FSD 42 - Medical and/or Dental Expense Advance

Scope

Introduction

Doctors, dentists and hospitals may not be prepared to wait for payment from medical, dental or hospitalization insurance plans. Accordingly, where the employee can demonstrate eligibility for future reimbursement for health care or dental expenses, either from the Comprehensive Coverage of the Public Service Health Care Plan or the Public Service Dental Care Plan or pursuant to the Foreign Service Directives, the employer will make an advance to the employee for the purpose of paying medical or dental expenses.

The intent of this directive is to provide financial support for larger expenses, rather than for routine medical and dental expenditures.

Directive

42.1 Application

42.1.1 Where an employee incurs expenses for health and/or dental care and is eligible for reimbursement either from the Comprehensive Coverage of the Public Service Health Care Plan or the Public Service Dental Care Plan or pursuant to the Foreign Service Directives, the deputy head may authorize an advance to the extent of such expenses. Such advances shall be authorized only:

1. where the advance is not less than $500; and
2. where, subject to subsections 42.1.5, 42.1.6 and 42.1.7, the employee agrees to repay the advance within 6 months; and
3. where the employee submits an estimate of costs from the doctor, dentist or hospital representing 90% of the advance requested; and
4. on condition that the employee undertakes in writing on the Medical and/or Dental Expense Advance form to endorse and remit to the Receiver General for Canada any cheque issued by the underwriters or by the employer under the provisions of another foreign service directive in reimbursement for the medical or dental expenses for which the advance was authorized; and
5. in the case of an advance for dental expenses for dependants not covered by the Public Service Dental Care Plan (PSDCP), employees may be asked to provide proof of coverage.

42.1.2 In order to protect employees from exchange rate fluctuations, advances may be calculated and reimbursed in Canadian dollars or in some other currency, where this is the currency used in all of the following:

1. the estimate of costs from the health care provider submitted by the employee in support of the medical/dental expense advance;
2. the payment for services for which the advance was approved; and
3. the reimbursement of the employee's claim of insurance.

42.1.3 An employee shall not be eligible for an advance for medical expenses incurred following relocation to Canada when the employee's provincial insurance plan has been reinstated or when the doctor, hospital or other health care facility is prepared to await settlement from the employee's provincial or other medical insurance plan.

42.1.4 Except as provided in subsection 42.1.7, where, for any reason, any cheque issued by the Plan Administrator or by the employer under the provisions of another foreign service directive in reimbursement for the medical or dental expenses for which the advance was authorized is not endorsed and remitted to the Receiver General for Canada by the employee, such advance shall be repaid upon receipt of such settlement.

42.1.5 Except as provided in subsection 42.1.7, where an employee who has received settlement from the Plan Administrator or from the employer, fails to repay any outstanding portion of the advance within 60 days of the date(s) on which the settlement cheque(s) were issued, such outstanding portion of the advance shall be subject to recovery pursuant to the relevant provisions of the Financial Administration Act.

42.1.6 Except where provided in subsection 42.1.7, where an advance has been authorized under this directive, the employee shall ensure that a claim under the Comprehensive Coverage of the Public Service Health Care Plan or the Public Service Dental Care Plan is submitted as soon as possible, notwithstanding the time requirements that the plans have in place for accepting claims. In the event that a claim is rejected under the plan because of lateness, the employee may not claim under FSD 39 – Health Care Expenses of these directives and shall be responsible for full repayment of the advance, which shall be subject to recovery pursuant to the relevant provisions of the Financial Administration Act.

42.1.7 An extension of the repayment period may be granted where the deputy head is satisfied that exceptional circumstances beyond the reasonable control of the employee prevent an employee from repaying the advance granted pursuant to subsection 42.1.1 within the required period.