Private Health Services Plan

Administrative Policy

24 January 2019 External T.I. 2016-0651291E5 - Revised PHSP position - Self-insured plan

measuring compliance with the 90% METC-eligible expense test

For insured and self-insured private health services plans (PHSPs), what are the tax consequences if not all or substantially all of the actual amounts paid under the plan are for medical expenses that are eligible for the medical expense tax credit (METC) – and do different considerations apply to a self-insured health care spending accounts (HCSA) which sets a ceiling on the amounts that can be claimed under the plan? CRA stated:

An insured plan (employer pays premiums under a contract of insurance) will generally be considered to be a PHSP if all of the expenses covered under the plan are medical expenses or connected expenses, and “all or substantially all” (generally 90% or more) of the premiums paid under the plan relate to medical expenses that are eligible for the METC. The actual benefits paid to employees in the year are not considered … .

As an example, CRA indicated that an insurance plan would meet the above test notwithstanding that only 88% of the benefits paid were METC-eligible if over 90% of the premiums paid related to coverage for METC-eligible expenses.

In the case of a self-insured plan, the test is one of whether all or substantially all of the benefits paid to all employees in the calendar year are for METC-eligible expenses. The employees’ allocation of the ceiling amount to the various expense categories is not considered, so that in the HCSA example, if the portion of the benefits paid in the year for METC-eligible benefits was, say, 92%, it would not matter that the total ceiling amounts allocated to METC-eligible expenses was only 80%. In the rare case where each HCSA was determined to be a separate plan, this same test would be applied on a plan-by-plan basis.

Locations of other summaries Wordcount
Tax Topics - Income Tax Act - Section 6 - Subsection 6(1) - Paragraph 6(1)(a) - Subparagraph 6(1)(a)(i) employee allocated ceiling amounts do not affect application of 90% METC-eligible expense test where a self-inusred plan 207

22 January 2019 External T.I. 2016-0645581E5 - Health and welfare trusts (HWTs)

extension to non-employees/employee or union funded plan/requirements for rehab plan

CRA indicated that a health and welfare trust (“HWT”) which is jointly established by a union and multiple employers, can provide benefit coverage to non-unionized employees of participating employers, retired employees, and individuals who are not employees (i.e., dependants or survivors of current or retired employees where the underlying plan (i.e., a group sickness or accident insurance plan (“GSAIP”), a private health services plan (“PHSP”), or a group term life insurance policy (“GTLIP”)) allows for the provision of benefit coverage to such individuals – although a GTLIP may only provide benefit coverage to current and former (including retired) employees.

Although Folio S2-F1-C1 indicates that a trust funded only with contributions made by employees or an employee union would not qualify as a HWT, there is no explicit requirement that an employer be legally obligated to make contributions in respect of each plan or policy administered by a HWT. Accordingly:

[W]here is it established that retired employees may be provided benefit coverage through a GSAIP, PHSP, or GTLIP, and none of the participating employers have a legal obligation to pay any premiums or contributions in respect of the particular plan or policy, it would appear permissible for a HWT to administer such a plan or policy provided that the trust also administers other employer-funded plans or policies.

A HWT may administer a plan that offers drug and alcohol rehabilitation services, provided the plan qualifies as a PHSP, which entails a requirement inter alia that substantially all of the premiums paid under the plan relate to the coverage of medical expenses that are eligible for the medical expense tax credit.

Locations of other summaries Wordcount
Tax Topics - Income Tax Act - Section 6 - Subsection 6(1) - Paragraph 6(1)(a) - Subparagraph 6(1)(a)(i) HWT can administer a plan that is funded only with union or employee contributes where it also has employer-funded plans 432

12 December 2018 External T.I. 2017-0718661E5 - Private health services plan

coverage for employee's U.S. medical expenses would qualify if they were substantially METC-type expenses

The purpose of a Blue Cross and Blue Shield insurance plan (XXXXXXXXXX Blue Cross plan is to reimburse an employee for certain medical and health care costs the employee incurs while in the U.S. CRA stated:

[A] plan is a PHSP, amongst other conditions, if ‘all or substantially all’ of the premiums paid under the plan relate to medical expenses that are eligible for the medical expense tax credit (METC). “All or substantially all” generally means 90% or more.

… Folio S1-F1-C1 … states that, notwithstanding several exceptions, “eligible medical expenses are not restricted to those paid in Canada or for medical services provided in Canada”.

Whether ‘all or substantially all’ of the premiums paid under the … plan relate to medical expenses that are eligible for the …METC … is a question of fact and can only be determined by the insurer of the plan.

Words and Phrases
substantially all
Locations of other summaries Wordcount
Tax Topics - Income Tax Act - Section 6 - Subsection 6(1) - Paragraph 6(1)(a) - Subparagraph 6(1)(a)(i) coverage for U.S. expenses of METC type generally eligible 113

14 September 2017 Roundtable, 2017-0703871C6 - CPA Alberta 2017 Q9: PHSP for owner-managers

a self-insured health care spending account (“HCSA”) for a sole employee-shareholder likely will not qualify as a private health services plan

Provided that an employee (who is also a shareholder) is active in the business of a corporation whose only employees are also shareholders, and the benefits under the corporation’s private health services plan are reasonable and consistent with the benefits that would be offered to an arm’s length employee performing similar services, would the benefits be considered to be derived from the individual’s employment and in respect of a private health services plan? CRA responded:

…IT-529[, para. 16 notes] … “[I]n order for a health care spending account to qualify as a plan of insurance, there must be a reasonable element of risk. …[If] there is little risk that the employee will not be reimbursed for the full amount allocated to that employee annually, then the arrangement is not a plan of insurance and therefore, not a private health services plan.” In a situation where a corporation provides a self-insured HCSA for its only employee who is also its sole shareholder (sole employee-shareholder), it is likely that the sole employee-shareholder would be reimbursed for the full amount allocated to him or her annually.

