Higher Health · Patient Coverage Guide

Get the most out of your health benefits

Many patients pay out of pocket for care they could have claimed. This guide shows you how to use your insurance, your Health Spending Account (HSA/HCSA) and a tax credit — in the right order, so you never leave money on the table.

Not sure what you have? Ask us

Start here — the short version

If you don’t want to read the whole thing, this is all you really need:

We give you an itemized receipt for your visit.
Send it to your work health plan (yours, or your spouse’s) to get paid back what they cover.
Whatever’s left, use your health spending account if you have one — it’s often the best way to pay for nurse practitioner visits.
Still something left? Keep the receipt for tax time. You may get a little back.

Not sure about any of this? That’s normal. Email us at frontdesk@higherhealthcentre.com and we’ll walk you through what you have and what to send where. You don’t need to figure it out alone.

Why this matters

Most workplace benefits and Health Spending Accounts run on a yearly cycle, and unused coverage generally does not roll over. If you have coverage for naturopathic or nurse practitioner care and don’t use it before your plan resets, that coverage is simply gone.

Use it or lose it. Benefit maximums reset at your plan’s year-end and do not carry forward. HSA/HCSA credits may expire or carry forward for a limited time, depending on your plan — check your balance, your claim deadline and your carry-forward rules. If you have care you’ve been meaning to book, it’s usually better to do it before your plan resets.

The golden rule: claim in order, and never claim the same dollar twice. Start with your own insurance, then a spouse’s plan, then your HSA/HCSA — and keep receipts for anything left over for tax time.

Your three possible sources of coverage

You may have one, two, or all three. Not sure? Check your benefits app or ask your employer — or ask us to help you check.

Use first

Your insurance plan

Health benefits through your own or a spouse’s employer.

Use after benefits

Your spending account

Many Canadian plans use HSA or HCSA to describe an employer-funded Health Spending Account.

Use at tax time

Your tax credit

Eligible unpaid medical expenses may reduce the income tax you owe.

The four steps — in this order

If a step doesn’t apply to you, skip it. At each step, claim only the amount that hasn’t already been paid. Keep every receipt and payment statement as you go.

Try your health benefits

Send the full itemized receipt to your own insurance plan first.

Use first

Try a spouse’s plan

If you have access to one, send the full original itemized receipt along with the first plan’s payment statement (the “explanation of benefits”).

Coordinate the balance

Use your HSA/HCSA

If you have one, submit only the amount still unpaid. This is often the best way to cover nurse practitioner visits, which many regular plans don’t include.

Best for NP visits

Keep the rest for tax time

Save receipts for any eligible amount no plan will reimburse. It may count toward the Medical Expense Tax Credit.

Use at tax time

What’s an “explanation of benefits”? It’s your insurer’s payment statement — it shows what they paid and what’s still unpaid. You’ll often need it to claim the balance on the next plan.

1. Check your regular health benefits

Every plan is different — even two people at the same insurer can have different coverage, because their employers chose different plans. The fastest way to find out is to ask. Copy the questions below and send or read them to your insurer.

Copy & send these 5 questions to your insurer

Do I have coverage for services provided by an Ontario naturopathic doctor?
What is my annual maximum, and is there a per-visit maximum?
Are professional services provided by a nurse practitioner covered?
Do I need a physician’s referral or pre-approval?
Can I coordinate the unpaid balance through my spouse’s or partner’s plan?

Tip: Write down the representative’s name, the date, and your call reference number in case you need to follow up.

How Higher Health services are usually handled

Naturopathic doctor visits

Commonly submitted under naturopathic or paramedical coverage, subject to your plan’s rules and limits.

Nurse practitioner services

Not covered by every regular benefit plan. Ask your insurer about NP professional fees specifically — and if they’re not covered, this is exactly where your HSA/HCSA and the tax credit matter most.

Prescription medications

Assessed under your drug plan. Coverage, deductibles and pre-authorization rules vary.

Lab testing & IV-related fees

Professional, administration and supply fees may be treated differently — confirm each item with your insurer.

Supplements & over-the-counter products

Usually not covered by benefits, and the CRA generally does not allow over-the-counter vitamins or supplements for the tax credit.

Direct billing. When available, Higher Health may be able to submit an eligible claim directly to your insurer so you pay less up front. You’re still responsible for confirming your coverage and paying any amount your plan doesn’t cover. Ask us whether we can direct-bill your plan.

What we give you so your claim goes through

Insurers need specific details before they can assess a claim. Every itemized receipt we issue for naturopathic doctor and nurse practitioner visits includes:

The practitioner’s name and their registration / license number (many insurers require this)
A clear description of the service provided
The date of service
The amount paid, with any applicable HST shown
Our clinic details and contact information

If your insurer or HSA administrator asks for anything else — an explanation of benefits, a prescription, or a referral — just let us know and we’ll help where we can.

2. Check whether you have an HSA or HCSA

A Health Spending Account (HSA), sometimes called a Health Care Spending Account (HCSA), is a separate pool of money some employers provide. It usually gives you a dollar balance you can spend on eligible medical expenses, and your plan administrator makes the final call.

