Massage Therapy and Group Extended Health Benefits in Ontario
Please note the information on this page is of general nature and may not be applicable to your individual circumstances. Please consult with your insurer or group benefits coordinator to obtain more clarification. Treatment fees are solely the client's responsibility.
Massage therapy is not covered by OHIP, but many group health plans reimburse treatments provided by CMTO-registered therapists. According to CMTO rules, registered massage therapists in Ontario must keep financial rules and provide receipts to clients. Clients may submit receipts to their group insurance plans for reimbursement.
Key insurance considerations:
Eligibility: Only treatments by CMTO-registered massage therapists qualify for reimbursement.
Coverage: Plans typically reimburse 70% - 100% of fees, subject to an annual maximum. The annual maximum often ranging from hundreds to thousands of dollars per family member.
Physician Referrals: Some plans (but not PSHCP) require a doctor's referral/prescription, though many family doctors acknowledge the value of massage therapy for many muscular, skeletal, and general health conditions, and will issue a referral on request.
Combined Maximums: Some plans require shared limits across various healthcare services (e.g. physiotherapy, acupuncture, chiropractor), while others have specific limits for each of the various healthcare services.
Health Care Spending Account (HCSA): If available, these accounts can be used for additional health related purposes, including registered massage therapy, once primary coverage is exhausted.
Spouses & Children: Spouses and common law spouses are typically covered, requiring a positive enrollment through your company benefits coordinator. Dependents under 18 are typically covered, and dependents over 18 may qualify if enrolled in full-time studies, usually up to the age of 25. Annual insurance maximums are typically independent for each family member, while HCSA limits shared across the entire family.
Coordination of Benefits: If both spouses have group benefits plans, they are coordinated and maximums are summed both for spouses and kids. More information.
Automotive accidents If you have been injured in an automotive accident, registered massage therapy treatment is an essential component of recovery and is typically covered by accident benefits under your auto insurance. Please consult your insurance adjuster to determine eligibility. Due to current regulations, massage therapy services for Motor Vehicle Accident only when part of treatment plan create by physician or physical therapist. If required, make appointment with physio therapist in clinic I work and I can see you for massage at the same location.
Ottawa Police: Covers 100% -$12 per visit copay up to $1250 per year specifically for massage therapy
Ottawa Paramedics: Covers 90% up to $1000 per year which is combined (physiotherapist, chiropractor, chiropodist, podiatrist, osteopath, naturopath, speech therapist, massage therapist, and acupuncturist)
RCMP: RCMP coverage includes up to $4,800 annually, combined with other rehabilitation services, and requires a doctor's note annually.
Ontario retired teachers: Covers 80% up to $1350 per year, combined with other professional services and requires a doctor's note annually.
Algoinquin College staff and other Colleges of Applied Arts and Technology: Covers 90% up to $4750 per year combined with all other paramedical services.
Illustrative Example: Federal Public Service Health Plan (PSHCP)
Consider a situation of a family with two spouses both working for the Federal Government and are enrolled in PSHCP, with two eligible dependents:
Per the maximum eligible expenses, each spouse has an annual massage therapy maximum of $400, reimbursed at 80%. Note this maximum this exclusive to registered massage therapy and is not shared with other healthcare services (e.g. physiotherapy, acupuncture, chiropractor).
Physician prescription/referral is not required.
Each family is independently eligible as follows:
First $500: The primary plan reimburses 80% x $500 = $400, and the secondary plan covered the remaining 20% = $100. The family did not incur any out-of-pocket expenses.
Next $375: The primary plan is exhausted, so the secondary plan reimburses 80% or $300. The family incurs $75 of out-of-pocket expenses.
In this scenario, family will thus receive a significant reimbursement for each family member spending up to $875 on registered massage therapy treatments per year, with $800 reimbursed by insurance and $75 being out-of-pocket.
Annual maximums and reimbursement levels vary across different insurance plans and providers.
For more information or to book your appointment, please contact me today!