best.
You may need health insurance if:
• you don’t have coverage through your employer
• you’re a small business owner with no group benefits
• there are restrictions to what your provincial plan covers
As an entrepreneur, self-employed professional, employee or seasonal worker who doesn’t have the employee benefits available in many companies, a personal health plan may be what you’re looking for to cover dental bills, drug expenses and other medical costs.
Providing affordable coverage
In acknowledgment of the growing need for personal health coverage, we offer personal health insurance to Canadian residents. This nationwide program provides affordable coverage for unexpected health problems and emergencies as well as many ongoing health-related needs not covered by provincial and territorial plans.
Administrative Services Only
ASOER_page.pdf (printable pdf version)
An Administrative Services Only Plan (ASO) is a cost effective alternative for companies offering group insurance benefits to their employees.
Working much the same as traditional group benefits coverage, an ASO can:
• Provide reimbursement to your employees for their medical expenses
• Cover items not covered by traditional group insurance programs
What is an ASO?
ASO is simply a funding mechanism for a traditional Group Life and Health insurance program. A Group Life and Health plan can be divided into two parts, specifically pooled and experience rated benefits. Pooled are benefits such as Life insurance and Long Term Disability. Pooled benefits are always insured due to the risk involved. Experience rated benefits include Dental and Extended Health.
In an ASO contract, the pooled benefits are insured and for the experience rated benefits, the employer pays the cost of claims incurred along with a fee for claims adjudication and administration.
This funding model, although typically used for larger employers, can be implemented for small and medium sized companies as well. It simply allows employers to benefit from lower expense charges in return for assuming the claims risk.
To limit the claims risk assumed by the employer an insurance product called a “Stoploss” is applied for, which limits the employer’s liability to a predetermined level.
ASO Feature Highlights
• Flexible Plan design
• Lower overall costs in the long term
• Available to companies with as few as 5 employees
• Easy to administer
• Mirrors a Traditional Insured plan
• Drug card available
• Dental claims can be paid directly to the Dentist
Private Health Services Plan Limited Company
PHSPER_page.pdf (printable pdf version)
A Private Health Services Plan is a cost effective, tax efficient means for Corporations to cover health and dental expenses or supplement existing group insurance benefits for their employees.
Working as a stand alone plan or with your existing group benefits coverage, a PHSP can:
• Provide reimbursement to your employees for their medical expenses
• Cover items not covered or paid for under a current group insurance program,
• Reimburse costs incurred for medical expenses to employees,
• Create a tax deductible business expense
What is PHSP?
PHSP is a tax-effective means of covering Health, Dental or Vision Care expenses. When properly set up, a Private Health Services Plan (PHSP), recognized by Canada Revenue Agency (CRA), allows businesses to deduct health-related expenses eligible under the Income Tax Act. Eligible PHSP charges are treated the same as group insurance premiums; as a deductible business expense. PHSP reimbursements paid to individuals are not taxable in the hands of the employee who receives them (except in Quebec where provincial taxes apply). IT-339R2 – Meaning of PHSP
PHSP covers all supplies and services considered eligible medical expenses under the Canadian Income Tax Act. You designate the spending limits and you and your employees receive 100% coverage for all eligible expenses to that limit with no monthly premiums. This could include prescription drugs, dental, vision, orthodontic treatments, the co-insurance amounts you are responsible for, or expenses that may be in excess of limits under your current group insurance program.
PHSP Feature Highlights
• Expenses/ costs are known upfront
• No initial set up fee
• No monthly premiums
• Employer has the option of different employee classes with different spending limits
• Employees are reimbursed for qualifying expenses
• 10% Adjudication fee is charged on eligible claims (HST is charged on adjudication fee only)
• Benefit levels can be prorated for the plan’s first year
• Plans are based on a calendar year
What is an allowable expense?
Please see the list of eligible expenditures.
Expenses_page.pdf
Private Health Services Plan Sole Proprietor
PHSPER_sole_page.pdf (printable pdf version)
A Private Health Services Plan is a cost effective, tax efficient means for Corporations to cover health and dental expenses or supplement existing group insurance benefits for their employees.
Working as a stand alone plan or with your existing group benefits coverage, a PHSP can:
• Provide reimbursement to your employees for their medical expenses
• Cover items not covered or paid for under a current group insurance program,
• Reimburse costs incurred for medical expenses to employees,
• Create a tax deductible business expense
What is PHSP?
