One of the most common questions we get about Health Spending Accounts (HSAs) is: Why is osteopathy eligible if it’s not listed under the Medical Expense Tax Credit (METC)? The answer lies in how HSAs determine eligibility—by following a combination of guidelines from both the METC and the Canadian Life and Health Insurance Association (CLHIA).
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HSAs are structured as private health services plans, meaning they must align with industry standards while also adhering to tax regulations. Unlike a standard private insurance plan, HSAs follow both the METC guidelines (which define tax-deductible medical expenses) and CLHIA guidelines (which reflect what private health insurers typically cover).This dual framework ensures that an HSA is compliant with both Canada Revenue Agency (CRA) tax rules and common industry practices—but it also means that some expenses that don’t appear on the METC list (like osteopathy) may still be eligible.
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​Why is Osteopathy Covered?

Osteopathy is classified as a paramedical service and is widely covered by private health plans in Canada. While it may not be explicitly listed on the METC, it is recognized under CLHIA’s Extended Health Guidelines, which outline eligible expenses for private health insurance plans. Since HSAs function similarly to private health insurance in many ways, osteopathy is included as an eligible expense.For a claim to be eligible under an HSA:
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While the METC is the basis for determining which medical expenses qualify for tax deductions, HSAs do not follow it exclusively. Instead, eligibility is determined by both the METC and CLHIA guidelines, ensuring that expenses align with both tax regulations and private health insurance standards.

​So, if you’ve been seeing an osteopath and have an HSA, rest assured—your treatments are eligible for reimbursement as long as they meet the standard documentation requirements!