How to read your workplace health benefits before you spend them

A benefits booklet is written to be accurate rather than readable, which is why most people meet its limits by exceeding them. The questions below are the ones that actually cost money, and all of them can be answered in about ten minutes by your booklet or your insurer's app.

The six questions worth answering

1. What is the annual maximum for each service? Physiotherapy, massage and chiropractic are frequently pooled under one combined limit — spending it on one leaves nothing for the others.
2. When does the year reset? Usually 1 January, not your hire date. Unspent money rarely carries over, which makes December worth planning around.
3. What percentage is reimbursed? Eighty per cent of a $120 visit still leaves you paying $24 each time.
4. Which credentials are accepted? Many plans reimburse a registered psychologist but not a registered psychotherapist, even though both are regulated and both provide therapy. This one catches people out constantly.
5. Is a doctor's referral required? Some plans need one on file before the first visit, and will not pay retroactively.
6. Is there direct billing? If the clinic bills your insurer directly you pay only the difference, instead of carrying the full amount for weeks.

Check whether somebody else should be paying

Before using your own benefits: if the injury happened at work, WSIB covers the treatment and you should not be paying. If it happened in a car accident, your auto insurer pays first through statutory accident benefits, regardless of fault. People routinely burn through a year's benefits on an injury somebody else was obliged to fund.

Making a fixed amount go further

When your plan covers a dollar amount rather than a number of visits, a shorter appointment focused on one problem often delivers more than a long general one. Ask your professional to set you up with something to do at home between appointments — most will, and it is the difference between needing eight visits and needing four.

Sources

• Canadian Life and Health Insurance Association
• Workplace Safety and Insurance Board (WSIB)