Many of us supplement our health care with paramedical treatments and services that may not be covered by the public health system. Fortunately, many of these treatments are covered by your group benefits plan. 

Your plan provides you with coverage to ensure you get the best care for your health. This may include paramedical services, as part of your extended health care benefits, and provides coverage for several different types of health-care services, such as physiotherapy, chiropractic, massage therapy, counselling and more. 

To help you choose the right provider, here’s what you need to know:

Review your benefits booklet to find out:

• Which paramedical services are covered under your plan

• If a doctor’s referral is required (e.g. massage therapy)

• The maximum amount covered for each benefit year

• Your benefit/policy year (e.g. September 1 – August 31, January 1 – December 31)

• Any coinsurance or deductible that you pay towards the cost of the service or item

Is your provider recommending what is medically necessary? Ask questions about your treatment plan and advocate for yourself to ensure your paramedical provider is clear about what they are doing to help you get better and why. It is also important to use only what’s medically necessary, and most importantly, use it well to help protect the sustainability of your benefits plan.

Ensure your provider is in good standing. Research your provider’s professional credentials and check that they are accredited by a Canadian or international professional organization (in the place where the service is provided). Be sure to also check the delisted providers list to ensure your new and current providers/suppliers are in good standing before you book your appointment. If the provider/supplier is on the list, these claims will not be approved or eligible for reimbursement.

Check that your provider is following good business practices. When working with your provider, we recommend that you check your receipts to make sure you’re charged for what you paid for. 

Find out what your R&C limits are. There are maximum allowable amounts (also called reasonable and customary limits, or R&Cs for short) that an insurer will reimburse on a service or item. This amount reflects the typical cost associated with this service or product in a specific geographical region. While physicians, dentists and hospital services adhere to a provincial fee guide, paramedical service providers do not. Therefore, the insurers/claim payors have established R&C limits to ensure claims are not excessive and to reduce benefits fraud or abuse. 

Choose the right paramedical provider for your health by selecting a provider that is focused on getting you better. 

To see your maximum coverage in a benefits year, go into My Benefits under Coverage & Balances. You’ll see details on your Vision, Dental and Paramedical coverage, and for some benefits, you’ll be able to see your remaining coverage for this benefits cycle.