Employer benefits can reset at year end: what to check before December

Why check before year end

Many items in an employer benefits plan have annual limits, and unused amounts are lost. Physiotherapy, massage, acupuncture and the annual dental maximum are typical examples. Ten minutes with your policy before December can be worth a few hundred dollars.

Three things to check in your policy

1. Whether limits run on the calendar year (reset on January 1) or the policy year.
2. The annual limit for each item: physiotherapy, massage, acupuncture, counselling, dental, eyeglasses and so on.
3. The claim submission deadline. Deadlines differ by plan, and late claims are not paid.

Limits vary by employer. In one published university employee Sun Life policy, for example, physiotherapy and massage are about $500 a year each at 80%, eyeglasses are covered every 24 months, cleanings every 6 or 9 months, and dental has an annual maximum. This is only an example; use your own policy.^[6]

Health spending accounts (HSA)

According to a CRA interpretation, unused HSA credits can be carried forward for up to 12 months, after which they are forfeited. Whether and how the carry-forward applies depends on how your employer set up the plan.^[3]

When both spouses have coverage

• Claim with your own plan first, then submit the unpaid balance to your spouse's plan. Together the two plans cannot pay more than 100% of the cost.^[4]
• For children, claim first with the plan of the parent whose birthday falls earlier in the year.^[4]

Check that the provider is registered

In BC, massage therapists and acupuncturists are regulated by CCHPBC, and physiotherapists and psychologists by CHCPBC. Both colleges have online registers.^[5] Registered clinical counsellors (RCC) are not a government-regulated profession at present, so whether they are reimbursed depends on your policy wording.

Unreimbursed costs can reduce tax

Medical expenses your insurance did not pay can be claimed on your tax return. Federally, the amount above the lesser of 3% of net income and a fixed federal amount can be claimed; the provincial threshold is calculated separately. Amounts already reimbursed by insurance cannot be claimed again.^[1][2]