Check What Your Benefits Cover
See what an extended health plan typically pays for physio, massage, dental, vision and more.
Extended health benefits pay for the care your provincial plan leaves out, which for most people who have them means physiotherapy, massage, dental, vision and prescriptions. Every plan sets its own percentages and limits, so two colleagues at different companies can pay very different amounts for the same appointment.
The tool below shows how a typical plan is laid out. Everything after it explains how to read your own.
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We keep an anonymous record of what you look up, with no names, contact details or IP addresses, to understand what Canadians need.
This tool provides general information and does not constitute medical, financial or insurance advice. The plan shown is a sample with made-up figures. Your plan booklet or insurer has the final word on your coverage, and tax rules should be confirmed with the Canada Revenue Agency or a tax professional. Call 911 or go to your nearest emergency department for any medical emergency. Plans differ; your plan booklet or insurer has the final word on your coverage.
Reading Your Own Plan
Your plan booklet holds every number this page talks about, and five minutes with it saves a surprise at the front desk.
- Find your benefits booklet or log in to your insurer's member site, since that is where the real numbers live.
- Look up the coverage percentage for the service you want, which tells you how much of each visit the plan pays.
- Check the yearly maximum and any per-visit limit, because either one can run out before you expect.
- Note whether the service needs a doctor's referral before the plan will pay.
- Ask the clinic whether it can bill your insurer directly, so you only pay your share at the desk.
Why Your Teeth Were Left Out of Medicare
When Saskatchewan launched medicare on July 1, 1962, it paid for doctors, and most of the province's physicians walked off the job that same day. The 23-day strike ended with a compromise, the model spread across the country within a decade, and its basic shape has held ever since.
That shape was written into law in 1984. The Canada Health Act defines insured services as hospital care, physician care and dental surgery performed in hospital. Everything outside that list, from the dentist's chair to the physio clinic to the pharmacy counter, falls to each province to fund or not, and most of it lands on you.
Extended health benefits grew up in that gap. They are the reason a cleaning, a pair of glasses or a course of physio costs one person nothing and the next person a week's groceries.
What the Numbers Mean
Every plan describes its coverage with the same handful of numbers, even when the amounts behind them differ completely.
The sample plan in the tool uses made-up figures to show the layout. Your own booklet is the only source for your real numbers, and your insurer has the final word on any claim.
Words You Will Hear
Coinsurance. The percentage of a bill you pay yourself after the plan pays its share.
Annual maximum. The ceiling on what the plan pays for a service or group of services in one benefit year.
Benefit year. The 12 months your maximums run over, which may follow the calendar or your plan's own start date.
Coordination of benefits. Claiming through two plans, such as yours and a spouse's, so the second can pick up what the first did not.
Health spending account. A set amount your employer gives you each year to spend on eligible health costs, often including things the main plan does not cover.
Direct billing. The clinic sends the claim to your insurer for you, so you pay only your share at the visit.
Why the Maximum Matters More Than the Percentage
People tend to remember the percentage and forget the ceiling. A plan that pays 80 per cent of physiotherapy sounds generous, but if the yearly maximum is small, a course of treatment after an injury can use it up within weeks, and every visit after that is yours to pay.
That is why the annual maximum on your health benefits is the number to check before you book a block of appointments. Spreading visits across two benefit years, combining your plan with a spouse's, or drawing on a health spending account can all stretch the same treatment further.
When the Sample Plan Gets It Wrong
A sample plan shows the shape of coverage. Real plans differ in ways that matter.
- Your employer chooses the percentages and maximums, so no two plans match exactly.
- Some plans group physiotherapy, massage and chiropractic under one shared maximum rather than separate ones.
- Some services, often massage therapy, need a doctor's referral before the plan pays.
- Plans can cap what they pay per visit, even when the percentage looks high.
- Coverage for travel, drugs and dental often sits in separate sections with their own rules.
- Changing jobs, retiring or leaving a spouse's plan can end coverage on a set date.
When You Have No Plan at All
Plenty of Canadians work without benefits, and a few public programs fill part of the gap. The federal Canadian Dental Care Plan covers residents with an adjusted family net income under $90,000 who have no access to private dental insurance and have filed a tax return. Nearly six million people were enrolled for 2025 to 2026 by January 2026, though Medimap's look at the plan's first report card found many still face out-of-pocket costs.
Some provinces also help with therapy costs for people on lower incomes. British Columbia's MSP supplementary benefits pay $23 a visit, for up to 10 visits a year combined, toward physiotherapy, massage, chiropractic and several other therapies for eligible residents. And whatever your situation, premiums you pay for a private health plan and unreimbursed medical costs can count toward the medical expense tax credit.
Common questions
How Much Does Insurance Cover for Physiotherapy?
It depends entirely on your plan. Most plans pay a percentage of each visit up to a yearly maximum, and some add a per-visit cap. Your booklet or your insurer's member site shows the exact numbers, and the clinic can usually confirm what you will owe before you book.
Do I Need a Referral for Massage Therapy?
Some plans require one and some do not. Where a plan asks for a doctor's referral, it usually needs to be in place before the treatment, so check your booklet first. A family doctor, walk-in clinic or virtual visit can usually provide one.
Can I Use My Plan and My Spouse's Plan Together?
Usually, yes. Coordination of benefits lets you claim through your own plan first and then send the unpaid balance to your spouse's plan. The two together can often cover most of a bill that one plan alone would only partly pay.
When Does My Annual Maximum Reset?
At the start of each benefit year, which may be January 1 or your plan's own anniversary date. Your booklet states which, and timing a course of treatment across that date can leave room in both years. If you are partway through treatment near the reset, your clinic can help you plan visits around it.
Are Benefit Premiums Tax Deductible?
They count toward a tax credit rather than a deduction. Premiums you pay yourself for a private health services plan are an eligible medical expense for the federal medical expense tax credit, along with unreimbursed costs. Premiums your employer pays that are not included in your income cannot be claimed.
Where Can I Check My Exact Coverage?
Your benefits booklet and your insurer's member site are the official sources, and your human resources team can tell you which insurer your employer uses. For dental help without a plan, the Government of Canada publishes the full Canadian Dental Care Plan rules.
Once you know what your plan pays, you can book a physiotherapist, find a massage therapist or find a dentist near you, and keep exploring in the Medimap Health Hub.