When you’ve reached the point of needing chiropractic care, a concern that can come up is: “Does my insurance cover chiropractic?” While chiropractic care is well-worth any associated out-of-pocket cost, having extended health benefits to help with the cost of visits is ideal. In Ontario, residents usually have two types of health insurance coverage: the Ontario Health Insurance Plan (OHIP), and additional private coverage (Extended Health Care or EHC). Luckily, most people with EHC have some sort of chiropractic coverage!
Does OHIP Pay for Chiropractic Care?
As of December 1, 2004, the Ontario Health Insurance Plan (OHIP) effectively stopped covering all chiropractic services in the province. That means the answer is (and has been for 15 plus years) no: OHIP will not pay for chiropractic services you receive at CW Rehab or anywhere else. Luckily, access to Extended Health Care (EHC) is available through unions, associations, or offered by employers. EHC is privately administered and often considered a supplementary medical plan for the way it broadens your access to delisted OHIP services (including chiropractic care and some physiotherapy services). Of course, you have the option to pay for any service out of pocket, but you may not need to.
Does EHC Cover Chiropractic?
EHC will usually cover at least part of chiropractic care. An Environics survey conducted in 2019 found that 80% of patients used their private/supplemental health plans to pay for chiropractic services. You’ll need to speak with your benefits administrator to find out what your plan offers and what kind of financial limitations you’ll be subject to, as well as any conditions that must be met (pre-approvals, deductibles, etc.).
Your EHC will also be able to give you detailed information about maximums for the cost they’re prepared to pay, whether or not other members of your immediate family will share access to these services, and how much is available in your HSA (health spending account) or PSA (personal spending account). There may also be limits for visiting certain kinds of healthcare professionals or caps on reimbursements. These are important topics to discuss with your benefits administrator.
So while OHIP does not cover chiropractic care, it doesn’t mean you’re out of luck! Most EHC plans will cover some form of physiotherapy or chiropractic sessions with qualified experts as ‘paramedical’ services. And, as a member of the plan, you have the right to voice your concerns or opinions about what is and is not covered by your insurance. If there are strict limitations that you believe should be discussed, we encourage you to lobby your employer to make changes.
Keep in mind that all EHCs look somewhat different, and are contingent upon the employer providing the plan. Individual determinations/limitations for chiropractic coverage rely on a number of unique factors for each member, which is why it’s important to speak directly with an administrator to learn the specifics of your plan.
Chiropractor in Toronto
CW Rehab serves residents of greater Toronto in our downtown office. For those without EHC, we accept out-of-pocket payments and our patients find the positive impact of our care on their health is well worth the investment. If you’re ready to experience the benefits of our services, contact us today to book an appointment! n