How
is AccertaChoice Tax deductible?
Private health services plan premiums,
contributions or other consideration
paid for by the employer qualify as
business outlays or expenses of the
employer for purposes of paragraph
18(1)(a) of the Income Tax Act. Contributions
made by an employer to or under a
private health services plan on behalf
of an employee are excluded from the
employee's income from an office or
employment by virtue of subparagraph
6(1)(a)(i) of the Income Tax Act.
Click here for more info.
How does AccertaChoice Work?
Accerta funds the plan by making an
electronic debit from the customer's
bank account. This can either be on
a one-time payment, equal monthly
payments or pay per use basis. For
more info click here .
How much is the monthly cost?
That is up to you and is dependent
on your Plan's limit. You choose your
Plan's limit, based on your company's
budget or your needs. This is the
maximum amount you will ever spend.
And, our fees to you will never increase.
What if the employee wants
to contribute to the plan?
Employees contribute to an AccertaChoice
plan by having a Co-Payment. This
is a level of reimbursement for claims.
For example, John submits a claim
for $100.00 and he has a 20% Co-Payment.
His claim will be reimbursed for $80.00.
John has now contributed $20 to his
plan.
If we have
a 20% Co-Payment and $1,500.00 Annual
Maximum, how much benefit dollars
do we have?
You still have $1,500.00 benefit dollars
but with a 20% Co-Payment you can
submit $1,875.00 worth of claims.
What kind
of coverage is available? What is
covered under Extended Health Care
(EHC)?
We offer Dental, Extended Health Care,
Vision and Prescription Drug coverage.
Generally, services provided or prescriptions
issued to individuals by regulated
health care professionals are covered.
Click here to see some examples of
covered services.
Do we have
to have the same maximum for everyone?
No. If you can define a difference
between classes of employees you can
have varied Annual Maximums and Co-Payment
levels, as long as a reasonable differential
is maintained.
Can I sign
up as a single person plan?
If you own your own business and are
a Sole Proprietor you are eligible
for AccertaChoice under a couple of
conditions. AccertaChoice is a 100%
employer funded plan and is not available
to individuals. Click here for more
info.
Can the plan be topped up in the middle
of a contract?
Yes. By enrolling in our AccertaChoice
Plus plan, you can continue to submit
paper claims even after your Annual
Maximum is gone by using our Remittance
Form and attaching a Corporate cheque.
What if an employee leaves in the
middle of the contract?
If the employee did not use all of
their benefit dollars, this will result
in a surplus at the end of the benefit
year which can be used towards the
next benefit year.
What is EFT
and how does it work?
EFT-Electronic Funds Transfer is a
method of payment that Accerta offers
to their clients for payment of claims.
We will automatically deposit the
funds into the bank account of your
choice.
Who
is eligible as a Dependant?
Contributions made by an employer
to or under a private health services
plan on behalf of an employee are
excluded from the employee's income
from an office or employment by virtue
of subparagraph 6(1)(a)(i). On the
other hand, an amount paid by an employee
as a premium, contribution or other
consideration to a private health
services plan qualifies as a medical
expense for purposes of the medical
expense tax credit by virtue of paragraph
118.2(2)(q). The amounts so paid must
be for one or more of
(a)
The employee
(b) The employee's
spouse and
(c) Any member
of the employee's household with
whom the employee is connected by
blood relationship, marriage or
adoption.
Is
AccertaChoice Insurance?
No. With AccertaChoice you set up
and fund your own self-directed benefit
plan. You decide what is covered and
the maximum you want to spend. Accerta
administers the plan for you, ensuring
that all claims are legitimate and
promptly reimbursing claimants for
their healthcare costs. For recurring
expenses, such as for dental care
or for routine healthcare expenses,
this is a far more cost-effective
approach than buying insurance. To
protect against rare but potentially
catastrophic losses you can purchase
optional Catastrophic Stop Loss &
Travel insurance. (See below for questions
dealing with this coverage.)
What are
the advantages of AccertaChoice?
- More of your benefit dollar goes
to pay for healthcare than would
with insurance.
- You are in absolute control of
your costs.
- There is no fine print … no hidden
charges or exclusions from coverage.
- Virtually every health-related
expense can be covered.
- AccertaChoice is a tax deduction
for your company and AccertaChoice
benefits are tax-free for claimants.
About the only tax break left for
ordinary Canadians!
Can
retired persons or people that are
not working buy AccertaChoice?
No. AccertaChoice is an employee benefit
plan that companies and the self-employed
purchase for employees and their dependants.
AccertaChoice benefits become a part
of an employee’s overall compensation
package as a condition of employment.
What is Catastrophic Stop Loss Coverage?
This is insurance that protects plan
members in the event of catastrophic
expenses resulting from a disastrous
health event. Often, treatment for
these medical conditions can result
in healthcare claims that are not
covered by government health plans
and yet may be in the tens of thousands
of dollars. For example, a plan member
may contract a disease that requires
thousands of dollars a month in medication
or the care of a private nurse.
When is Catastrophic Stop Loss Available?
The coverage is provided after eligible
claims are incurred of more than $10,000
per individual or family member per
calendar year. Costs incurred to pay
for procedures that are not medically
necessary will not be included in
determining whether $10,000 in expenses
has been incurred.
What is an
eligible claim under Catastrophic
Stop Loss Coverage?
This policy covers eligible medical
expenses such as drugs, private duty
nursing, or paramedical services that
are not paid by provincial government
health care. It is not intended to
re-reimburse elective procedures such
as plastic surgery that may be covered
under an AccertaChoice Plan.
How do I claim under Catastrophic
Stop Loss Coverage?
All healthcare claims incurred by
the individual are submitted to ACCERTA.
They will be adjudicated based upon
the eligibility as defined in the
master contract. This policy includes
specific internal deductibles such
as $500/year for each paramedical
service. These specific deductibles
are described in the insurance policy.
All eligible claims totaling more
than the deductible of $10,000 plus
the various internal deductibles will
be reimbursed by the carrier ROYAL/SUN
ALLIANCE.
What are considered pre-existing conditions
under Catastrophic Stop Loss Coverage?
Many insurance policies exclude claims
resulting from illness that existed
at the time the insurance was purchased.
These illnesses are called pre-existing
conditions. Accerta’s Catastrophic
Stop Loss policy does not exclude
coverage for pre-existing conditions.
It does pay reduced benefits, however,
for claims arising from a pre-existing
condition. To determine potential
coverage, the costs of treatment for
the pre-existing condition incurred
by the participant (subscriber or
dependant) in the previous year are
considered. For example, if the participant
had $7,500 in eligible healthcare
expenses in the previous year, stop
loss available in such a situation
is limited to a maximum pay out of
$3,300. The formula showing how this
reduction is calculated is set out
in the insurance policy.
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