Extended Health Care Plan: Chiropractic Benefits

Extended Health Care Plan: Chiropractic Benefits

Dealing with Elimination of OHIP Funding:
The Government of Ontario has announced that, on December 1, 2004, after 30 years of assisting chiropractic patients by providing partial funding, it is withdrawing that assistance. This shifts part of the cost, $11.75 per initial visit and $9.65 per subsequent visit (to a maximum of $150 per year), from OHIP to patients.

Like several other health services that are not OHIP funded (i.e. dentistry, psychology) chiropractic remains an important part of the health care system and your health care team. You will continue to receive the highest quality care and attention we can provide at our office. 

Many health insurance plans cover chiropractic. Check your plan or speak to the plan administer to determine how your treatment may be paid for. We will assist you in completing any necessary forms.

Understanding Your Extended Health Care (EHC) Plan's Chiropractic Benefits:

What does the elimination of OHIP funding mean for my Extended Health Care (EHC) plan coverage?
As of December 1, 2004, the Ontario government has transferred (downloaded) the entire cost of chiropractic care to patients and EHC plans. Previously, the provincial government provided $9.65 per visit for approximately 15 visits.

Physiotherapy services provided by registered physiotherapists in Ontario were also affected with these budgetary cuts from the Ontario government.

Whether your EHC plan will absorb this transfer of costs will be determined by the sponsor of your plan. Generally, this is your employer. If your plan previously provided no coverage until your OHIP coverage was exhausted, you may now be able to access your chiropractic coverage immediately (i.e. - no out of pocket costs up to your plan's maximum.)  Some plan sponsors (employers) may have added a deductible.

You should check with your employer (i.e. Human Resources Department) or union to determine whether your EHC plan will absorb the transfer of costs from the public system and determine exactly what your coverage is after December 1, 2004.

Ask the following:

  • Does the plan provide for coverage for chiropractic services? This is often included under paramedical services.
  • How much of my chiropractor's fee will be paid by the EHC plan? Coverage may be: 
    • an amount per visit (i.e. $50. per visit), or
    • a percentage of your chiropractor's fee (i.e. 80% of the total fee), or
    • your plan may provide for a deductible, either a portion of the individual fee (i.e. $10. per visit) or a set amount per year before coverage begins.
  •  Is there an annual limit on my chiropractic coverage? Many plans will limit the total spending on chiropractic care (i.e. a maximum expenditure per year). Let your employer and/or union know that chiropractic coverage is important to you. Also tell them the level of coverage for chiropractic services you wish to be included in your EHC plan.
  • What is the role of my chiropractor in dealing with my EHC plan? Dr. Pisarek is there to provide important health care services to you. This is his/her most important role.  He will also help you to understand the fees associated with chiropractic care and will provide you with the information necessary to allow you to submit your chiropractic expenses to your EHC plan. He may also help you fill out your insurance form.

You can also contact the Ontario Chiropractic Association, 200 - 20 Victoria St., Toronto ON  M5C 2N8, Tel: 416-860-0070, or toll-free at 1-877-327-2273, Fax: 416-860-0857. Email: [email protected]; Website: www.chiropractic.on.ca

If you have additional questions, call Advanced Healthcare at (416) 633-3000 and speak to Dr. Pisarek or click here to send him an email.

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