Can I use an employer wellness account for ADHD assessment fees?

The answer depends on which of two very different accounts you hold

Employers use the word wellness loosely, and the two accounts it can refer to are governed by different rules. A health spending account (also called a health care spending account or HCSA) reimburses medical expenses that qualify under the Income Tax Act, and an ADHD assessment by an authorized practitioner qualifies. A wellness spending account (also called a personal, lifestyle or flexible spending account) reimburses whatever the employer chose to list, typically fitness, equipment, courses and sometimes mental health services, and is taxable income to you.

Your enrolment guide or benefits portal names the account, and the name usually tells you which set of rules applies. If the account pays for a gym membership, it is a wellness account and the employer's list governs. If it only pays for things you could claim on your tax return, it is a health spending account; that case is covered in detail at Can I use a health spending account (HSA) for an ADHD assessment?.

A health spending account is a private health services plan, so the CRA's medical expense rules decide

The reason a health spending account can pay for an assessment without creating taxable income is that it meets the CRA's definition of a private health services plan (PHSP). The CRA sets four conditions: the plan covers only medical or hospital expenses and connected costs; all or substantially all of the premiums or, for a self-insured account, the benefits paid relate to medical expenses eligible for the medical expense tax credit; the plan operates as insurance; and coverage is limited to employees and their family members. The CRA reads all or substantially all as 90% or more.

An ADHD assessment satisfies the medical expense test because the CRA counts diagnostic services by an authorized medical practitioner as medical services, and nurse practitioners and psychologists are on its authorized list in every province Finding Focus serves. That means the $399 adult assessment or the $699 youth assessment with Finding Focus, conducted by licensed nurse practitioners and clinicians, is the kind of expense the account exists to reimburse. The administrator will want the same receipt the CRA would: patient name, date, description, amount, and the practitioner's designation and registration number.

A wellness account is a taxable benefit with a list your employer wrote

Because a wellness account is not a PHSP, the employer is free to include anything it likes, and the reimbursement is reported as employment income on your T4. Employers design these lists to encourage healthy habits, so common categories are fitness memberships and equipment, sports fees, nutrition counselling, wellness apps, ergonomic furniture, professional development and childcare. Mental health appears on many lists, sometimes as counselling or therapy, sometimes as mental health services, and occasionally as health assessments. Whether an ADHD assessment fits depends on the exact wording, and administrators apply it literally.

• Find the eligible-expense list in your benefits portal; it is usually a document separate from the group benefits booklet.
• Look for wording such as mental health services, counselling, psychological services, health assessments, or medical services not covered by the health plan.
• If the list is silent, ask HR or the administrator in writing before booking and keep the answer. Some employers add categories on request at the next plan renewal.
• Remember that whatever is reimbursed is taxed as income, so a $399 reimbursement is worth less to you than the same amount from a health spending account.

Submit the itemized receipt within the plan year and watch the carry-forward rules

Both accounts run on a benefit year, and unclaimed credits do not last forever. Health spending accounts typically allow either unused credits or unclaimed expenses to carry forward for one further year, but not both, and the CRA's PHSP rules limit how long credits can roll. Wellness accounts follow whatever the employer set, often with no carry-forward at all. Submit the receipt for an assessment as soon as you have it rather than at year end.

1. Get an itemized receipt for each service: the assessment, and any document such as the $49 standard diagnosis letter or the $99 healthcare-provider report, on separate lines or separate receipts.
2. If you also have an extended health benefit that covers the provider type, submit there first; a health spending account pays the balance after other coverage.
3. Upload to the correct account. A receipt sent to the wellness account when it belonged in the health spending account can be declined and resubmitted, but only inside the claim window.
4. Keep copies. If either account declines the claim, the unreimbursed amount can still be claimed on your tax return, which is covered at Can I claim ADHD assessment fees on the Medical Expense Tax Credit?.

Therapy and coaching split across the two accounts in a predictable way

Follow-on care after an assessment tends to fall neatly on one side or the other. Cognitive behavioural therapy from a Registered Social Worker is a medical service by an authorized practitioner in every province Finding Focus serves except Prince Edward Island, so it belongs in the health spending account. ADHD coaching, even from the same social worker, is aimed at skills and habits rather than treatment, which makes it a poor fit for a health spending account and a natural fit for a wellness account that lists coaching, personal development or mental wellness. Finding Focus therapy sessions run 50 minutes from $149, for adults in Ontario, with receipts showing the RSW designation; fees and plan handling are set out at therapy fees and insurance.

If you are in therapy partly because of low mood or anxiety, the account you use has no bearing on the care, only on the tax treatment. If you need help right now, call or text 9-8-8, Canada's Suicide Crisis Helpline, or call 911.