Health Spending Account (HSA) Guide: Eligible Expenses

Overview

A Health Spending Account (HSA) offers a tax-efficient method to cover a broad spectrum of health and dental expenses. For those with existing coverage through a traditional insurance group plan, it's advisable to utilize that primary coverage initially. The HSA serves as a supplementary resource, covering any remaining balances, including deductibles, co-payments, and expenses not covered by your primary insurance plan.

When submitting claims, always include the "Explanation of Benefits" from your insurance provider, which details the payment made towards each expense. Digital copies of this document are acceptable and can be found online from your insurance provider's online self-serve client portal.

If you don't have an insurance plan, you can submit your expenses directly to your HSA provider.

Eligible Expenses

The scope of expenses eligible for HSA coverage extends to both domestic and international services. While Garrett Agencies strives to maintain an accurate and current list of eligible expenses, it's important to note that the Canada Revenue Agency (CRA)'s guidelines ultimately prevail in cases of discrepancy.

Prescription Medications:

Eligible:

• Medications prescribed by a licensed medical practitioner and dispensed by a pharmacist. Official prescription receipts are required and must reference the patient name, drug name, drug DIN identification number, prescribing doctor name, amount paid and date.
• Injection fees and insulin treatments.

Not Eligible:

• Over-the-counter items like vitamins and naturopathic remedies.

Vision Care:

Eligible:

• Prescription eyewear, including eye glasses, sunglasses, and contact lenses. These can be purchased either in-store, or online. Related expenses such as taxes and shipping are also eligible.
• Clip-on sunglasses and non-prescription sunglasses are eligible when submitted with prescription eye glasses and contact lenses respectively.
• Services from eye care professionals (Ophthalmologist, Optometrist and Optician) including eye exams, laser eye surgery, and vision therapy.

Not Eligible:

• Over-the-counter items like contact lens solution and generic reading glasses.

Dental Services:

Eligible:

• All dental and orthodontic services provided by licensed practitioners.
• Braces & Invisalign.

Not Eligible:

• Cosmetic procedures (e.g. teeth whitening, home bleaching kits, dental veneers, others) are not eligible as they are considered non-essential.
• Cosmetic procedures are only eligible if deemed medically necessary and accompanied by a doctors note confirming same.

Wellness and Specialist Care:

Eligible:

• Any service performed by a qualified medical practitioner (as specified by the CRA or country if outside of Canada), including:
  • Acupuncturists
  • Allergists
  • Chiropractors
  • Cosmetic Surgeon (non-cosmetic)*
  • Dermatologist (non-cosmetic)*
  • Dieticians
  • Homeopaths
  • Kinesiologists
  • Naturopaths
  • Physiotherapists
  • Podiatrists/Orthopedists (foot orthotics)
  • Psychiatrists
  • Psychologists
  • Registered Massage Therapists
  • Social Workers
• Certain weight loss programs supervised by CRA authorized medical practitioners.
• If procedure is required as a result of a medical condition or considered “medically necessary” for mental wellness reasons, a doctor’s note will be required for it’s consideration.

Maternity and Reproductive Health:

Eligible:

• Baby Breathing Monitors (CRA requirements to be met for eligibility)
• Breast pumps
• Cord Blood Storing (newborn stem cell storage for future health needs)
• Cryo storage for eggs
• Gynecologist
• In vitro fertilization, not including donations to a sperm bank
• Midwife Services
• Obstetrician (Pregnancy, Childbirth, Postpartum Specialist)
• Pre-natal/post-natal/maternity classes led by CRA authorized medical practitioner
• Prescription Birth Control

Family Care:

Eligible:

• Any service performed by a qualified medical practitioner (as specified by the CRA or country if outside of Canada), including:
  • Acne and Acne Scarring Treatment
  • Full-time attendant or care in a nursing home for patients with prolonged mental or physical impairment. Must be certified medical practitioner.
  • Home care (attendant must be non-relative)
  • Homemaker service (recovery from illness/surgery or disability reasons). Contact us for details
  • Learning assistance, tutoring services (supplementary to primary education taught by a non-relative) and specialized schools for individuals with a diagnosed learning disability. Contact us for specific document requirements.
  • Learning Psych Assessment needed for Individualized Program Plan (IPP) educational provisions
  • Lip Reading
  • Pediatrician (Children’s Physician)
  • Reasonable costs for adapting a residence to accommodate a disabled person (i.e., wheelchair ramp, lifts, bath facilities)
  • Sign language training
  • Specially trained animals to assist blind, deaf, or severely impaired persons, including the cost of its care and maintenance
  • Speech Therapists

Health Equipment and Devices:

Eligible:

• Artificial eyes/limbs/Prosthesis
• Artificial kidney machine
• Blood glucose meter
• Brace for a limb (e.g., Core Shorts, compression stockings and sized limb braces)
• Crutches
• Diabetic pumps
• Heart Monitors
• Hospital beds for home
• Neck/Spinal brace
• Osteogenesis Stimulator (healthy bone repair therapy)
• Sleep Apnea (e.g., CPAP machines and supplies)
• Vision/Hearing/Speech impaired aids
• Wheelchair
• Wigs (medical reasons)

Contact your HSA provider for specific documentation requirements.

Hospital and Medical Services:

Eligible:

• Ambulance Charges, including Medi-Van patient transport (non lights/sirens)
• Anesthetist
• Audiology/Speech
• Blood transfusion/Bone Marrow
• Diathermy Nursing (muscle tissue heat therapy)
• Hospital bills/Use of operating room
• Hydrotherapy (water therapy for pain management). This excludes hot tub purchases.
• Organ Transplant/Transplant
• Ultra-violet ray treatments for skin conditions (e.g., psoriasis)
• Upgrade to Semi-Private or Private Room
• Vaccines/Injections/Insulin treatments
• X-Ray Treatment/Technician

Insurance Premiums:

• Premiums for private health insurance plans are eligible, Including medical, dental, and hospitalization plans. They can be claimed as a medical expense, as long as 90% or more of the premiums paid under the plan are for eligible medical expenses. For more information, see CRA Interpretation Bulletin IT-339, Meaning of private health services plan and New position on private health services plans – Questions and answers.

Additional Covered Expenses:

• Costs related to travel for medical treatment. i.e. Transportation, meals and accommodations. Reasonable expenses for meals, accommodation and travel costs for a patient and an accompanying attendant may be deductible if: equivalent medical services are not available locally, the route traveled is reasonably direct and medical treatment is reasonable and distance travelling is at least 40 kilometers one way. Proof of medical appointment is needed.

Contact your HSA provider for travel forms and further requirements.

HSA Claim Submission Guidelines

For all claims, ensure documentation is thorough, including detailed receipts and, where required, medical justification. For specific items or services, consult with your HSA provider to understand the necessary documentation and eligibility criteria.

If you have an insurance plan, submit your claims to your plan first. You can subsequently submit the "Explanation of Benefits' to your HSA provider for reimbursement of any remaining amounts that are not reimbursed by your insurance plan.

This guide aims to provide a clear understanding of how to leverage your Health Spending Account (HSA) effectively. However, always refer to the CRA's guidelines for the most authoritative and up-to-date information on eligible expenses.