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    Friday
    Jun172011

    Where can the ESORSE HYBRID Pay-Direct Health Card be used?

    Now that the Esorse card has been enhanced to become a Visa® prepaid card it can be used at any Regulated Health Care Professional service provider and/or product supplier of medical related products (the list of eligible Practitioners may vary by Province).
     
    They do not have to be a member of our Associate Provider Network - although being a member brings additional advantages! All that is required is that they have a computer to file the claim electronically, and a POS terminal to swipe the card.
     
    The list of Professionals includes:
     
    Audiologists and Speech Language Pathologists
    Chiropodists/Podiatrists
    Chiropractors
    Dental Hygienists 
    Dentists/Orthodontists
    Denturists
    Dieticians
    • Hospitals
    Massage Therapists
    Medical Laboratory Technologists
    Medical Radiation Technologists
    Midwives
    Nurses
    Occupational Therapists
    Opticians
    Optometrists
    Pharmacists
    Physicians & Surgeons
    Physiotherapists
    Psychologists & Psychological Associates
    Respiratory Therapists
    Transitional Council of the College of Homeopaths of Ontario
    Transitional Council of the College of Naturopaths of Ontario
    Transitional Council of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario
     
    The fees of the above Regulated Health Care Professionals may qualify as an eligible medical expense that may be claimed under the Medical Expense Tax Credit on one’s personal Federal Income Tax Return in accordance with Section 118.2 (2) of the Income Tax Act and Interpretation Bulletin IT-519R2. Eligible expenses may also be reimbursed under an insured group benefits program, or self -insured program such as an employer funded ASO Program (Administrative Services Only), or a Health Spending Account as outlined in Interpretation Bulletin It-529.
     

    Fees from non-regulated professionals such as Marriage Counselors, Sports Therapists, Social Workers, etc. cannot be reimbursed via the Esorse Pay-Direct Hybrid Health Card, nor can they be claimed as an eligible Medical Expense in accordance with the Income Tax Act. While some insurers may allow the fees from these professionals to be reimbursed under their group programs they are placing their clients at risk in the event of an audit by Canada Revenue Agency. The Esorse system will not recognize such claims.

    How does the ESORSE HYBRID Card work?

    1. The Esorse cardholder is provided with a welcome letter and instructions on how to use the card on enrolment under a program administered by Esorse. It includes instructions on how to log onto the system and the password and identification required to access their account 24/7.
    2. The cardholder presents the card to the associated health service provider who submits a claim electronically to Esorse for the services or product supplied. 

    3. The Esorse system adjudicates the claim immediately in real-time for eligibility under the cardholder’s benefits program, whether it is a fully insured individual or group benefits program, or self-insured employer ASO (Administrative Services Only) program, or a Health Spending Account. Due to its multi-function capability the service provider may have to swipe the card twice to secure full payment as the card contains two purses of funds that can be accessed.
    4. The Provider has a maximum of 15 minutes to process the claim after the Esorse system has confirmed eligibility of the claim, otherwise the system will time out and the POS transaction will be declined which will result in the Provider having to resubmit the claim.
    5. The Esorse system remits payment in accordance with the applicable program parameters to the service provider or instructs the provider to swipe the card to secure payment.

    6. If the total claim is more than the eligible benefit payment amount the service provider will collect the balance outstanding from the cardholder in cash, debit, or credit card. The Esorse system will record that the claim was only partially paid and, if applicable, such as under a Health Spending Account will hold the balance of the claim and remit it to the cardholder’s bank account after the next monthly employer contribution has been received.