Questions Employees Should Ask About Their Benefits Plan
Taking the time to understand your benefits before you need them can help you make more informed healthcare decisions, avoid unnecessary out-of-pocket expenses, and take advantage of resources that support your overall wellbeing.
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- Chris Biddeson
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Employee benefits are an important part of overall compensation, but many employees do not fully understand the coverage available to them. In fact, many employees only review their benefits when they need healthcare services, submit a claim, or receive an unexpected expense.
Taking the time to understand your benefits before you need them can help you make more informed healthcare decisions, avoid unnecessary out-of-pocket expenses, and take advantage of resources that support your overall wellbeing.
Whether you are newly enrolled in a benefits plan or have had coverage for years, asking the right questions can help you better understand your coverage and make the most of the support available to you.
Do I Know What Services Are Covered?
One of the most common misconceptions about employee benefits is assuming that all plans offer the same coverage. While many plans include prescription drugs, dental care, and vision services, coverage levels and eligible expenses can vary significantly.
Reviewing your benefits booklet or member portal can help you understand what services are covered, what limitations may apply, and whether there are exclusions that could affect your claims. Having this information ahead of time can help prevent surprises when you need care.
How Much Coverage Is Available Each Year?
Understanding what is covered is important, but it is equally important to know how much coverage is available.
Many benefits plans include annual maximums or spending limits for services such as dental care, vision expenses, mental health support, and paramedical practitioners. Knowing these limits can help employees plan treatments and make informed decisions about when and how to use their benefits throughout the year.
A quick review of your coverage details can provide valuable insight into how your benefits are structured and what expenses may require additional planning.
Are Preventative and Wellness Services Included?
Benefits plans are not just designed to help when health issues arise. Many plans also support preventative care and wellness initiatives that can contribute to long-term health.
Coverage may include routine dental exams, vision examinations, vaccinations, health screenings, or other wellness-related services. Taking advantage of preventative care opportunities can help identify concerns earlier and support healthier outcomes over time.
Employees who regularly use preventative benefits often gain more value from their coverage while supporting their overall wellbeing.
What Wellness Resources Are Available?
Many employees are surprised to learn that their benefits plan may offer much more than traditional healthcare coverage.
Depending on the plan, employees may have access to Employee Assistance Programs (EAPs), mental health resources, virtual healthcare services, health coaching, wellness programs, and other support tools.
These resources are often designed to help employees navigate personal challenges, improve wellbeing, and access care more conveniently. Understanding what is available can help employees find support before challenges become more difficult to manage.
Does My Plan Include a Health Spending Account?
Some employee benefits plans include a Health Spending Account (HSA), which can provide additional flexibility for eligible healthcare expenses.
Unlike traditional coverage categories that may have specific limits or restrictions, an HSA can often be used for a broader range of qualifying medical expenses. Understanding whether your plan includes an HSA, how much funding is available, and how claims are submitted can help you maximize the value of your overall benefits package.
For many employees, an HSA can be a valuable tool for managing healthcare expenses that may not be fully covered elsewhere.
List of Eligible Health Expenses in a Canadian HSA
| HSA* | Other | |
|---|---|---|
| Acupuncture |  | |
| Assistive Mobility Device | | |
| Audiologist Services & Hearing Aids | | |
| Autism Treatments | | |
| Cataract Surgery | | |
| Chiropodist Services | | |
| Chiropractic Services | |  |
| Contact Lenses | | |
| Dental Hygienist Services | | |
| Dental Technologist Services | | |
| Prescription Drugs | | |
| Elderly Parent & Department Care | | |
| Fertility Drugs & Treatment Services | | |
| Laser Eye Surgery | | |
| Massage Therapist (RMT) | | |
| Medical Laboratory Services | | |
| Medical Radiation Treatment | | |
| Midwife Services | | |
| Naturopath Services | | |
| Occupational Therapist Services | | |
| Optician Services | | |
| Optometrist Services | | |
| Orthodontic Services | | |
| Physiotherapist Services | | |
| Prescription Sunglasses | | |
| Psychologist Services | | |
| Respiratory Therapists | |
For the complete and most current list of eligible medical expenses, refer to the CRA’s Income Tax Folio S1–F1–C1, Medical Expense Tax Credit.
What is NOT eligible
Ineligible expenses may instead be covered through WSA.
- Cosmetic procedures (teeth whitening, Botox),
- gym memberships,
- fitness equipment,
- nutritional supplements,
- and services from non-licenced practitioners
These types of expenses are generally not eligible under an HSA.
Note that eligible practitioner types can vary by province, so it is worth confirming coverage for specific services in your jurisdiction.
Ineligible expenses may be covered through a Wellness Spending Account (WSA).
Who Can Be Covered Under My Plan?
Benefits are not always limited to the employee alone. Many plans allow coverage for spouses, partners, and dependent children.
However, eligibility requirements can vary. Employees should understand who qualifies for coverage, what documentation may be required, and how life events such as marriage, the birth of a child, or adoption may affect their benefits.
Keeping coverage information up to date helps ensure family members can access the support they need when they need it.
Do I Understand the Claims Process?
Even the best benefits plan can feel frustrating if employees are unsure how to submit claims.
Some healthcare providers may submit claims directly to the benefits provider, while other expenses may require employees to submit documentation themselves. Understanding how claims are processed, what receipts should be retained, and how claim status can be tracked can make the reimbursement process much smoother.
Taking a few minutes to familiarize yourself with the claims process today can save time and frustration later.
Are There Waiting Periods or Coverage Requirements?
Some benefits plans include waiting periods before certain types of coverage become available. Employees may also encounter eligibility requirements that affect when specific benefits can be accessed.
Understanding these details can help avoid confusion and ensure employees know when coverage begins and what requirements may apply.
What Happens When Life Circumstances Change?
Life changes can often affect benefits coverage. Events such as marriage, welcoming a child, changes in dependent status, or employment transitions may require updates to your plan information.
Knowing how and when these changes should be reported can help ensure coverage remains accurate and uninterrupted.
Where Can I Find Help If I Have Questions?
Benefits plans can sometimes feel complex, especially when employees are navigating coverage categories, spending limits, claims procedures, and eligibility rules.
Fortunately, many providers offer member portals, online resources, customer support teams, and educational materials designed to help employees better understand their coverage.
Using these resources can help employees make more informed decisions and gain greater confidence in their benefits plan.
Making the Most of Your Benefits
A benefits plan is designed to support your physical health, mental wellbeing, and financial peace of mind, but its value depends on understanding how it works.
By taking the time to ask questions about coverage, spending limits, wellness resources, Health Spending Accounts, eligibility requirements, and claims procedures, employees can make more informed healthcare decisions and maximize the support available to them.
The more familiar you are with your benefits, the better prepared you will be to take advantage of the valuable resources your plan provides.
Supporting Better Benefits Experiences
When employees understand and actively use their benefits, everyone benefits. Employees gain greater access to healthcare resources and support services, while employers help foster healthier, more engaged workplaces.
Providing flexible, easy-to-understand benefits is an important part of supporting today’s workforce. Contact our team to learn how Quikcard’s employee benefits plans and Health Spending Accounts can help organizations deliver meaningful coverage that meets the diverse needs of their employees.
