Health Care Plans: Reasonable and Customary Charges

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Have you ever wondered what your Extended Health Care plan actually covers?

Typically, Extended Health Care plans include coverage for the services of several types of healthcare practitioners, such as chiropractors and massage therapists.

There is a range of usual fees practitioners in each province charge for services.

Insurance companies use these “reasonable and customary” fees as the basis for pricing their benefit plans and determining the maximum eligible amount that they will reimburse. Most provider associations publish a suggested fee schedule for their practitioners.  

However, there is no requirement for them to charge according to this and fees for similar services can sometimes differ substantially from one practitioner to another.

Most paramedical expenses claimed by plan members fall within the reasonable and customary fee range. If a healthcare practitioner chooses to charge more, the member is responsible for the extra cost. Does this make the current system outdated?

Below, are the reasonable and customary charges for each type of practitioner in British Columbia, Canada (note: Some carriers do not publish their listing as they believe it helps protect the plan member, as some service providers will then charge the maximum allowable rate, as well as limit any fraudulent or excessive service fees.)

Your plan may not cover all the practitioners listed below, so make sure to check your contract or contact your group benefits representative if you are unsure.

Practitioners’ reasonable and customary charges:

  • Acupuncturist (For Initial assessment and Subsequent visit) – $100
  • Audiologist (per hour) – $125 
  • Chiropodist or Podiatrist – (For Initial assessment and Subsequent visit) – $100
  • Chiropractor – Initial assessment $135; Subsequent visit $60 
  • Dietician (per hour) – $150 
  • Massage Therapist (per hour) – $100
  • Naturopath – Initial assessment $210;  Subsequent visit $155 
  • Occupational Therapist (per hour) – $140
  • Optometrist (For Initial assessment and Subsequent visit) – $120 
  • Ophthalmologist (For Initial assessment and Subsequent visit) – $200
  • Osteopath – (For Initial assessment and Subsequent visit) – $120
  • Physiotherapist – Initial assessment $80;  Subsequent visit $135
  • Psychologist (per hour) – $190
  • Social Worker (per hour) – $175
  • Speech Therapist (per hour) – $120

This list only reflects the maximum Reasonable and Customary amount allowed per treatment. Claims will still be subject to the terms of your policy.

Also read: Tips For Reducing Sugar

Usually, a plan limits paramedical services to one treatment, per service, per person, per day. It is the plan member’s responsibility to ensure their paramedical providers possess the credentials accepted by their insurance carrier.

We hope this guide helps you to better understand your Extended Health Care Plan.

If you’re an employer perhaps it will encourage you to review your plan, and whether change could potentially be beneficial for your employees Extended Health Care Plan.

Ly Siu

I am a dedicated, proven professional with more than 20 years of Benefits and Human Resources experience in both the private and public sector.  I will provide you and your employees with a customized and cost-effective benefit plan that gives you the greatest value, while meeting your organizational goals and budgets. My most important objective is to save you TIME and MONEY – so you can focus on managing your business operations.

The Value Of Employee Benefits

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Why Should You Consider Offering Benefits To Your Employees?

As a small business owner, you understand how important your employees are to you. The company wouldn’t be where it is without them. Simply put, employees can make or break the company.

Besides wanting to treat your employees well and making sure they have everything they need to do the best job they can, you want them in good health. Employee benefits are the only way you will be able to ensure and enforce that your employees maintain the best of health.

This can be even more critical if your employees are operating machinery and vehicles or performing any task that could potentially put themselves or others at risk.

Employee benefits plans have numerous advantages:

  • Attract and retain high-quality employees; studies show better compensation and benefits is the number one reason candidates cite for accepting a job.
  • Creates a healthy culture; having healthy employees’ results in increased productivity and reduced absenteeism. This mitigates some of the cost of providing the benefits plan.
  • Tax Deduction; they are a tax efficient way to increase a compensation package for both employee and the employer.
  • Cost Effective protection for employees and their families; there are no requirements to pay into CPP or EI and the employee gets tax free medical benefits.
  • Increased morale; it helps establishes the company policy on health and sickness, employees feel that their well being matters.
  • And last but not least… Employees value employee benefits! For some people it can mean the difference in whether or not they or their child can get something like braces or glasses.

Today, top employees demand a comprehensive health insurance plan.  In fact, in a 2016 Canada health survey, 77% of respondents say they wouldn’t move to a job that didn’t include some health benefits.

As an employer that gives some solid reasoning as to why you should implement benefits (if you don’t offer them already). Employees are looking for a company that takes care of them and their needs, just as much as employers are looking for someone who takes care of the company and puts their best foot forward every day.

Employee benefits are just another reminder that you give what you get. In life and business it is doing things differently or better than everyone else that sets you apart. The truth of employee benefits is that offering them at all can help you rise above the competition when it comes to recruiting your next star employee.

Ly Siu

I am a dedicated, proven professional with more than 20 years of Benefits and Human Resources experience in both the private and public sector.  I will provide you and your employees with a customized and cost-effective benefit plan that gives you the greatest value, while meeting your organizational goals and budgets. My most important objective is to save you TIME and MONEY – so you can focus on managing your business operations.