Canadians with certain group health plans, like health-care spending accounts and medical reimbursement plans, may now be able to get reimbursed for some COVID-19 tests.
Dave Patriarche, president of Mainstay Insurance and founder of the Canadian Group Insurance Brokers, said coverage for diagnostic and screening tests as well as antibody/serology tests may be covered under these plans if the member has a prescription. Typically, said Patriarche, the tests aren’t covered under standard group benefits plans.
A message on the Sun Life website dated Jan. 25, said Ottawa typically publicly funds the cost of the COVID-19 test. "We don’t cover this cost under an Extended Health Care plan. But if your employee pays for the cost of a private test, it may be eligible under their Health Spending Account. For it to be eligible, the COVID-19 test must be prescribed by: a doctor, a nurse practitioner (NP), or a dentist.”
Manulife said it too will cover the test – under certain conditions. "A claim for a COVID-19 test, when accompanied by a prescription, is an expense that’s permitted by the rules governing Health Care Spending Accounts (HCSAs) in Canada. The Medical Expenses Tax Credit allows HCSAs to cover expenses for diagnostic tests when prescribed by a medical practitioner.
Kevin Dorse, Assistant Vice President, Strategic Communications and Public Affairs with the Canadian Life and Health Insurance Association, added that the kinds of products and services that can be reimbursed through plans like the health-care spending account are outlined under Canada Revenue Agency’s Medical Expense Tax Credit.
Rapid antigen tests
The Ontario government made rapid antigen tests free around Christmas and Ottawa sent 140 million rapid antigen tests to the provinces and territories earlier this year, allocated on a per-capita basis.
Some other groups, like the Ontario Chamber of Commerce, in partnership with other organizations, rolled out free rapid tests for small- and medium-sized businesses.
In the U.S., the Biden Administration announced that it will distribute one billion free home COVID-19 tests and make them available to most Americans at no cost. It is also requiring that as of Jan. 15 “individuals covered by a health insurance plan who purchase an FDA-approved, over-the-counter COVID-19 diagnostic test will be able to have those tests covered by their insurance.”
But Dorse said the Canadian health care system is fundamentally different than it is in the United States, affecting the role that private insurers play.
In an e-mail, Dorse said American private insurers reimburse end-to-end costs from health care practitioners, including hospitals, doctors, labs and other sources. In Canada, private insurers’ plans have deliberately excluded costs for diagnostic tests like MRIs and x-rays, but some private insurers are moving ahead with reimbursing group plan members through their health-care spending accounts.
“The federal government has been very clear that it will provide the tools provinces and territories need to respond to the spread of COVID-19 – that includes the costs of rapid tests. Since rapid tests are being made available through the public system, they aren’t covered through traditional private insurance plans,” said Dorse.