The claims process for any benefit provision that is impacted by enhancements will be paid as follows:
- Claims reimbursed between January 1, 2026, and 11:59 pm on January 14, 2026, will initially be paid based on the plan design before enhancements were finalized. However, Canada Life will automatically reassess these claims and send the difference owing to the member through the regular process. Members do not need to re-submit claims for re-adjudication nor do they need to contact Canada Life or Target to initiate re-assessment. This means members with direct deposit will see two deposits for the same claim. One based on the prior plan and the second based on the plan enhancement. Please note that this reassessment may take some time to process and the second payment for the plan enhancement will be issued as soon as possible.
- Claims that are received by Canada Life after January 14, 2026, will be assessed at the enhancement coverage level.
- If your service provider uses point of sale payment, you will be reimbursed based on the plan design before enhancements up to and including January 14, 2026. If you use point of sale as of January 15, 2026, payment will be calculated based on the enhanced plan design.
- Claims with a service date prior to January 1, 2026, are ineligible for reimbursement at the enhanced coverage level.
If there are any delays, a correction will be made, and you will be reimbursed at the higher level.
While we couldn’t increase the $1,200 yearly maximum for each paramedical service, we were successful in bringing an HCSA that gives Active Members the flexibility to claim paramedical expenses, or other medical expenses as defined in the Income Tax Act.
The $75 per visit was agreed upon after a careful analysis of the usage of the plan, combined with the reasonable and customary fees for each type of paramedical services. While this new amount may not cover a full appointment in some cases, it subsidizes paramedical services to a far greater level. Keep in mind that starting in April 2026, Active Members can use the newly announced HCSA to further reimburse paramedical expenses above the new per visit and yearly maximums, up to the amount of funds remaining in a Member’s HCSA.
Our insured benefit plans follow the standards set by the broader OPS. Other OPS plans include per visit caps for paramedical services, and removing these caps in our plans would impact the entire OPS framework. With over 16,000 active and retired members plus dependents enrolled in the plans, caps help keep premiums stable so benefits remain available year after year.
The benefit enhancements announced are effective January 1, 2026. However, Canada Life requires additional time to program these changes into their systems. The target for completion of these system updates is January 14, 2026. (The Health Care Spending Account for Active Members is effective April 1, 2026.)
Yes. To bring this new benefit to you as soon as possible, we have agreed to a shortened first year, with escalating entitlements in the following two years. Only expenses with a service date on or after April 1st will be eligible under the HCSA.
Keep in mind that unused HCSA account balances can be carried forward up to one calendar year. This means if a member does not use the entire $650 allocation in 2026, the remaining balance can be carried forward and added to the 2027 allocation.
There are numerous eligible expenses for reimbursement through the HCSA, as dictated by the Canada Revenue Agency (CRA), such as those services performed by dentists, medical doctors, nurse practitioners, optometrists, and many more that are not covered by your OPPA health and dental plans. For a full list of authorized practitioners by province or territory, follow the link to the CRA list of authorized medical practitioners for the purposes of claiming medical expenses.
Please note that the CRA defines eligible dependents differently than the OPPA insured benefits plan terms. The HCSA will provide coverage for you, your partner, and other dependents as defined in the Income Tax Act who rely on the Member. A full list of dependents for medical expenses covered can be found in the Income Tax Act (see Sections 1.4 – 1.7).
Any remaining balances for eligible health, vision, or dental expenses that are not fully reimbursed under your regular insured benefits plan can be claimed through the HCSA. If you have coverage under a partner’s plan, you must first submit the claim to that plan and apply any coordination of benefits. After both plans have processed their portions, you can submit any outstanding eligible amount to the HCSA for reimbursement.
No. Only expenses defined in the Income Tax Act are eligible for reimbursement through the HCSA. Eligible benefits through an HSCA are tax-free to members. (Benefits are taxable in Quebec.) General wellness items such as a gym membership, etc. are taxable expenses and therefore ineligible under an HCSA.
Our analysis of Ontario Public Sector (OPS) bargaining agents confirmed the Government’s position that no other Union or Association has an insured benefits plan and an HCSA for Retired Members. The Government’s position on this matter did not evolve during the bargaining process.
A communication dedicated to the HCSA details will be sent to the membership closer to the implementation date. This communication will also include information on claim co-ordination and submission.