Physiotherapy Coverage via Health Insurance Plans
By Krista DeKuyper | September 23, 2023 |
Physiotherapy, short for “physical therapy”, can be extremely important when it comes to recovering from a physical impairment resulting from an accident or illness. Find out if you can access physiotherapy coverage via health insurance plans below.
Physiotherapy involves recovery via exercises that are designed to improve mobility and health. In addition, a good physiotherapy program will also encourage a patient to incorporate various life style changes such as getting regular exercise and avoiding physical activities that could lead to re-injury.
Physiotherapy is often used to treat conditions such as the following:
- Neuromusculoskeletal problems such as back pain, arthritis, sporting and other physical activity injuries.
- Cardiovascular issues that result from events such as heart attacks and chronic heart disease.
- Respiratory difficulties due to medical conditions such as bad asthma attacks and COPD (Chronic Obstructive Pulmonary Disease).
- Neurological conditions caused by Parkinson’s Disease and strokes.
- Physiotherapy typically consists of the following:
- The physiotherapist familiarizes themselves with your medical history. This includes what happened just prior to the accident or illness that led to physical impairment, as well as life style considerations such as the amount of exercise you get, the amount of sitting you do, etc.
- An assessment is made of your physical condition.
- A treatment plan is devised to alleviate your particular condition (e.g. exercises to be performed, any medical equipment that is required, etc.).
Physiotherapy Coverage via Provincial Healthcare Plans
Some Canadians assume that physiotherapy costs are fully covered by their provincial healthcare plan, but unfortunately, this is often not the case.
In fact, in most healthcare cases physiotherapists costs are not covered. There are exceptions, however, and this is heavily dependent on the province where you live.
Physiotherapy MAY be covered if:
- You are a young person (e.g. child or teenager).
- You are an elderly person.
- The physiotherapy is performed in a hospital.
- Physiotherapy is required to recover from an illness or injury for which you were hospitalized.
- You are on a financial assistance program.
Check your provincial government’s web site for more details. You can also use our provincial healthcare summaries (links in the footer of this web page), which may have physiotherapy coverage information.
Employee Benefits Coverage for Physiotherapy
Employee benefits plans are also called “group health insurance”, and they are obtained through your employer.
Group plans are either partially or fully paid for by the company you work for.
Physiotherapy is classified as a “paramedical” coverage, and paramedicals are almost always covered by employee benefits. Other types of paramedical coverages (besides physiotherapy) are chiropractors, massage therapy, speech therapy and naturopaths.
Group insurance coverage for physiotherapy costs can be summarized as follows:
- Always covered as a paramedical service
- Coverage is always limited by annual, overall plan maximums
- Oftentimes coverage is limited to $350 to $750 per year
- Many group plans cover anywhere from 80% to 100% of costs
- There may be maximum cost per visit that is covered (e.g. $20 – $25 per visit)
- Physiotherapy does not require a doctor’s referral
Personal Health Insurance Coverage for Chiropractic Costs
Unlike employee benefits, personal health insurance (also called “individual health insurance” or “family health insurance”) is NOT provided via an employer. Rather, coverage is purchased on an individual or family basis.
These individual plans are either guaranteed issue or they are medically underwritten.
Underwritten plans involve the answering of medical questions, along with allowing the insurance company access to your medical records. Guaranteed issue plans, on the other hand, do not entail any medical questions, and acceptance is guaranteed. (Note that drug coverage amounts are lower for the guaranteed plans).
Similar to group insurance, physiotherapy is lumped together with other paramedical coverages.
The following summarizes individual health insurance coverage for physiotherapy costs:
- Always included with other paramedical coverages such as chiropractors and massage therapy
- Covers “reasonable and customary charges”
- Coverage is always limited by annual plan maximums
- Physiotherapy maximums range anywhere from $250/year to $600/year (may include all paramedical costs)
- There is often a maximum cost per visit, approximately $25 to $40
- There may be a maximum # of annual visits
- Physiotherapy coverage does not require a doctor’s referral
- Benefits payable only after yearly maximum allowed under your provincial healthcare plan has been reached (although having said this, most of the time physiotherapy is not covered by Canadian provincial healthcare plans)
- Some individual plans have a Catastrophic coverage option, which increases the amount of available physiotherapy coverage*
If you want to know how much the premiums are for these plans then please note that we offer instant, online quotes for guaranteed issue health plans and medically underwritten plans.
Specific Health Plans and Chiropractic Coverage
Please refer to the following for specific physiotherapy coverage via the individual health and dental plans we offer here at HealthQuotes.ca:
| Plan | Per Visit Maxmium | Max. # of Annual Visits | Annual Maximum |
| Flexcare (Manulife) |  | | $250 |
| Blue Vision Global Regular Benefits (Ontario Blue Cross) | $20 | 20 | |
| Blue Vision Global Enhanced Benefits (Ontario Blue Cross) | $25 | 20 | |
| PHI Basic Plan (Sun Life) | 60%, up to $25 | | $250 per person |
| PHI Standard Plan (Sun Life) | 100% coverage | | $300 per person |
| PHI Enhanced Plan (Sun Life) | 100% coverage | | $400 per person |
| Sonata Core Plan (Great West Life) | $30 | | $300 per person |
| Sonata Elite Plan (Great West Life) | $40 | | $400 per person |
| FollowMe** Basic Plan (Manulife) | $15 | 20 | |
| FollowMe** All Other Plans (Manulife) | 100% coverage | | $650 per person (all paramedicals combined) |
| Blue Vision Express** (Ontario Blue Cross) | $20 | | $350 |
Conclusion
We really hope you found this article about physiotherapy coverage via Canadian health insurance plans helpful.
If you would like more information please contact us, we would love to hear from you!
* If you have the Catastrophic option (with the Manulife Flexcare plan) then there is unlimited physiotherapy coverage IF required for an accident that requires a hospital stay of at least 24 hours.
** These plans are guaranteed issue (no medical questions, acceptance is guaranteed).