PHSP is a tax-effective means of covering Health, Dental or Vision Care expenses. When properly set up, a Private Health Services Plan (PHSP), recognized by Canada Revenue Agency (CRA), allows businesses to deduct health-related expenses eligible under the Income Tax Act. Eligible PHSP charges are treated the same as group insurance premiums; as a deductible business expense. PHSP reimbursements paid to individuals are not taxable in the hands of the employee who receives them (except in Quebec where provincial taxes apply). IT-339R2 – Meaning of PHSP
PHSP covers all supplies and services considered eligible medical expenses under the Canadian Income Tax Act. You designate the spending limits and you and your employees receive 100% coverage for all eligible expenses to that limit with no monthly premiums. This could include prescription drugs, dental, vision, orthodontic treatments, the co-insurance amounts you are responsible for, or expenses that may be in excess of limits under your current group insurance program.
PHSP Feature Highlights
• Expenses/ costs are known upfront
• No initial set up fee
• No monthly premiums
• Employer has the option of different employee classes with different spending limits
• Employees are reimbursed for qualifying expenses
• 10% Adjudication fee is charged on eligible claims (HST is charged on adjudication fee only)
• Benefit levels can be prorated for the plan’s first year
• Plans are based on a calendar year
What is an allowable expense?
Please see the list of eligible expenditures.
Expenses_page.pdf
Eligibility
You may qualify for deductions if;
a) Your net income from businesses in which you are regularly and actively engaged must represent at least 50% of your net income for the year.
b) Your net income from sources other than business does not exceed $10,000.
c) Your Sole Proprietorship employs at least one employee other than yourself.
Spending Limits
Maximum of $1,500 for individual and other members of the household who are 18 years of age or older and $750 for each member under the age of 18.
Business owner’s coverage must be equal to the least amount of coverage offered to employees.
Individual Insurance Plans
Small businesses have a big need for a financial plan. Pacific Employee Benefits will work with you to develop a plan that protects you and your business.
Life Insurance provides the assurance to business owners and their employees that their families will be taken care of should they die suddenly or after a prolonged illness.
A life insurance policy pays a cash benefit, tax free, to your beneficiaries when you die. The amount of money for which you are insured and the type of insurance you buy depends on your needs.
Risk of illness and injury is something we all have. Both are unfortunate realities to many people. Health Insurance can provide money for treatment or time in a long term care facility. It can replace lost income or pay for travel to and from doctors.
Sometimes health insurance is referred to as “living benefits”; because, unlike life insurance, the insured person is alive and receiving the benefit.
Our team of advisors in association with SunLife Financial will work together with you to develop a plan that protects you and your business.
Group RRSP
A Group Registered Retirement Savings Plan (RRSP) is an employer-sponsored retirement savings plan. The plan is administered on a group basis by the employer. Contributions are made by pay-roll deduction, on a pre-tax basis, through a Group RRSP administrator. Employee contributions can be matched by the employer. Contributions made by the employer are taxable as income to the employee.
Investment decisions are made by the employee with the use of Pacific Employee Benefits expertise. The options are similar to those accessible to an individual RRSP.
Group RRSP Feature Highlights
• Immediate tax relief to employee
• Low administrative costs
• Not subject to provincial pension regulations, therefore flexible in terms of employee eligibility and contribution levels
• Income splitting is available through spousal contributions
Eligible Expenses Page
Expenses_page.pdf (printable pdf version)
Note: CRA form number IT-519R2 (consolidated) a 19 page document entitled: “Medical Expense and Disability Tax Credits and Attendant Care Expense Deductions” gives more detail on qualifying expenses. It is available on request.
Professional Services
Any service performed by a qualified medical practitioner including but not limited to the following:
Acupuncturist
Gynecologist
Orthodontist
Psychiatrist
All Optical Services
Massage Therapy
Orthopedist
Psychoanalyst
Chiropodist
Naturopath
Osteopath
Psychologist (if licensed)
Chiropractor
Neurologist
Pediatrician
Registered Nurse
Christian Science Practitioner
Obstetrician
Physician
Speech Therapist (if treated for Pathological or Audiological)
Oculist
Physiotherapist
Denturist
Ophthalmologist
Plastic Surgeon
Surgeon
Dentist
Optician
Podiatrist
Therapist
Dermatologist
Optometrist
Practical Nurse (for medical services)
Note: A qualified medical practitioner means a person who is authorized to practice in accordance with the laws of the province and certified according to the practitioner’s governing body.
All Basic and Major Dental Services
Dental X-rays
Examinations
Filling Teeth
Oral Surgery (eg. Root canal)
Denture Repair & Replacement
Extracting teeth
Gum Treatment
Straightening Teeth (eg. Braces)
Laboratory Examinations and Tests
Blood Tests
Metabolism Tests
Stool Examination
X-ray Examination
Cardiographs
Spinal Fluid Tests
Urine Analysis
Hospital Services
Anesthetist
Oxygen Masks, Tents
Vaccines
X-ray Technician
Hospital Bills
Use of Operating Room
Medicines
Any non-prescription medicines (over the counter), prescribed by a qualified medical practitioner and recorded by a licensed pharmacist.
