OPIP Health Spending Account
The OMA Priority Insurance Program’s Health Spending Account (HSA) is a flexible program that pays for eligible health and medical expenses. An HSA holds credits that can be used to reimburse a wide variety of eligible health-care services or supplies that are not already covered by OHIP or any other insurance plan.A Health Spending Account is only available to those members who opt out of health coverage because they have health insurance coverage elsewhere.
What is the advantage of an HSA?
An HSA can be used to pay for a wide range of expenses (up to the dollar limit of the account) as long as they qualify as a medical, dental or hospital expense under the Income Tax Act (Canada).
The annual cost for members with a Health Spending Account is $230 — this amount is due on Jan. 1. Members with the OPIP Critical Illness benefit and a Health Spending Account will have their annual critical illness premium withdrawn from their bank account in 12 monthly payments.
How much is in the HSA?
OMA members who participate in OPIP and may have health coverage through their employer’s plan or their spouse’s plan can opt out of the OPIP Health plan and participate in the Health Spending Account (HSA).
Members who are under age 65 and have opted out of health coverage are allotted $350 for their HSA and $50,000 for critical illness coverage.
Members who are age 65 or over and have opted out of health coverage are allotted $500 for their HSA.
What is covered?
Members can claim a wide range of expenses as long as they qualify as a medical, dental or hospital expense under the Income Tax Act (Canada). HSA-eligible expenses include:
Health and dental deductibles/co-insurance payments or expenses above maximum coverage limits
Premiums for other health insurance plans (such as Extended Health Care, Dental Insurance)
Dental care services, including exams, fillings, extractions and orthodontic services
Eyeglasses, contact lenses and laser eye surgery
Services of health-care providers, including physiotherapists, registered massage therapists, chiropodists, chiropractors, speech therapists, psychologists and more
Who is covered by an HSA?
An HSA can cover expenses for members and their dependents, even if they are not covered under members’ benefits plans1.
Carrying unused credits forward
If members do not use all of their credits in the calendar year, the OPIP HSA allows them to roll over the balance of unused credits to one subsequent year. The credits for any year can only be rolled over once. Roll-over credits will always be used first to pay claims before any new credits are used.
For example, credits granted in year one — if not fully used in that year — can roll forward to year two. If still unused at the end of year two, the credits will expire. If year one credits are carried forward into year two, eligible claims submitted in year two will be paid for with year one credits first, until all remaining year one credits are fully used.
The rules for HSA eligibility are established through the Income Tax Act (Canada) as determined by the Canada Revenue Agency. Items that do not qualify include fitness club fees, non-prescribed drugs, home gym equipment, health and wellness books, Critical Illness Insurance premiums, and so on.
Complete information, regarding details on eligible expense rules, can be obtained through the CRA website.
Once a member is enroled in OPIP, they can register to submit HSA claims electronically or print claim forms.
Using the Sun Life app
With the my Sun Life app, you can:
- Submit claims
- Check your coverage details
- View your balances
- Access your coverage cards
- Take a screenshot of your coverage cards and keep them handy for whenever you’re off the grid
- Save your coverage cards to Apple Wallet for quick and easy access
- Search for health-care providers, view ratings of and request appointments using provider search
- Use your smartphone camera to scan the Drug Identification Number (DIN) to get information of a drug and its alternatives
- Call Sun Life from the app — your plan details are linked to the call through the app
- Find exclusive savings with marketplace. Browse through money-saving offers that include vision, fitness, wellness, food and nutrition
1 A dependent for the purposes of the HSA is your spouse, your children or any other person whom you may claim as a dependent under the Income Tax Act (Canada). For example, this could include members of your extended family, such as your parents, grandparents or grandchildren.
OPIP Health Spending Account is underwritten by Sun Life Assurance Company of Canada. Sun Life Assurance Company of Canada is the insurer of this product and is a member of the Sun Life group of companies. For inquiries, please call Sun Life’s Client Care Centre at 1-800-758-1641, Monday to Friday, 8 a.m. to 8 p.m. ET. or visit www.sunlife.ca.
For complete details regarding coverage, please see the terms and conditions of Policy 50131. If there is any conflict between this document and the wording of the policies (or the certificate), the wording of the policies will govern. A copy of the policy may be requested.
Premium rates and discounts are not guaranteed and are subject to change upon notice.
Exclusions and limitations may apply.