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2340 Dundas St. West Unit G05
Toronto ON, M6P 4A9

How to Use Your Work Benefits: Common Questions


 

So you’ve got some benefits through your work. Fantastic! Enhanced Health Care benefits, or EHC for short, can be a major employment perk. They provide enhanced health coverage and access to paramedic services that aren’t normally available through OHIP.

 

But now that you have them, you’re probably wondering about the best way to use them! You’re likely paying into your benefit pool every month or every year, so you have every right to take full advantage of the benefits in your package. That’s what they are there for, after all.

 

Employment benefits packages vary widely, but they all have several things in common. They likely provide dental and vision coverage, prescription medication coverage, and a variety of paramedical services – a huge category of health and wellness services like massage or chiropractic care that you would normally pay out of pocket for. Some work benefits also cover orthotics, optometrist services, therapy, and more.

The benefits of using benefits

Money saved! You don’t pay for services out of pocket.
 
More options for your health and wellness. Massage therapy, acupuncture, chiropractic are all paramedic services that are popular for a reason. You get access to enhanced support for wellness, rehabilitation, pain management and treatment without relying on OHIP for coverage.
 
No paperwork. Look for a service provider that offers direct billing and they will handle all the communication with your insurance company. You need to only show up for your appointment.

How do I know what’s available to me?

You can consult your benefits package paperwork that likely includes a booklet outlining all the services covered and coverage limits. Another good way is to call the insurance company underwriting your work benefits and asking them! This is a routine customer service call that they are accustomed to answering and they will be happy to walk you through it.

 

How much can I spend on services?

The answer really depends on your benefits package. There could be limits on a few things:
 
???? The number of visits covered per year, for example, up to 10 visits to a physical therapist or one optometrist appointment per year.
 
???? The total amount you spend on a specific service per visit. For example, your chiropractic session could cost $100 while your insurance would only cover a set amount of $75.
 
???? Only a percentage of the total service cost could be covered, for example, 80% of a massage therapy session regardless of its dollar cost.
 
???? Last but not least, some services may require your family doctor’s referral or a pre-approval issued by your insurance.

 

It’s always a good idea to check your benefits booklet or give your insurance company a call when in doubt. Your clinic or service provider could also assist in communicating with your insurance and obtaining the necessary referrals to provide the service for you.

Do I need a family doctor referral?

It depends! It’s not common to ask for a referral for a massage or a chiropractic assessment, but more specialized services that incur costs for your insurance company may need a referral.

So can I just make an appointment with a provider and show up?

Pretty much! If the service you need doesn’t require a referral or a pre-approval, you can make an appointment as you would for any other health provider and just show up. You should bring your insurance policy information with you to help facilitate direct billing. The clinic of your choice will take it from there!

 

Do you have other questions relating to using your work benefits? Please don’t hesitate to get in touch with us by calling, emailing or sending us a Facebook message! We would be delighted to help and also to expand this article.