Health Care Spending Account Benefits (HCSA) – Health SolutionsPlus

For qualifying members, a Health Care Spending Account (HCSA) is an account through which you may be reimbursed for healthcare and dental expenses up to a predetermined annual credit amount. The Trustees of your Health & Welfare Plan will establish the credits for your benefit level prior to each plan year. These credits may be used to cover expenses not covered by group health plans or to top-up expenses not fully covered by group health plans, including deductibles and co-payment amounts. Also, since annual credits are in the form of before tax dollars, the HCSA is a tax-effective way of paying for your health-related expenses.

How will I know the balance of my HCSA?

To check your current account balance, contact a customer service representative at Great-West Life toll-free at 1-877-883-7072. Hours of service are 7 a.m. to 6 p.m. CST for service in English and 7 a.m. to 5 p.m. CST for service in French.

Eligibility
You and your dependents are eligible for HCSA credits through your Benefits Plan if you are covered for basic healthcare benefits under your or your spouse’s group health plan. In addition to the dependents eligible for coverage under your basic health plan, HCSA benefits are extended to any other person for whom you are entitled to claim a medical expense tax credit under the Income Tax Act (Canada).

Termination
Your HCSA coverage terminates when your basic healthcare coverage terminates or when your Trustees discontinue the plan.

Your dependents’ HCSA coverage terminates when your coverage terminates or when they no longer qualify, whichever is earlier.

Covered Expenses
Coverage is provided for those expenses:

  • that qualify for a medical expense tax credit under the Income Tax Act (Canada), as may be amended from time to time, or
  • that Great-West Life deems to be eligible medical expenses under a private health services plan, as defined by the Income Tax Act (Canada), as may be amended from time to time.

Please refer to the Canada Revenue Agency website for information on medical expenses that qualify for the medical expense tax credit under the Income Tax Act (Canada). For additional information on covered expenses, contact a customer service representative at Great-West Life toll-free at 1-877-883-7072.

Benefits will be paid for 100% of covered expenses that are incurred while you and your dependents are covered, up to a maximum annual payment equal to the credits in your HCSA. Dental expenses, other than orthodontic expenses, are considered to be incurred when treatment is completed. Orthodontic expenses are considered to be incurred on a periodic basis throughout the course of treatment. All other expenses are considered to be incurred when you or your dependent receives the service or supply.

Credits are available for covered expenses incurred in a plan year. Any remaining credits will be carried forward for covered expenses incurred in the following plan year. If they are not used for expenses incurred in that plan year, they are automatically forfeited.

The maximum annual payment available under your account will consist of the amount of the credit directed to it for the plan year plus any unused amount from the previous year.

Limitations

No benefits are paid for:

  • Expenses that private benefit plans are not permitted to cover by law
  • Services or supplies you are entitled to without charge by law or for which a charge is made only because you have coverage under a private benefit plan
  • Any portion of the expense for services or supplies for which benefits have been paid under your basic health plan, another group plan or a government plan

How to Make a Claim

You have the option of submitting a claim by using the Health SolutionsPlus card, or by using the Health SolutionsPlus claim form. Claims for paramedical services, visioncare and dentalcare expenses incurred in Canada may also be submitted online.

The Health SolutionsPlus card is made available to you for use for covered expenses in accordance with the terms and conditions set out in your cardholder agreement.

You may submit a claim against the HCSA plan first, or you may choose to first submit it to a government plan or another private insurance plan under which you or any eligible dependents are covered. If other plans have paid first, you may submit a claim for any remaining balance of the expense to the HCSA plan online or by using the Health SolutionsPlus claim form.

If you use the Health SolutionsPlus card:

  • For drug expenses, you must first use your Pay Direct drug card to claim benefits from your basic plan. You would then use your Health SolutionsPlus card to claim benefits for any balance from your HCSA plan
  • For dental expenses for which your dental office submits your claim electronically, your claim will be considered first under your basic plan. You would then use your Health SolutionsPlus card to claim benefits for any balance from your HCSA plan
  • WARNING - For other expenses, your claim will be considered first under your HCSA plan, even though a portion of the expense may be covered under the basic plan sponsored by your employer

If you choose to use your Health SolutionsPlus card to pay for an expense, the amount will be drawn from the credits in your account whether or not coverage is available for the expense under another plan. However, if the expense would have been partially or completely covered under the basic plan sponsored by your plan administrator, you should submit a claim for the expense to the basic plan.

The amount that would have been paid under the basic plan may be credited back to your account and paid instead under the basic plan if:

  • No other coverage is available for that expense except under the basic plan, or
  • Other coverage is available for that expense under another plan, but the basic plan would pay benefits before the other plan

Using the Health SolutionsPlus card:

  • You must activate the card in order to use it, following the card activation instructions on the card
  • To use your card to pay for prescriptions, you must activate your card at least one full business day before ordering or dropping off a prescription at the pharmacy
  • The card is intended for use in Canada and can only be used at merchants who accept VISA®, and are included in the Health SolutionsPlus approved provider network
  • The card will not work at automated teller machines (ATMs) or retail stores
  • The card will not work if the expense exceeds your current account balance. Ask your provider if you can split the cost at the register. Use the balance on your card, and then pay the remaining amount using another method of payment
  • You must retain your receipt for 12 months from the date you submit your claim to Great-West Life as a record of the transaction, and you must submit it to Great-West Life on request
  • Great-West Life may, in its own discretion, suspend or terminate the use of your Health SolutionsPlus card at any time, with or without cause, and without prior notice
  • If your card is lost or stolen, notify your plan administrator immediately by contacting a customer service representative at Great-West Life toll-free at 1-877-883-7072
  • If your card is declined, use the claim form or online option

Using the Health SolutionsPlus claim form:

If you elect to use the claim form, use form M445D(HSPT) for dental claims, and form M635D(HSPT) for all other claims.

Claim submission deadlines:

Claims against the HCSA must be submitted to the Great-West Life Benefit Payment Office before the earliest of the following:

  • 6 months after the end of the plan year in which the expenses are incurred
  • the date the HCSA contract terminates, if it terminates because your employer fails to make a required payment
  • 31 days after the date the HCSA contract terminates, if it terminates for any other reason