Understanding Your Extended Health Benefits Before the End of the Year

As the end of the year approaches, you may start hearing reminders to use your extended health benefits before they reset. But before booking an appointment simply because you have coverage available, it’s worth taking a few minutes to understand what your plan actually includes.

Extended health plans vary. Depending on your individual plan, you may have coverage for services such as physiotherapy, chiropractic care, registered massage therapy and other health services. Coverage amounts, referral requirements, annual limits and eligible services can differ between plans.

Understanding those details can help you make informed decisions about your care and avoid surprises when submitting a claim.

Start by understanding your coverage

Your insurer or benefits provider is the best source for information about your specific plan. Before booking, consider checking:

• Which health professions does your plan cover?

• How much coverage do you have remaining this benefit year?

• Is there a maximum amount per appointment or per year?

• Does your plan require a physician’s referral for reimbursement?

• When does your benefit year reset?

• Are there specific requirements for submitting a claim?

• Does your plan allow direct billing?

It’s important not to assume that a particular service or treatment technique is covered simply because it’s provided by a regulated health professional.

Your individual insurance plan determines coverage.

Do you need a doctor’s referral?

Whether you need a referral for insurance reimbursement depends on your benefits plan.

Some plans may reimburse eligible services without a physician’s referral, while others may require one. If you're unsure, check your policy or contact your insurer directly before your appointment.

It’s also useful to distinguish an insurance requirement from a clinical referral. A referral requested by an insurer is related to the terms of your benefits coverage and doesn’t necessarily determine whether you can contact a clinic about an appointment.

Using your benefits with a purpose

Having benefits remaining doesn’t mean you need treatment.

But if you’ve been experiencing an issue such as pain, stiffness, difficulty with movement, an injury, or a change in your ability to participate in your usual activities, an assessment with an appropriate health professional can help determine whether treatment is indicated and discuss options based on your individual circumstances.

The assessment should guide the care plan, not the amount of insurance coverage you have available.

This can also help you think ahead about the activities that matter to you, whether that’s returning to exercise, managing the physical demands of work, preparing for a sport, or simply moving more comfortably during everyday activities.

One clinic, different areas of care

Strength Through Motion is a multidisciplinary clinic in Richmond offering physiotherapy, chiropractic care, registered massage therapy, kinesiology and active rehabilitation.

That doesn’t mean every patient needs every service. Your needs, assessment findings and goals should determine what type of care is appropriate.

Having different disciplines available in one clinic can make it easier to access different types of care when they’re appropriate for your individual situation.

What about IMS or shockwave therapy?

Some STM practitioners incorporate treatment techniques such as intramuscular stimulation (IMS) or shockwave therapy (SWT) when clinically appropriate and within their training and scope of practice.

Insurance coverage shouldn’t be assumed based on the treatment technique itself. Reimbursement depends on your individual plan and how your insurer defines eligible physiotherapy services. If coverage is important to your decision, confirm the details with your insurer before treatment.

Can STM bill your insurance provider directly?

STM offers direct billing to participating extended health insurers where available.

Direct billing can reduce the claim paperwork you need to submit, but it doesn’t guarantee an insurer will reimburse an appointment. Your individual benefits plan determines coverage, eligibility, deductibles, plan limits, and any remaining balance.

Before your appointment, check your current coverage or contact your insurer if you have questions about what your plan includes.

Before your extended benefits reset

If your benefit year is approaching its reset date, this is a useful time to review your plan rather than simply trying to use whatever coverage remains.

Understand what you’re covered for. Consider whether there’s a health or movement concern you’ve been meaning to address. And if you decide to seek care, choose the appropriate regulated health professional based on your needs.

If you’re unsure which STM service may be appropriate, call us directly at 604-630-8815 or email us at admin@stmhealth.ca, and we can share information about the services available and help you choose an appropriate starting point.