Frequently Asked Questions
What is Cost Plus Medical Coverage?
Cost Plus is a mechanism set up by the Canadian Government to allow
businesses to cover medical expenses for employees in an "insurance
like" plan without either the company or the employee contributing taxes
on the amount. We offer coverage only to employees of Registered and
Professional Corporations. We are unable to offer coverage to individuals or to sole
Cost Plus is more formally known as a Private Health Services Plan (PHSP)
How does it work?
Your company submits your claim along with a company cheque for the claim total plus 10%. Shield adjudicates your claim issues you a personal cheque for the full amount of your claim. You receive your claim reimbursement 100% tax free, and your company has a 100% eligible business expense.
What can I claim?
You can claim any medical expense which is allowed by Canada Revenue
Agency. In general, any service provided by a medical practitioner
(Dentist, Physician, Optometrist, Pharmacist, Physio Therapist,
Acupuncturist etc) licensed by the jurisdiction (province) in
which they practice. Exclusions include products with nutritional value
and procedures which are purely cosmetic in nature.
There are no exclusions for pre-existing conditions. You can also claim certain travel and meal expenses. Both travel and medical insurance premiums are also eligible to be claimed.
Who does it cover?
Any persons residing in your household who are related by blood, marriage or adoption are covered. This includes yourself, your spouse, children and parents. Shield is currently offering coverage to employees working in the four Western Provinces: BC, Alberta, Saskatchewan and Manitoba.
What does it cost?
There is a one time enrolment fee of $239 (including taxes) for the
company which includes all current and future employees. Once your
company is enrolled, there are no monthly or yearly maintenance fees and
premiums of any kind.
When you submit a claim, there is an administration fee (the cost plus portion) which is 10% of the claim amount. Taxes are included in the administration fee; not on top.
How do I enroll?
Your company would simply fill out an application form/contract with Shield and submit both to the shield office. Your coverage starts in the month that we receive your application. The company should also submit a Personal Data Sheet for each covered employee.
How do I make a claim?
Simply fill out a claim form either online (it totals it for you) or
offline and submit your signed claim form along with your original
receipts and a company cheque for the total claim plus 10% by mail to
Shield. Please keep a copy in case the post office loses your claim.
We require the original receipts and not copies as a safeguard that the receipts are not being double claimed.
We will send a cheque to you personally eight days after we receive your claim. If you prefer, you can provide us with a void personal cheque (once only) and we can do a direct deposit to your bank account at no extra charge.
What are Shields responsibilities?
At Shield we adjudicate each claim. This means that we look at each receipt and each claim to see that claimed expenses are eligible and inform you if they are not. We watch for items which you may not know are eligible and let you know about those as well. We are available on the phone for any questions you might have. We keep records of your claim history to help you in case of any Canada Revenue Agency questions.
It seems too good to be true, how do I know it is legitimate?
Anything that looks too good to be true usually is. In this case, we suggest that you simply check with your accountant or tax advisor, either corporate or personal. They should know about Cost Plus medical benefits and if they desire, they are welcome to contact our Chartered Accountant.
What is the fine print?
Simply that all companies are eligible to offer a Cost Plus Plan, that you must be an employee (get a T4) to receive coverage and that the expense must be allowed by Canada Revenue Agency. You only pay when you make an eligible claim (others are refunded) and there are no hidden fees or catches with our plan. Call and talk to us and we will be pleased to explain further or answer any other questions.