In the context of health insurance, and health spending accounts (HSAs) in Canada, “eligible expenses” refer to the types of medical, dental, and related healthcare costs that are covered under a health insurance policy or can be reimbursed through a health spending account. These expenses must meet the criteria set by the insurance policy or HSA guidelines and are often aligned with the Canada Revenue Agency’s (CRA) definitions of medical expenses for tax deduction purposes. It usually describes what a health spending account can reimburse, based on the CRA’s list of medical expenses; what a specific insurance policy pays for is its covered expenses.
Key aspects of eligible expenses include:
Medical services
Costs associated with services provided by licensed medical practitioners, such as doctors, specialists, and surgeons, for the diagnosis, treatment, or prevention of a medical condition.
Hospital services
Charges for hospital stays, including room and board, surgical procedures, and other hospital-provided services necessary for medical care.
Prescription medications
Costs for prescription drugs prescribed by a licensed practitioner and dispensed by a registered pharmacist. Over-the-counter medications are typically not covered unless specifically listed.
Dental services
Expenses related to dental care, including check-ups, cleanings, fillings, extractions, and orthodontic treatments, depending on the policy or HSA rules.
Vision care
Costs for eye examinations, prescription eyeglasses, contact lenses, and sometimes laser eye surgery.
Medical equipment and supplies
Purchases or rentals of medical equipment prescribed by a healthcare professional, such as wheelchairs, crutches, hearing aids, and in some cases, home modifications for accessibility.
Therapeutic services
Fees for services provided by registered therapists, such as physiotherapists, chiropractors, massage therapists, and psychologists, when the therapist is recognized as a medical practitioner in the province where the service is provided (massage therapists, for example, are recognized only in some provinces). Depending on the policy, an insurance plan may also require a doctor’s referral.
Preventive care and vaccinations
Costs associated with preventive healthcare services, including vaccinations and health screenings, if covered by the policy or HSA.
Special conditions
Some policies or HSAs may cover alternative treatments, fertility treatments, or other specialized medical services under certain conditions.
Limitations and exclusions
While many types of healthcare expenses can be eligible, insurance policies and HSAs often have limitations or exclusions on coverage. It’s important to review the specific terms of a policy or HSA to understand what is considered an eligible expense.