OPIP Health Care Spending Account

The OMA Priority Insurance Program’s Health Care Spending Account (HCSA) is a flexible program that pays for eligible health and medical expenses. An HCSA 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 Care Spending Account is only available to those members who opt out of health coverage because they have health insurance coverage elsewhere.

An HCSA 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 Care Spending Account is $230 — this amount is due on January 1. Members with the OPIP Critical Illness benefit and a Health Care Spending Account will have their annual critical illness premium withdrawn from their bank account in 12 monthly payments.

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 Care Spending Account (HCSA).

Members who are under age 65 and have opted out of health coverage are allotted $350 for their HCSA 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 HCSA.

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).

HCSA-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

An HCSA can cover expenses for members and their dependents, even if they are not covered under members’ benefits plans.¹ 

If members do not use all of their credits in the calendar year, the OPIP HCSA 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.