Terms

1. In accordance with Subsection 248(1) of the Income Tax Act, Brock Health Administration Ltd. (hereafter known as Brock Health) by this document establishes a “cost plus” Private Health Services Plan with the Planholder named in Part A. Brock Health indemnifies the Covered Claimants of the Planholder for all Eligible Expenses for the agreed upon cost plus fee to be paid by the Planholder upon remittance of claim by the Covered Claimant.

2. The Brock Health PHSP applies to all Eligible Expenses. For this agreement Eligible Expenses are those defined in Subsection 118.2(2) of the Income Tax Act. These are outlined in Canada Revenue Agency Interpretation Bulletin IT-519R2. Medical Expense Tax Credit Folio

3. The Brock Health PHSP covers all employees as defined by the Planholder in Appendix A. The term Covered Claimant 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 Covered Claimant will be eligible for coverage from the effective dates established in Appendix A.

4. The Planholder will establish an effective date after which coverage is provided by the plan. This date can be for any 12 month period ending in the current fiscal year (meaning no further than the start of the current fiscal year):

5. The Planholder may choose to offer this benefit plan to Covered Claimants in differing levels of sponsorship based on the position or critical importance of the employee within the firm. The Planholder may not limit participation in the Brock Health PHSP based solely on position as a shareholder. The Brock Health PHSP cannot be offered to one employee of a class while excluding an employee of the same class. For this plan the Planholder has established the following classes of sponsorship. The members of these classes are established in Appendix A

6. Brock Health will adjudicate each claim submitted to ensure the following:
a) The expenses are Eligible Expenses as per section 2
b) The claimant is a Covered Claimant as per section 3
c) The maximum coverage limits and dates as authorized by the Planholder have not been exceeded
d) The claim form has been properly completed, authorized and the corresponding payment has been received.

7. Upon completion of the claim adjudication, Brock Health will issue a cheque or Direct Deposit in re-imbursement for the total cost of the eligible expenses to the claimant.

8. Brock Health will issue an Annual Client Statement to the Planholder to reconcile all claims for tax reporting at the end of the fiscal year.

The registration fee to be paid with this application is $100.00 CAD

Authorization

By typing my name below, I signify 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. The act of inputting my name below serves as a general electronic signature and is legally binding.

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