…[R]egardless of whether a HCSA qualifies as a PHSP, a sole employee-shareholder who receives benefits out of the HCSA in his or her capacity as a shareholder is required to include such benefits in his or her income under subsection 15(1) … .

[The] general presumption that a sole employee-shareholder receives a benefit or an allowance in his or her capacity as a shareholder … may not apply if the benefit or allowance is comparable (in nature and amount) to benefits and allowances generally offered to non-shareholder employees of similar-sized businesses, who perform similar services and have similar responsibilities.

Locations of other summaries Wordcount
Tax Topics - Income Tax Act - Section 6 - Subsection 6(1) - Paragraph 6(1)(a) - Subparagraph 6(1)(a)(i) sole employee-shareholder unlikely to qualify for PHSP 95

May 2017 CPA Alberta Roundtable, ITA Q.9

private health service plan rules generally are not available for a sole shareholder-employee

A small business only having employee(s) who are also shareholder(s), establishes a notional health care spending account(s) (a type of “private health services plan” under s. 248(1)) under which the corporation administers the accounts for its employee(s) as part of their contract(s) of employment. Would the benefits be in respect of a private health services plan? CRA responded:

[A]s noted in … IT-529 … “[I]n order for a health care spending account to qualify as a plan of insurance, there must be a reasonable element of risk. For example, if the plan or arrangement is such that there is little risk that the employee will not be reimbursed for the full amount allocated to that employee annually, then the arrangement is not a plan of insurance and therefore, not a private health services plan.” In a situation where a corporation provides a self-insured HCSA for its only employee who is also its sole shareholder (sole employee-shareholder), it is likely that the sole employee-shareholder would be reimbursed for the full amount allocated to him or her annually. …

Locations of other summaries Wordcount
Tax Topics - Income Tax Act - Section 15 - Subsection 15(1) general presumption that employee-shareholder receives health care spending account benefits as shareholder 128
Tax Topics - Income Tax Act - Section 6 - Subsection 6(1) - Paragraph 6(1)(a) - Subparagraph 6(1)(a)(i) HCSA for sole shareholder-employee unlikely to operate as insurance plan 200

8 December 2014 External T.I. 2014-0543891E5 F - Régime privé d'assurance-maladie

CRA willing to treat a flex plan as being bifurcated into a PHSP and non-PHSP if medical expense portion is recorded separately

In the course of a general discussion of a flex plan, CRA stated:

Where a plan or arrangement covers expenses other than medical expenses, the plan or arrangement is not eligible as a PHSP. However, we accept that where the employer establish a separate plan for medical expenses so that the plan covers those medical expenses, thee plan can qualify as a PHSP. Where it is not possible to establish a separate plan for medical expenses, we are generally prepared to treat the plan as two separate plans if the employer records the medical expense portion separately from the other expenses. In this way, and subject to compliance with all other conditions, only the part of the plan covering medical expenses may be eligible as a PHSP.

S2-F1-C1 - Health and Welfare Trusts

no. employees

1.5 …There is no minimum number of employees that must be covered under a private health services plan.

25 June 2014 External T.I. 2014-0521301E5 - PHSP - employee-shareholder

cost-plus plan

A cost-plus health plan ("Plan") administered by a third party (e.g., insurance company) is offered by a corporation to its sole shareholder who is also the sole employee. CRA stated:

[A] cost-plus plan under which the administrator agrees to reimburse the sole employee-shareholder, his or her spouse, and members of his or her household for actual medical and hospital expenses and receives, as consideration, an amount equal to the amount reimbursed plus an administrative fee, does not qualify as a PHSP since it does not contain the necessary elements of insurance.

15 October 2013 External T.I. 2013-0498001E5 F - Transfert de sommes inutilisées entre régimes

transfer from individual healthcare spending account to another PHSP is permitted

Is it possible for the employer (a university) to reallocate the unused credits from the individual healthcare spending account for professional employees (qualifying as a private health services plan) to another PHSP ("second plan") or to the global group insurance account without affecting the qualification of the healthcare spending account as a PHSP? CRA responded:

[A] healthcare spending account that allows the transfer of funds to another plan that qualifies as a PHSP could retain its PHSP designation. However, if the healthcare spending account allowed for the transfer of unused amounts to another plan, such as a group insurance plan, the healthcare spending account would not be considered a PHSP.

26 May 1995 T.I. 950171 (C.T.O. "Self-Funded Private Health Services Plans")

A self-funded dental care plan can qualify as a private health services plan.

15 June 1993 T.I. (Tax Window, No. 32, p. 12, ¶2606)

A plan providing coverage for a partner of the same sex does not qualify as a private health services plan. Where it is not feasible to have a separate plan which is not a private health services plan, RC is prepared to treat a plan as being two separate plans provided the administrator accounts for contribution separately.

13 June 1991 T.I. (Tax Window, No. 4, p. 28, ¶1301)

An employer funded arrangement to cover employee medical expenses will not be a private health insurance plan if it permits excess contributions and medical expenses to be carried forward from year to year.

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