Good to know: an expense your regular plan declined may still be accepted by your HSA/HCSA. Don’t assume it’s excluded — submit it or ask.

Before you submit, check these five things

Your current HSA/HCSA balance
The claim deadline, and whether unused funds expire or carry forward
Whether you must submit to your regular benefits first
Whether your spouse and eligible dependants can use the account
Which documents are required

You may be asked for an itemized receipt, an explanation of benefits, a prescription, or a referral.

3. Claim what’s left at tax time

Whatever you end up paying out of your own pocket, save the receipt. When you file your taxes, you may be able to include medical expenses you paid yourself in a claim for the Medical Expense Tax Credit. In Ontario, visits with naturopathic doctors and nurse practitioners usually count. Not everything we offer qualifies — the CRA keeps a list of authorized medical practitioners by province, and services from practitioners outside that list (including nutritionists) generally do not, even where the care itself is valuable.

The simple version: keep every receipt for care you paid for. Give them to whoever does your taxes (or your accountant) and ask, “Can I claim these medical expenses?” You won’t get the full cost back — it’s a partial credit — but for many families it adds up, especially if you had a lot of care in one year.

A few honest notes: it’s a credit that lowers the tax you owe, so if you don’t owe any tax it may not help you — your accountant can tell you. Over-the-counter vitamins and supplements generally don’t count.

There is a threshold. The CRA subtracts the lesser of 3% of your net income or a fixed annual amount from your total eligible expenses, and only what remains counts toward the credit. A small leftover balance on its own often produces no credit at all — but it can contribute to one once you combine it with the rest of your family’s eligible medical expenses for the year.

Two things worth asking your accountant. You can choose any 12-month period ending in the tax year rather than being locked to January to December, and the spouse with the lower net income is usually the one who should make the family claim, because the 3% threshold is calculated on their income. The threshold amounts are indexed and change every year, so confirm the current figures rather than guessing.

How the four steps stack up

Say you had a year of naturopathic and nurse practitioner care. Here is the order the payments come in — each source only pays the part the one before it did not cover:

Cost of your care over the year	Your starting amount
Your work health plan pays back	Up to your plan’s annual maximum
Your spouse’s plan pays back	Coordinates part of the remaining balance
Your health spending account pays	Up to your available balance
What’s left is your out-of-pocket cost	Keep these receipts for tax time

How much actually reaches you at the end depends entirely on your own plans. Annual maximums for naturopathic care are often a few hundred dollars, so some patients have most of their care covered and others much less. (Confirm your own limits with your insurer.)

Confirm with your accountant. Thresholds and eligibility change, and everyone’s situation is different. Treat this page as general information and confirm what applies to you with a tax professional before you file.

Your 10-minute action plan

Open your benefits portal

Look for naturopathic, paramedical, nurse practitioner, prescription drug, and HSA/HCSA coverage.

Call your insurer if the wording is unclear

Use the five copyable questions above. Record the representative’s name and your reference number — then email us what they told you at frontdesk@higherhealthcentre.com if you’d like help making sense of it.

Submit in the right order

Your plan, then a spouse’s plan if available, then your HSA/HCSA.

Save the paperwork

Keep itemized receipts and each explanation of benefits together for tax time.

Common questions

Your insurer, HSA administrator, and the CRA make the final eligibility decisions. These answers explain the general process.

Can Higher Health tell me exactly what my plan covers?

We can give you an itemized receipt and may be able to direct-bill eligible services. Only your insurer can confirm the coverage, limits and rules in your specific plan — but we’re happy to help you figure out what to ask.

Is an HSA/HCSA the same as regular insurance?

No. Regular benefits typically have category limits. An HSA/HCSA usually gives you a separate dollar balance for eligible medical expenses.

Can I use my HSA if my regular plan declines the claim?

Possibly. An expense not covered by regular benefits may still be considered by your HSA/HCSA. Submit it, or ask your plan administrator.

Can I claim an amount on my taxes if insurance paid it?

Generally no. Only the eligible amount that was not and will not be reimbursed may count toward the METC.

Can I claim supplements as a medical expense?

The CRA generally does not allow over-the-counter medications, vitamins or supplements for the METC, even when recommended by a practitioner. Limited exceptions may apply — confirm with your accountant.

Helpful CRA references

Ready to make the most of your coverage?

Whether it’s your first visit or your next, we’ll help you use the benefits you already have. Not sure what you’re covered for? Ask us — we’ll help you check before you book.

Ask us how to check your coverage

Questions about your receipt? Email frontdesk@higherhealthcentre.com

Higher Health · 3363 Yonge Street, 2nd Floor, Toronto · frontdesk@higherhealthcentre.com.
We can explain your receipt and, where available, direct-bill eligible services. Your insurer, HSA administrator and the CRA make the final decisions on coverage and eligibility. General Ontario information, current as of July 2026 — this is not a promise of coverage and not tax advice. Confirm your coverage with your insurer and your tax situation with your accountant before you file.

How to Use Your Health Benefits, HSA & Tax Credits