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Find Out if You’re Covered in Ontario for Physiotherapy

Physiotherapy is covered by the extended health benefits packages of many insurers. If you require physiotherapy and have an insurance plan, the best approach is to get as much information as possible about your available coverage before you begin treatment with a physiotherapist.

What Questions Should I Ask My Insurer to Determine My Coverage?
If you’ve never been to a physiotherapist before, it’s difficult to know what to ask your insurer. We recommend asking the following:
  1. Does the insurance company require a physician’s referral to cover physiotherapy treatment?
  2. Does the insurance company have a per-visit maximum, meaning, is there a limit to what the insurance company pays out for each visit?
  3. Does the insurance plan have an annual limit?
  4. Is the insurance plan’s physiotherapy coverage combined with any other healthcare? Sometimes, plans have a total amount that they pay for a group of health care providers.
  5. How are claims handled? Can the physiotherapy provider bill the insurance company directly, or will you (the patient) have to pay for care upfront and submit an invoice for reimbursement?

Coverage Options
A number of coverage options are available to people living in Ontario.

Employer-Provided Coverage/Private Extended Health Benefits (EHB)
Many people pay their own extended health care insurance premiums or have coverage for physiotherapy care through workplace insurance plans. Check your plan details for requirements, coverage limits and program inclusions.

Direct billing is available with the following insurers:
Great-West Life
Blue Cross
Green Shield Canada
Sun Life

Workplace Safety & Insurance Board (WSIB)
The Workplace Safety and Insurance Act gives injured workers the right to choose the service provider from whom they get care. They also have the right to consult a physiotherapist without a referral from a physician or any other healthcare practitioner.

For specific diagnostic categories, the WSIB has implemented Programs of Care. In order to deliver treatment under a Program of Care, physiotherapists must be registered with the WSIB.

Motor Vehicle Accident (MVA) Coverage
Coverage provided through automobile insurers is overseen by the Statutory Accidental Benefits Schedule (SABS) regulation under the Insurance Act.

Veteran's Affairs Canada (DVA) Benefits
Coverage provided through the DVA program is overseen by the Veterans Affairs Canada office, and you must qualify under their regulations.

Should you qualify for services under the DVA program, direct billing is available with your valid K Number.

Ontario Health Insurance Plan (OHIP)
OHIP coverage for physiotherapy is provided at a Designated Physiotherapy Clinic. Patients must have a doctor's referral and:
  • Be 19 years old or younger; or
  • Be 65 years old or older; or
  • Be receiving benefits under the Ontario Disability Support Program or Family Works; or
  • Have been overnight in the hospital for a condition that now requires physiotherapy treatment.