All Prescription Drugs
Oxygen
Insulin or Substitutes
Tapes or Tablets- for sugar content tests by diabetics, if prescribed.
Liver Extract- injectable for pernicious anemia
Vitamin B12 – for pernicious anemia
Prescribed Medical Treatments
Blood Transfusion
Healing Services
Pre-Natal, Post-Natal Treatments
Ultra-violet Ray Treatments
Bone Marrow or Organ Transplant
Hydrotherapy
Whirlpool Baths
Injections
Psychotherapy
X-ray Treatments
Insulin Treatments
Nursing (by Registered Nurse)
Radium Therapy
Diathermy
Speech Pathology or Audiology
Electric Shock Treatments
Material and Apparatus Which are Prescribed by a Recognized Medical Practitioner
An external breast prosthesis
Heart monitors or pace makers
Any device designed to assist walking where the individual has a mobility impairment
Hospital bed, if required in home.
Inductive coupling osteogenesis stimulator.
Contact Lenses
Infusion pumps for diabetes including peripherals.
Devices designed to assist a person to use bathtubs, showers or toilets.
Monitors attached to babies identified as being prone to Sudden Infant Death Syndrome.
Devices designed to enable individuals with a mobility impairment to operate a vehicle.
Optical scanner or similar devices for a blind individual to enable them to read print.
Devices used by individuals suffering form a chronic respiratory ailment or a severe chronic immune system disregulation.
Orthopedic shoes or boots.
Oxygen Tent
Electronic or computerized environmental control systems for individuals with severe and prolonged mobility restrictions.
Power-operated guided chair installation for stairways.
Power-operated lifts and transportation equipment designed to allow access to buildings, vehicles or to allow wheelchair access to vehicle.
Electronic speech synthesizers for mute individuals
Equipment that enable deaf or mute persons to make and receive telephone calls including visual ringing indicators, acoustic coupler, teletypewriter, which makes telephone communication possible with other persons.
Synthetic speech systems, Braille printers and large print-on-screen devices that enable blind persons to utilize computers.
Extremity pumps or elastic support hose to reduce lymph edema swelling.
Syringes
Television closed caption decoders.
Eye Glasses
Wigs if required as a result of disease, accident or medical treatment.
Other Materials and Apparatus Which Don’t Require a Prescription
Any apparatus or material, paid to a doctor, dentist, nurse or hospital.
Catheters, catheter trays, tubing, diapers, disposable briefs required by incontinent persons.
Any device to aid the hearing of a deaf person including bone-conduction telephone receivers, extra-loud audible signals and devices to permit volume adjustment of telephone equipment above normal levels.
Colostomy pads
Crutches
Hernia Truss
Ileostomy Pads
Artificial Eye
Iron Lung
Artificial kidney machine, including installation, operating costs.
Laryngeal speaking aid.
Artificial Limb
Rocking bed for polio victim
Blood sugar level measuring devices for diabetics
Spinal braces
Brace for a limb
Wheelchair
Other Expenditures
Ambulance Charges
Transportation costs-to hospital, clinic or doctor office to obtain services not otherwise available
Home Maker Service and Home Care (attendant must be a non-relative)
Prescription birth control pills
Transportation, meals and accommodation, reasonable expenses for a patient and an accompanying attendant may be deductible if:
Reasonable costs for adapting a residence to accommodate a disabled person (eg. Wheelchair ramp, lifts, bath facilities)
1.equivalent medical service is not available locally
2.the route traveled is reasonably direct
3.medical treatment is reasonable and distance traveled is at least 80 kilometers
Rehabilitive therapy, lip reading and sign language training
Specially trained animals to assist blind, deaf or severely impaired persons, including the cost of its care and maintenance
The following Expenditures would NOT be covered under this plan
Acupuncture treatments if they are not performed by a licensed physician
Scales for weighing food
Special foods or beverage except if they are to be taken to alleviate or treat illness and not solely for nutritional purposes. Such claims must be accompanied by a letter from a medical doctor
Air conditioners, humidifiers, dehumidifiers or air cleaners
Antiseptic diaper service
Health programs offered by resort hotels, health clubs
Illegal operations, treatment or drugs
Toothpaste
Maternity clothes
Wigs-unless made to order for individuals who have suffered abnormal hair loss owing to disease, medical treatment or accident
Medical expenses for which you are reimbursed or are entitled to be reimbursed form other plans
Non-prescription birth control devices
Payments to a municipality where the municipality employed a Doctor to provide medical services to its residents
Important – Provincial Health Care premiums ARE NOT eligible expenditures.