Therapies Covered by Workplace Insurance Benefits

If your employer provides group benefits, you’re in luck. Your benefits could cover some or all of your therapy appointments. 

Workplace benefits booklet

When you use your workplace benefits plan, you work directly with the insurance provider, not your employer.

Every benefits package is different. The info from your insurance provider—usually outlined in a document called a benefits booklet—isn’t always easy to understand.

Remember, while “therapist” and “counsellor” are generic terms referring to mental health professionals, your benefits provider will be very specific when they describe what type of professionals they cover.

Check out the section in this guide on types of therapists to better understand what these designations mean.

When booking a therapist via First Session, each practitioner will have their designation clearly stated, and you can even search by designation.

How does billing work?

Usually, your workplace health benefits will cover a certain dollar amount or percentage per visit, up to a maximum for that service type. For example, your therapist charges $120 per session, and your workplace benefits provide you $100 per visit up to an annual maximum of $500—you will pay $20 per visit yourself, and you will have enough coverage for five sessions each year. Thereafter, your costs for therapy will be out-of-pocket.

Some insurance policies may require you to pay a deductible (an amount you’re required to pay before your insurance kicks in), and then they’ll cover a percentage of the remaining bill, often referred to as co-insurance. For example, your therapist charges $120 per session. Your deductible is $20 and your co-insurance is 80/20, or 80%. Your insurance company will pay 80% of the remaining bill and you pay 20% 

• Appointment fee: $120
• Deductible: $20 (you’ll pay this first, then your insurance coverage kicks in)
• Remaining fee: $100
• Insurance coverage at 80%: $80
• Your remaining costs at 20%: $20

Typically you have a health insurance card (physical or digital), which includes your member information. A health services provider can use that info to quickly charge their fee to your provider.

Most therapists do not provide direct billing, so you will pay up-front for your appointment and then submit a claim to be reimbursed by your benefits provider. Usually claims are filed online or in an app. In order to file a claim, you’ll need a receipt that shows the amount paid, the therapist’s name, designation, and licence number as well as the type and length of appointment. 

Workplace Health Benefits Terminology:

If you’re unsure about how your coverage works, be sure to reach out to your HR representative or your health benefits provider and they’ll be happy to explain it to you. Here is a full guide to help you find a therapist in Canada who is covered by your insurance.

Here are some common terms you might come across in your benefits booklet:

• Annual maximum: The total amount of treatment your insurer will pay for over the course of a calendar year. Once you’ve exceeded this amount, you must pay out of your own pocket.
• Reasonable and customary: The amount your insurance company has determined they are willing to cover per appointment or session, for a particular therapist designation in a specific location (usually province).
• Coinsurance: The percentage you’ll pay for covered health services after taking into account your deductible. If you have an 80/20 plan, your insurance covers 80% of the costs and you pay the remaining 20%. ‍
• Deductible: The amount (not including copay) you must pay out of pocket before your insurance plan kicks in. ‍
• Out-of-pocket costs: These are the costs you must pay, because they aren’t covered by your insurance. Deductibles, coinsurance, and copays are all out-of-pocket costs.‍
• Out-of-pocket limit or out-of-pocket maximum: Your healthcare plan may include an out-of-pocket limit or maximum; this is the highest total amount you’ll be required to pay during the course of the year for a certain category of health services.
• ‍Paramedical services: An umbrella term used to cover services such as massage therapy, physiotherapy, dieticians covered under extended healthcare benefits. Different providers include different types of treatment in this category, so it’s important to read your benefits booklet closely.

Other types of workplace coverage

Your benefits booklet will also explain other services that may be available to you, like Employee and Family Assistance Programs (EFAP) and Health Care Spending Accounts (HCSA). 

An employee assistance program (EAP) is offered by your benefits provider. It lets you connect directly through them to mental health services instead of seeking a therapist on your own and submitting a claim for the cost after. 

Your employer is not notified that you have used the EAP service. Just like the rest of your benefits, your usage of these services is private.

Health Care Spending Accounts (HCSA) are growing in popularity due to their flexibility and personalization. A HCSA gives you a set amount of money to spend on health services each year. You may be able to use it to close “gaps” in insurance coverage—for example, if your package only covers 80% of each appointment you can withdraw from your HCSA to pay the remaining 20%. Or you may use it to pay for services not traditionally covered by group benefits, such as gym memberships or sports equipment.

If you’re having serious difficulty interpreting your benefits package, schedule a visit with your HR representative to get some help navigating it. Alternatively, you could phone your insurance provider or chat directly with them on their website.