BETWEEN: OLYMPIA BENEFITS INC., of 2300 – 125 9th Avenue SE, Calgary, Alberta  T2G 0P6
    (hereinafter called "Olympia")

– and –

Your Company / Business name as defined in the electronic My HSA sign-up form


The employer has established a Health Spending Account, Travel Medical Insurance and Emergency Medical Insurance (collectively, the “Plan”) for its sole employee and his or her dependants, a summary of which will be provided by Olympia to the employee and the dependants

Olympia and the Employer hereby agree as follows:

Responsibilities of Olympia

Olympia shall provide the following services to the Employer:

Olympia will provide online information services to the Employer with regard to requirements to establish the Plan for its employee and his or her dependents and will assist the Employer with implementing the Plan electronically.

Olympia will administer and manage the Plan electronically on an ongoing basis.

  • Electronic administration of the Plan will include but not be limited to the following:
    • Establishing Accounts for the eligible employee and dependents, as authorized by the Employer.
    • Confirming online that claims meet eligibility requirements through random audits.
    • Monitoring claim pool to ensure account maximums are not exceeded.
    • Establishing client reporting procedures electronically.
    • Processing elections on year end account balances, if so directed by the Employer.
    • Processing claims from the employee and the dependents.

Olympia will follow the guidelines and procedure manuals set forth by respective Provincial Health Information Acts and the Federal Freedom of Information and Privacy Protection Act.

Olympia will be entitled to all interest earned on temporary account funds.

Responsibilities of the Employer

The Employer will ensure that the Plan remains funded, in a manner necessary to meet its obligations to the employee (and the dependents) and Olympia. In the event that the Employer fails to fund the Plan as required, Olympia is under no obligation to, and will not pay out claims submitted by the employee or the dependents.

The Employer shall provide Olympia with a current record of the eligible employee and dependents covered under the Plan.

The Employer shall notify Olympia immediately about changes affecting the eligibility of any employee and/or dependents in a manner that is satisfactory to Olympia.

Other Terms

The Employer authorizes Olympia to apply payments from the Employer’s account in settlement of eligible benefits of the employee and the dependents under the Plan.

Olympia shall not be liable in the event that it has paid a benefit for which an employee or dependent was not eligible because the Employer failed to supply Olympia with timely or accurate information in a manner satisfactory to Olympia.

The Employer agrees to pay Olympia an annual fee of $299.00 for a Family Plan (the employee plus dependents) or $199.00 for a Single Plan (employee with no dependents) for administering the Plan (Olympia reserves the right to increase the annual fee for subsequent years upon providing the Employer with at least 30 days’ notice).

This Agreement shall automatically renew on each subsequent anniversary date for successive one year terms, unless the Employer provides Olympia with written notice at least 30 days prior to the end of the term, advising that the Employer does not intend to renew this Agreement.

The Employer agrees to pay Olympia the annual fee on the first day of each renewal term.

This agreement may be terminated immediately by either party upon written notice to the offices of the other party.

Termination of this agreement constitutes termination of the Plan.  In the event this Agreement is terminated by the Employer within 10 days from the effective date of this Agreement, and no claims have been made under the Plan, Olympia agrees to refund the annual fee paid by the Employer.

In the event this agreement is terminated, Olympia shall have no obligations under the Plan.

This agreement, together with the electronic My HSA Employee sign-up form and the electronic My HSA Employer sign-up form for the Plan, constitutes the entire agreement.

The Employer agrees that all claims must be made in the Plan Year.  For the purposes of this Agreement, Plan Year shall mean the 364 day period following the effective date of the Plan.

The parties hereto consent and agree to communicate with each other electronically.

In addition, Federal and Provincial sales taxes will be levied on fees when applicable.