Smartin Benefits Plan Owner Enrolment Form

Enrolling your Company with Smartin Benefits, makes you the Plan Owner.

Terms and Conditions:

Please read our Terms and Conditions carefully.

In accordance with Subsection 248(1) of the Canada Income Tax Act, this enrolment establishes a cost-plus arm’s length Private Health Services Plan (PHSP) between Smartin Benefits and the Company (Plan Owner) as identified by Company Name below. For each claim submitted by the Plan Owner’s covered Employees (Plan Members), Smartin Benefits charges the Plan Owner for the total payment amount (all eligible medical expenses, plus the agreed upon administration fee, plus applicable taxes on the administration fee) and reimburses the Plan Members for all eligible medical expenses upon receiving payment from Plan Owner.
The Smartin Benefits Plan applies to all eligible medical expenses as specified in Subsection 118.2(2) of the Canada Income Tax Act. These are outlined in Canada Revenue Agency (CRA) Interpretation Bulletin IT-519R2 (Medical Expense Tax Credits).
The Smartin Benefits Plan provides coverage to all Plan Members as specified by the Plan Owner:

For the Plan Members to be eligible for this benefit, they must earn a T4 salary;
The term Plan Members includes the Employee, the Employee’s spouse or any member of the Employee's household with whom the Employee is connected by blood relationship, marriage or adoption;
There is no limitation by age;
The Plan Members may claim eligible expenses incurred from the first date of their employment.

Smartin Benefits will adjudicate each claim submitted to ensure the following:

The medical expenses are eligible as per section 2;
The Plan Member is eligible a as per section 3;
The maximum benefit level and dates set by the Plan Owner are not exceeded;
The claim form has been properly completed, the corresponding payment plus administration fees and applicable receipts are included.

Upon completion of the claim adjudication, Smartin Benefits will issue a reimbursement for the cost of all eligible medical expenses to the Plan Member.
Smartin Benefits will issue tax receipts to the Plan Owner to allow the business to claim the cost of enrolment, medical expenses, administration fees and applicable taxes.
Important: Smartin Benefits provides this service to Canadian Incorporated Companies only. By proceeding and enrolling your Company with a Smartin Benefits Plan, you confirm that the Company you are enrolling, is Incorporated under Provincial or Federal jurisdiction of Canada. Enrollment fees paid for incorrectly enrolled companies will not be refunded.

Please Agree:

* Yes, I have read the Terms and Conditions. I agree, and I want to Enroll into the Smartin Benefits Plan.

Company Information:

Please check the box:

* Yes, my Company is Incorporated.

Canada Revenue Agency is clear on this point: You must be an Incorporated Company to take advantage of a Smartin Benefits Private Health Services Plan.

Company Name: * Please provide the Company's Legal Name

Next Fiscal Year End: * This date is used for year-end reminders

Company's Mailing Address: *

City: *

Province: *

Postal Code: *

Plan Details:

Plan Administration Officer's Name: * All communications will be conducted with this person

Plan Admin Email: *

A copy of this enrollment will be sent here.

Plan Admin Telephone: *

Effective Plan Date: *

By default, the Smartin Benefits Plan is effective immediately once the enrollment form is received, but you may choose to specify a date on which the plan starts. Note: You can backdate the plan up to one year.

Job Classification (Class, Position, Annual $ Limit):

The Plan Owner may elect to offer this PHSP to Plan Members in varying levels of maximum benefit based on the position or critical importance of the Plan Member within the business. Choose Job Classification(s) for the Employees of your Company. It is required that each Employee within a Job Classification be extended the same annual limits. These Job Classifications can be used when completing the Plan Member Enrolment Forms. This can make future administration easier.

Referrals:

We are always interested to know how you found us. Any names provided below will be kept strictly confidential. We use this information to determine how effective our marketing is and to thank 3rd parties for referrals.

Accountant

Financial Broker

Internet Search

Flyer

Friend

Other

Referral Name:

Referral Email:

Authorization and Confirmation:

Note: The act of inputting your name below serves as a general electronic signature and is legally binding.

I acknowledge (by typing my name below) that the information contained in this application is accurate and true to my knowledge and that I have the authorization to act on the behalf of my organization. I also agree to provide this PHSP to the Plan Members and will pay for all account funding and administration fees as required.

Authorizing Signature: *

Authorize Date: *

* How are you planning to pay for the Enrolment?

Interact e-Transfer (Use: info@smartinbenefits.com)

Electronic Bank Transfer (We will send you our bank details)

Credit Card (Use Activate Plan button on Enroll page)

Cheque (Send to our mailing address)

Please select how you will pay for the Enrollment.

Additional Comments:

Last Step:

Once you completed all the required fields, click on the Enroll Company button:

Please pay the Enrollment Fee to activate your Smartin Benefits Plan.
Complete a Smartin Benefits Plan Member Enrolment Form(s) for each of your Employees.
We will send you a welcome letter once your details were checked and captured into our system.