Extended health and dental insurance and HCSA

Extended health and dental insurance and health care spending account

Sometimes it's the small things that turn out to be a big expense when you add them up. That's why offering extended health care (EHC) and dental care is so important. These coverages provide comprehensive, cost-effective solutions for today's health care needs.

For EHC and dental, you can choose to offer the basic or enhanced plan for your partners, sole proprietors and employees. This helps them pay for things like prescription drugs, glasses or contacts, paramedical services such as massage therapists and dental care.

Coverage details for EHC

Options Basic Enhanced
Medical evidence New participating firms with less than 5 people must provide medical evidence
Reimbursement level 80%
 100%
Deductible No deductible
Dispensing fee paid by plan member		 No deductible
Dispensing fee paid by plan member
Drugs Pay Direct – prescription only plus life-sustaining Pay Direct – prescription only plus life-sustaining
Hospital No coverage $150 per day
Vision No coverage $200 every 24 months
Paramedical
• Chiropractor
• Osteopath
• Podiatrist
• Chiropodist
• Massage therapist
• Naturopath
• Speech therapist
• Physiotherapist
• Psychologist		 No coverage $500 per year
Orthotics No coverage $150 per year
Private duty nurse $5,000 per calendar year $5,000 per calendar year
Hearing aids $1,500 per 3 calendar years $1,500 per 3 calendar years
Out-of-province emergency services 100% Emergency Travel Assistance included Lifetime maximum of $1,000,000 per person 100% Emergency Travel Assistance included Lifetime maximum of $1,000,000 per person
Major medical supplies For all medical equipment and supplies covered under this provision, covered expenses will be limited to the cost of the device or item that adequately meets the patient's fundamental medical needs.
Maximum benefit $1 million per covered person per lifetime $1 million per covered person per lifetime
Termination of benefits Earliest of the following to occur: attainment of age 69, retirement, or termination of employment

Coverage details for dental care

Options Basic Enhanced
Basic

80% of costs covered

12-month recall exams

90% of costs covered

9-month recall exams
Endodontics 
 80% of costs covered 90% of costs covered
Periodontics 

80% of costs covered

8 units per year

90% of costs covered

8 units per year
Major restorative 
 No coverage 50% of costs covered
Orthodontics
(only 10+ people)		 No coverage 50% of costs covered
Maximum benefit $1,000 per calendar year $1,500 per calendar year
$1,500 lifetime for
orthodontics
Termination of benefits Earliest of the following to occur: attainment of age 69, retirement, or termination of employment

Health Care Spending Account (HCSA)

The HCSA is optional. It's an easy, tax-effective way to include more health care choices in your insurance program. That's because an HCSA helps take care of health care needs above and beyond those covered under your EHC and dental care insurance plan. Plan members can use the dollar limit of the HCSA to pay for a wide range of expenses, as long as they qualify as a medical, dental or hospital expense under the Income Tax Act (Canada), without triggering a taxable benefit.

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Learn more

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For a quotation and enrollment information

Call 416-493-5586 or email bclewes@clewesconsult.com