Cost Plus
Cost Plus is a mechanism that can provide for payment of any health and/or dental treatments that are not covered at all - or that fall outside OHIP - or your existing Group Plan. Typically, these would be applicable for claims or benefits, which are either not covered at all or claim amounts that are higher than the existing group plan provides for under the conditions of the insured plan. The concept is straightforward.
The company or your employer pays for the claim in much the same way they pay premium, but...
- You pay for the benefit only when you use it, unlike monthly premium payments.
- The employer is able to write off/ deduct the claim (and related expenses) as an employee cost ... in exactly the same way they deduct the premium.
- The employee receives the benefit from the company as a non-taxable benefit. If the employer were to simply pay the bill on the employee's behalf or reimburse the employee after paying it, that amount would be taxable in the employee's hands and added to their T4.
Cost Plus can be used:
- To replace some conventionally insured group plans for small business or
- Top-Up Health and/or Dental benefits, for a specific employee class (see below), where limitations have been put in place on the insured plan to control the unit rates on that plan.
Cost Plus is Ideal:
- Where high claims experience for a definable employee class, (i.e. Executives or Management) negatively affects the rating on the balance of the plan. If those high claims are included in the regular insured group plan, then the overall Loss Ratio will be forced higher, meaning the rating for that benefit - for all employees, will be higher.
- f the corporate intention is to make sure the claims for a defined class are paid but still control pricing of the insured group plan, then any amount over an established limit can still be paid - for that class - by Cost Plus.
There is no charge to set up a Cost Plus account. There are no on-going charges or administration costs unless the account is used.
Cost Plus Coverage and Conditions:
- Laser Eye Surgery
- Fertilization Treatments
- Smoking Cessation
- Orthodontic Treatment
- Medical Treatment for Obesity/Eating Disorders
- Chiropractic (in excess of Provincial Health Care)
- Vision Care/Eyeglasses
- Prescription Drugs (that are not covered under a regular Group Plan)
- Diabetic Supplies and Insulin
- Health and Dental Plan Deductibles
- Health and Dental benefits not covered by a Traditional Group Insurance Plan