Health Care Spending Account

Clinical Staff

A Health Care Spending Account (HCSA) is provided for reimbursement of medical expenses. Medical Expenses as defined by Income Tax Regulations are eligible for reimbursement including premiums for other insurance programs, dental expenses, vision care expenses, drugs, hospital, supplies and many other items.

The HCSA is $2,000 per calendar year for each member with family coverage and $1,000 per calendar year for each member with single coverage. These levels currently coincide with the level of deductibles for the extended health care insurance plan offered by OMA under the Ontario Priority Insurance Program for Physicians.

Unused amounts of the HCSA at year end are carried over and spent first in the following calendar year. Unused amounts at the end of the second calendar year are forfeited.

How a claim works:

For a family with two children, suppose annual drug, medical supplies, paramedical services are $3,380 and dental and vision care expenditures are $1,680 in a year. The member has also joined the OMA-OPIP program.

All drug, medical supplies, paramedical services should be submitted to OMA-OPIP on the OMA-OPIP claims form or by using the on-line services for plan members. OMA-OPIP will pay the eligible expenses above the deductible ($3,380-2,000 = $1,380). On the OMA-OPIP claims form, the Physician can ask the carrier (Sun Life) to also adjudicate all or a portion of the claim under the Western HCSA, which is administered by the same carrier. If there is an unused portion of the HCSA, the physician can also directly submit dental and vision care expenditures, and/or the premium paid for the OMA-OPIP plan. However, if the physician has alternative coverage (e.g., through a spousal plan), the physician may wish to submit the unreimbursed portion from the OMA plan to the other plan first. All reimbursement payments can be made by direct deposit to a physician’s bank account. The choice is the physician’s on what to claim against the HCSA.

Published on  and maintained in Cascade CMS.