Cost Plus coverage provides designated plan members and their dependents with additional benefits for expense items that aren’t covered and for items that exceed current coverage amounts identified in the benefits program. Under a Cost Plus program, a Cost Plus claim is an expense that is an eligible drug, dental or extended health claim under the Canadian Income Tax Act and is treated as a non-taxable benefit to the plan member.
Cost Plus claims are subject to a more rigorous adjudication process and the administrative fees to process these claim types are often materially larger than standard claims. Plan sponsors are required to pay the administrative fees and applicable taxes (premium and sales tax) for all Cost Plus claims processed on behalf of eligible plan members.
Please note that the Canada Revenue Agency may determine that a Cost Plus claim doesn’t qualify as a Private Health Services Plan (PHSP) and claims processed under this program may not qualify as a non-taxable benefit to the plan member. For this reason, we recommend that covered individuals consult their tax advisors before submitting claims under the Cost Plus program.