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Private Health Services Plans

Private Health Services Plan (PHSP) is also known as Cost Plus. PHSP can be used on top of a Group Life, Health and Dental Plan, to enhance your employee benefits by paying for excess things, not covered under the group plan. This plan ensures active involvement of your employees in choosing how to spend their allocated health dollars. 

PHSP can also be your alternative solution in case you cannot afford paying monthly premiums to sponsor a Group Life, Health and Dental plan for your people, but still want to provide them with some benefits. In this situation, PHSP allows you to sponsor benefits that work to your budget, and gives your people the flexibility to allocate the available funds as they wish. 

How does a PHSP work? 

You allocate each of your employees a spending account which can be $500, $1,000, or $5000, depending on your budget and goals. Pacific Employee Benefits sets this fund into an account, adjudicates claims for employees’ medical or dental expenses, eligible under the Canada Revenue Agency (CRA). Your employees decide how they are going to spend their account, or if they are going to spend it at all. 

Under this arrangement, you are paying medical expenses of an employee up to a predetermined level. If your employees do not deplete their spending account, it does not cost you anything.  You only pay for what they spend. The other advantage of PHSP is that it is a tax write off, and not a taxable benefit to your employees. 

With PHSP, you really get your dollar getting further. 

PHSP highlights:

  • expenses are known upfront
  • no initial set up fee
  • no monthly premiums
  • the employer has the option to differentiate employee classes by determining different spending limits
  • employees are reimbursed for eligible expenses 
  • 10% adjudication fee is charged on eligible claims (GST is charged on adjudication fee only)
  • benefit levels can be prorated for the plan’s first year
  • plans are based on a calendar year
  • tax advantages for both employers and employees

You can view the list of eligible expenses here.

How to submit a claim?

If you are a PHSP member, please note that:

  • Claim forms can be obtained from your employer, or you can download them here.
  • Please ensure that all claims submitted are the original official receipts. They must be mailed to Pacific Employee Benefits in the following address: provide address. Fax copies of claims will be declined. 
  • If you are claiming medical travel expenses, you must have a Medical Travel Form in lieu of Doctor’s letter of referral for services not available in your area. This form is to accompany the receipts for expenses. If you are not submitting travel receipts, you may claim the kilometres travelled as well as a per diem for meals for the patient and one attending person, in lieu of restaurant receipts. 
  • If your spouse is a member of a group benefits program, co-ordination of benefits can be accomplished by submitting claims to your spouse’s group benefits plan and your PHSP. If original receipts are submitted to your spouse’s plan, the explanation of benefit payment statement from your spouse’s insurance company must accompany your PHSP claim. 
Talk to our benefits advisors to learn more about PHSP for you and your people.  

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