Understanding Cost Plus - 16.09.2011

What is Cost Plus reimbursement?

Cost Plus is an option that can be exercised for health or dental expenses which exceed the coverage limits outlined in the contract or are not covered by the group insurance plan; however, they must be covered under the Canadian Income Tax Act. Expenses that are not insurable by law cannot be reimbursed under the Cost Plus option.

What are the advantages of Cost Plus?

  • It pays for expenses not covered under the group plan.
  • Premiums are a deductible business expense.
  • Benefits are a non-taxable income for the plan member.
  • Claims paid are not charged to the experience of the plan.

What expenses can be reimbursed by Cost Plus?

  • Deductibles and coinsurance
  • Amounts that exceed the benefit maximums
  • Expenses that are excluded from the group benefit plan, such as cosmetic surgery or cosmetic dentistry

What is the procedure to use Cost Plus?

  • A request form for Cost Plus reimbursement must be submitted by the policyholder to the Insurance Company. The request should include the type of expenses to be reimbursed, the name of the plan member for whom the reimbursement is to apply, together with the plan member’s certificate number.
  • This request must be accompanied by all supporting paid receipts. The total must include the amount of the expense to be reimbursed, plus the administration fee, plus any applicable premium and taxes.
  • A separate form must be completed for each plan member for whom Cost Plus reimbursement applies. If claims were incurred by dependants, their names must be clearly listed, with dates of birth and relationship to the plan member.
  • Your insurance company will then issue a cheque payable to the plan member for the amount of reimbursable expenses.