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Health Care Spending Account |
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Use
Use the Claim
for Health Care Spending Account Benefits form if you've paid
for medical expenses that are eligible under the definition of a
Qualifying Medical Expense under the Income Tax Act, which are not eligible
for reimbursement under any other plan of benefits. |
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Information Needed to Complete the Form
Your personal Member information and the Group policy number is needed to complete the form. In
addition you must list the expenses to be reimbursed and include
all original receipts.
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Notes
The expenses must have been incurred by you or one of
the eligible dependents currently on file with the Plan Administrator.
Completed forms should be forwarded to the Plan Administrator. |
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Frequently Asked Questions
What expenses can I be reimbursed for?
- The HSCA benefit may be used to reimburse for such
items as:
- deductibles and coinsurance of traditional plan benefits
- elective surgeries
- orthodontia, dentures and dental procedures
- laser eye surgery
- MRI, CT scans and cardiographs
- services from medical practitioners or hospitals
- eye glasses
- products required because of incontinence
- bone marrow or organ transplants
- drugs or medicaments that are prescribed by
a medical practitioner or dentist and recorded by a pharmacist, used in the
diagnosis, treatment or prevention of a disease or disorder;
or
- in vitro fertilization procedures.
For a complete list of eligible expenses,
see the Canada Revenue Agency web
site.
Premiums paid to a private health services plan,
such as for emergency travel insurance, may be reimbursed
through the HCSA. Medical Services Plan of BC (MSP)
premiums are not eligible.
Other questions on completing the form should be directed to the Plan Administrator.
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Plan Administrator
D.A. Townley & Associates Ltd.
101 – 4190 Lougheed Highway
Burnaby, BC V5C 6A8
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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PDF
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