Employee Claim FAQs

Now that your plan is all set up, it's time for your employees to start claiming! Here are some of the common questions we get from Benefit Coordinators regarding their employee claims. 

1. How do I know when my employees have made a claim and how much I need to pay?

• If we require funding from the business to pay for the claim, you will receive an emailed invoice indicating how much is required after we have received the claim in our system.

2. Am I able to see what my employees have claimed?

• To maintain privacy and confidentiality for your employees, you cannot see the specific details of their claims. We provide reports for you to view the breakdown of claims, such as how much the group has spent on physiotherapy, prescription drugs etc. but you cannot view the receipts or details of each claim.

3. If two employees submit claims around the same time, how do you know which claim to process first?

• We process claims on a “first in, first out” basis. This means that the claim we receive first is the one that is processed first. If there are not sufficient funds in the group to satisfy one or both of the claims received, we will notify the Benefit Coordinator that funding is required.

4. What happens if my employee has exhausted their benefits but submits a claim anyways, will it be paid? 

• If the employee does not have enough funding left in their balance, we will only pay out what they have in their balance. For example: if John sends in a claim for $100 but only has $75 remaining in his account, we will only reimburse him the $75. If John were to have a zero balance, we would simply reject the entire claim and not reimburse anything. 

5. How do you decide what is an eligible or qualified expense under a Health Spending Account? 

• We base our eligibility list on the Canada Revenue Agency and are always staying on top of any updates they may have to their list.