Claim Submission Guide for Health Spending Accounts

Till tapes and/or credit card slips do not provide the treatment information that is required.
You must submit detailed invoices that contain the following: Patient name, date of treatment/service, treatment/service provided, Authorized Medical Practitioner providing the service, total cost, and DIN# (drug number) if applicable. If you have insurance, see the "What to submit when you have insurance" section.

When claiming, ensure you move the till tapes to the side so they are not covering any invoice details. 

 

What to submit when you have insurance

You must submit your expenses to all insurance providers, including other HSAs before using the NHC spending account. We are the last payor. 

Any time there is insurance coverage involved we require the detailed Explanation of Benefits document (EOB, sometimes called a Claim Statement) from all insurance providers including other HSAs, for each expense you are claiming. 

This detailed document is issued directly by your insurance provider(s) and shows the treatment/service date, patient name, treatment/service details, total cost of treatment, the amount paid toward each expense (even if it is 0) and all applicable messaging/notes for each expense regarding why insurance paid the amounts they did. 

If you do not have your copy, contact your insurance provider directly to obtain it. Summary documents are not acceptable as they do not include all of the required details listed above.

If you don’t have other coverage for your expense(s), submit to National HealthClaim directly.

 

More details found here.

 

What to submit when you have no other dental coverage

The Standard Dental Claim Form is filled out by the dental office and includes information that does not typically appear on a regular dental invoice. Most commonly missing from other documents is a listed treatment date. While the billing date may be the same as the treatment date, this is not always the case. As dental claims are processed by the treatment date specifically, we do require clear confirmation. 

If you do not have insurance, always submit the Standard Dental Claim Form or Detailed Dental Ledger. It must contain the patient name, date of treatment, treatment details, total cost and a confirmation of payment in full.

 

What to submit for orthodontic claims

For orthodontic treatment expenses, submit a copy of each payment invoice. The payment invoice must clearly indicate the expense is for Orthodontics and what kind of expense it is (Deposit/Initial Payment/Monthly Installment). The receipt must include the patient name, amount and the date of the payment.

IMPORTANT: If you have any insurance or other coverage for orthodontic treatment, you must provide additional documentation. Your first orthodontic claim must include the Orthodontic Treatment/Financial plan, which shows the patient name and payment schedule you have arranged with the dentist. We will keep this plan on file so you will need to submit it only once.

When there is any insurance or other coverage for orthodontic treatments, you must submit the expenses to them first. They will process the claim according to the payment schedule and provide you with an Explanation of Benefits document (EOB, also sometimes called a Claim Statement). We require the EOB document for each payment you are claiming when other coverage has been involved.

You can click the link below to see more information about this required document. 

Explanation of Benefits (detail)

Regarding lump sum payments: Please be aware that we cannot reimburse lump sum payments if there is any other coverage involved with your orthodontic claim. If you have other coverage, you must make payments according to the payment plan that your insurance company is following. Making a lump sum payment when you have other coverage may prevent us from being able to reimburse your out-of-pocket payments for orthodontics.

 

What to submit for a travel medical claim

In order to claim expenses related to travelling for a medical appointment more than 80km from your home, you must provide the following:

1. A doctor's letter confirming (per CRA guidelines) that “substantially equivalent medical services are not available near your home and that under the circumstances, it is reasonable for you to travel to that place for those medical services.”
2. If you are claiming any travel companion expenses, you will also need the doctor's letter to certify that you were not able to travel alone to get medical services. This would allow you to claim their expenses as well.
3. Proof of your medical appointment. Preferably a detailed invoice, but a letter from the provider will suffice if you are not claiming the appointment cost itself.
4. The completed Travel Expense Form, which you can download here.

 

How to claim an expense in any currency other than CAD

In order to submit an expense in a currency other than CAD, you must include the following:

1. The original documents that meet our invoice requirements.
2. A translation of the invoice to English, if applicable.
3. Confirmation of payment and exchange rate to CAD. If payment was with a Canadian credit or debit card, the statement line showing the amount paid in CAD and the date of payment must be included. If payment was cash or a non-Canadian card, please include a note with your claim that explains how you paid, that there are no other documents available, and we will do the conversion on your behalf.

 

Requirements for expenses ordered online