How to Utilize Health Benefits & Improve Your Health

As we approach the end of the year many look towards their employee benefit plans to get massage, physio, chiropractic, naturopathy, foot orthotics etc. Some haven’t used benefits all year and others have long since maxed out their coverage. Here is some info to help navigate your plan.

Types of Plans

Some companies provide 100% coverage up to a set amount. This amount could vary from $200 upwards of $2000/year.

Levels of Coverage

Larger companies may have a tiered system which you choose a ‘level’ of coverage. In this case there are usually three levels with the first covering the least amount. Level three provides the best coverage but may cost more. In many cases you will pay ‘indirectly’ for a portion of your health coverage through payroll deductions.

Most plans provide a percentage of coverage. So if they cover 80% and you spend $100 on a massage they will reimburse $80.  The most common upper limit/year is $500. Again this can vary substantially across different plans.

Some plans require a ‘deductible’ to be paid each new year of coverage. In this case the first practitioner you see you may have to pay the first $25 or $50 but only once for the whole year.

Who is covered?

You may have a ‘family plan’ in which you, your spouse, and dependents all have the same insurance coverage.  An individual plan would only cover you. You may be able to ‘co-ordinate’ with your spouse’s plan if they also have one through an employer. For example – if you wanted to buy a pair of orthotics for $475 and your plan covered $300, you may be able to submit through your spouse’s family plan to get the other $175 covered.

When does coverage reset?

Most plans are calendar year (Jan. 1st – Dec. 31st) but some may reflect fiscal year for a given company.

What is covered? (We will only be discussing therapeutic services sometimes referred to as ‘paramedical’ in this post)

Here is a list of the most common therapies/services covered. Check with your Human Resources Department or employee benefit representative to see what your plan covers.

• Chiropractic
• Physiotherapy
• RMT (Massage Therapy)
• Naturopathy
• Osteopathy
• Psychology
• Speech Therapy
• Custom Foot Orthotics/Shoes
• Compression Stockings
• Braces (Such as knee or ankle)
• Personal Training
• Gym Membership (or corporate discount)
• Fitness Equipment

Do I need a referral from my Family Physician?

Most plans don’t require a referral for the above services but make sure you check first before booking an appointment.

What about custom foot orthotics?

Most plans do require a prescription in order to get custom foot orthotics. Usually your family physician, a walk-in clinic, a podiatrist (foot doctor), a chiropodist or in some cases a chiropractor can provide this. Again make sure you check first before ordering a pair.

How do I get reimbursed?

The insurance company will have claim forms in which you fill out and mail in with your receipts. Many companies now provide online submittal which is very convenient. Definitely opt in to direct deposit if available as you will be reimbursed a lot faster.

Always keep your receipts!

Remember – if you don’t use your benefits for a given coverage year – they do not carry over so USE THEM OR LOSE THEM!

This post is also featured on The GoodLife Blog.