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.

  1. In accordance with Subsection 248(1) of the Income Tax Act, Smartin Benefits by this enrolment form establishes a "cost plus" Private Health Services Plan (PHSP) with the Company (Plan Owner) identified below as Company Name of this document. Smartin Benefits reimburses the Covered Employees (Plan Members) of the Plan Owner for all eligible medical expenses for the agreed upon administration fee to be paid by the Plan Owner immediately upon submission of the claim on behalf of the Plan Member.

  2. 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).

  3. The Smartin Benefits Plan provides coverage to all Plan Members as specified by the Plan Owner. The term Plan Member 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 Member will be eligible for coverage from the effective date of the plan.

  4. Smartin Benefits will adjudicate each claim submitted to ensure the following:
    1. The medical expenses are eligible as per section 2;
    2. The Plan Member is eligible a as per section 3;
    3. The maximum benefit level and dates set by the Plan Owner are not exceeded;
    4. The claim form has been properly completed, the corresponding payment plus administration fees and applicable receipts are included.
  5. Upon completion of the claim adjudication, Smartin Benefits will issue a reimbursement for the cost of all eligible expenses to the Plan Member.

  6. 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 per transaction.

  7. Note: 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:

Company Information:

Please check the box:

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.

Please provide the Company's Legal Name
This date is used for year-end reminders

Plan Details:

All communications will be conducted with this person
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A copy of this enrollment will be sent here.
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.
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.

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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.

Please select how you will pay for the Enrollment.

Last Step:

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

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