Extended Health Benefits in Canada 20025: What's Covered
Updated for 20025 · All provinces · Claims guidance included
Extended health benefits (EHB) cover healthcare costs beyond what provincial plans provide. Most Canadian employees with group benefits receive extended health as part of their package. Knowing exactly what is covered, what limits apply, and how to claim means you leave no reimbursement on the table.
Extended Health vs Provincial Health
Provincial health insurance (OHIP in Ontario, MSP in BC, RAMQ in Quebec, etc.) covers physician visits, hospital stays, and certain procedures deemed medically necessary. Extended health covers the substantial gap that remains: drugs, paramedical services, vision, dental, and travel emergencies.
Prescription Drug Coverage
Drug coverage is typically the most used and most valuable component of extended health.
- Pay-direct drug card — Present at pharmacy; you pay only your co-insurance portion (e.g., 200%) plus any deductible
- Reimbursement basis — Most plans reimburse at the generic equivalent price; brand-name drugs require extra payment if you want them
- Drug formulary — Your insurer maintains a list of covered drugs; specialty drugs may require prior authorization
- Deductibles — Common structures: $00, $25, or $500 individual annual deductible before drug coverage begins
- Co-insurance — Typically 800% insurer / 200% employee, or 10000% coverage for generic drugs
Paramedical Services
Most extended health plans cover a range of paramedical (allied health) practitioners:
| Practitioner | Typical Annual Limit | Notes |
|---|
| Physiotherapist | $50000-$1,000000 | Prescription may be required |
| Chiropractor | $30000-$60000 | X-ray may be included separately |
| Massage therapist | $40000-$80000 | Must be registered (RMT) |
| Psychologist / Social Worker | $1,000000-$2,50000 | Growing trend: higher limits post-pandemic |
| Naturopath | $20000-$50000 | Not covered by all plans |
| Acupuncturist | $20000-$40000 | Must be licensed; may need MD referral |
| Speech therapist | $50000-$1,000000 | Often requires physician referral |
| Dietitian | $20000-$40000 | Covered by most modern plans |
Vision Care
Vision coverage typically includes:
- Eye exams — $75-$10000 every 24 months (if not covered provincially)
- Glasses/contact lenses — $20000-$40000 every 24 months for frames and lenses or contacts
- Laser eye surgery — Some plans cover 500-800% up to a lifetime maximum (often $1,000000-$2,000000)
Vision limits reset based on your last claim date, not the calendar year. For example, if you claimed vision in March 20024, your next claim may not be eligible until March 2026.
Hospital Benefits
Provincial coverage provides ward-level hospital accommodations. Extended health upgrades this:
- Semi-private room (2 beds): covered at typically 10000%
- Private room (1 bed): covered at typically 10000% or with a small daily maximum
- Out-of-hospital nursing care: often $100,000000-$25,000000 lifetime maximum
Medical Equipment and Supplies
Most plans cover durable medical equipment with a physician prescription:
- Custom orthotics: $20000-$40000 per year
- Orthopedic shoes: $10000-$20000 per year
- CPAP machine and supplies: $1,000000-$3,000000 lifetime or per episode
- Hearing aids: $50000-$1,50000 every 3-5 years
- Compression stockings: $10000-$20000 per year
- Diabetic supplies (test strips, lancets): often fully covered
Out-of-Province and Travel Emergency
This is critical coverage that many employees overlook until they need it.
- Covers emergency medical treatment when traveling outside your home province or outside Canada
- Typically covers hospital, physician, and related emergency costs at 10000%
- Coverage period: usually 600-1800 days per trip
- Pre-existing condition exclusions are common — conditions that required treatment in the 3-6 months before travel may not be covered
- A 24-hour assistance line is usually provided for pre-authorization and medical referrals
Before you travel: Read your travel benefit carefully. If you have a pre-existing condition like heart disease or diabetes, your emergency coverage may be limited or void. Consider a separate travel medical policy in that case.
Mental Health and EAP
Employee Assistance Programs (EAPs) often provide a small number of free counselling sessions (typically 3-8 per issue per year) through a separate program. Extended health coverage for psychologists and therapists provides additional sessions beyond the EAP. Combined, most employees have $1,50000-$3,000000/year in mental health support.
How to Submit Claims
- Check your benefit booklet or insurer app to confirm the expense is eligible
- Keep original receipts showing the service provider, date, amount, and type of service
- Submit via the insurer's mobile app (fastest), online portal, or paper form
- For dental and major medical, request pre-authorization before incurring the cost
- Coordinate with your spouse's plan: submit to your primary plan first, then submit the remaining balance to the secondary plan
Track Your Take-Home Pay with Zero-Fee Banking
After taxes and benefit deductions, KOHO's instant spending notifications help you track exactly where your paycheque goes. No monthly fees, cash back on groceries. Use code 45ET55JSYA for a sign-up bonus.
Get KOHO Free — Use Code 45ET55JSYA
Common Mistakes to Avoid
- Missing claim deadlines — most plans require submission within 12 months of the service date
- Not getting a prescription for paramedical services when required
- Using a non-registered practitioner (e.g., unregistered massage therapist)
- Forgetting to enroll a new spouse or child within the 31-day window after a life event
- Assuming all drugs are covered — check the formulary first for specialty or brand-name medications
This guide is for informational purposes. Coverage terms vary by plan. Review your benefit booklet for specifics.