CostPLUS is an optional arrangement you can offer to certain classes of employees and their dependents. It allows for reimbursement of eligible health expenses that go beyond your regular plan coverage, in a tax-effective way, following CRA guidelines. Typically, CostPLUS is used when you’d like to cover an employee’s health costs outside of the group plan on a one-off basis.
Quick Facts About CostPLUS
- Why use CostPLUS?
CostPLUS offers flexibility and potential tax advantages. Claims may be 100% tax-deductible for you as the employer, and you retain full control over which claims are submitted and approved. These claims are processed outside of your regular benefits plan, so they have no impact on your claims experience. - What expenses are eligible?
Expenses must meet the criteria under the Federal Income Tax Act—similar to a Health Spending Account. - What are the administration fees?
GroupHEALTH charges a 10% administration fee, with a $50 minimum and $250 maximum per submission.
How CostPLUS Works
- Determine Eligibility
You decide which employee classes are eligible to participate in CostPLUS. Before submitting any claims, a CostPLUS agreement must be completed and on file with GroupHEALTH. - Collect Required Documentation
Your employee must provide original receipts and any applicable Explanation of Benefits (EOB) statements from other group plans. You are responsible for collecting and verifying all documentation before submitting the claim. - Respect the Claim Timeframe
Claims must be submitted within 24 months of the expense—this includes the current calendar year and the 12 months prior. Claims outside this timeframe will not be accepted. - Submit to GroupHEALTH
Once you’ve confirmed eligibility and reviewed the documentation:- Complete the CostPLUS claim form (note: forms vary by province due to applicable taxes).
- Send the completed form, original receipts, and EOBs to GroupHEALTH.
- Include payment for the claim amount, administration fees, and any applicable taxes.
- Claim Processing & Reimbursement
After all required documents and payment are received, GroupHEALTH will process the claim and issue a reimbursement cheque directly to the employee, like a regular benefit claim.
Contact your GroupHEALTH Client Service Representative to discuss CostPLUS.