Insurance for Mental Health Therapy

Insurance for
Mental Health Therapy

Find information on paying for counselling therapy with insurance.

Is counselling therapy covered by Alberta Health Care Insurance?

In Alberta, some mental health services are covered by public health care, but mostly for crisis, short-term, or acute psychiatric concerns. Private therapists often have more freedom, control, and flexibility to work with clients from their own unique approach, and can offer more individualized care for a longer time frame. When private mental health therapists practice outside of publicly funded programs, they are no longer funded by the public. Alberta Health Care Insurance does not cover private therapy or psychology services.

Is online counselling covered by my insurance?

In Alberta, online or virtual therapy is covered by insurance the same as in-person services, therefore, you have access to a wide range of therapists and counsellors throughout Alberta with a variety of specialties and approaches.

What if I don't have insurance for therapy?

Mental health therapy is an investment that can pay off the rest of your life. If you don’t have insurance coverage and want to access a private practice therapist, or have used up your insurance coverage, you can pay the session fee out of pocket. If you can't afford the full cost of therapy, you can check out free and affordable therapy resources here.

 

Is therapy tax deductible in Alberta?

If you see a psychologist or social worker, your therapy services are GST exempt, and you can claim any portion you pay out of pocket as a medical expense to reduce your income tax. If you pay your social worker or psychologist but are reimbursed partially by insurance, you can claim the amount you were not reimbursed for on your taxes. 

Does my insurance get information about my therapy?

Using insurance coverage does not mean your insurance company has access to any information beyond dates and costs of service. Except for auto and disability insurance, no diagnosis or assessment is required for insurance to cover therapy and your therapist doesn’t need to submit reports to your group or individual insurance.

What kinds of insurance cover psychological therapy?

There are several insurance or benefits options available to pay for therapy, each covered in a section below:

  1. Group or individual insurance (extended health benefits)

  2. Health Spending Accounts (HSA)

  3. Auto insurance if you have been injured or distressed from a Motor Vehicle Accident (MVA)

  4. Short- or long-term disability insurance

1. What do I need to know to use insurance coverage for mental health therapy?

Have you checked your benefit package to see if you have coverage for therapy and psychology services?

Most Canadians have some form of mental health insurance benefits. You might have group insurance (extended health benefits) from your employer or education institute, or you might have coverage from your partner’s or parent’s employment or education institute. You might also have privately purchased insurance or benefits for individuals, families, small businesses, self-employed business owners, or corporations.

Many insurance and health benefits plans offer a minimum of $500 per year in mental health coverage, however, more companies are recognizing the impact of mental health on employees and increasing the coverage for therapy. Canada Life, EY Canada, Starbucks, RBC, and The Co-Operators now offer employees $5,000 annually, Manulife offers $10,000 and SunLife offers $12,500 annually.

You can find out the details of your own insurance coverage by contacting your HR, calling your health insurance benefits provider, or creating an account and logging into your online insurance profile. You will usually find mental health therapy coverage under extended health benefits or a paramedical services category. You might want to find out from your insurer:

 

a. the types of mental health professionals covered

b. the $ amount or # of sessions covered per year and the % covered

c. if there are any coverage specifications

d. when the insurance renews/rolls-over

e. if they offer direct billing

 

a. What mental health professionals are covered by insurance?

There are a variety of mental health professionals in Alberta. To cover private therapy, most insurance providers require the therapist or counsellor to be licensed and have a registration number with a professional regulating college or association. Most insurance providers require therapists to be registered in the client’s province. Psychologists and Social Workers registered in Alberta can only see clients living in the province. You might want to ensure which professional designations your insurance covers before starting therapy. A few of the common mental health professionals in Alberta include:

 

Your insurance might also cover art therapists, play therapists, marriage and family therapists, and other registered counsellors.

 

You can ask a therapist which insurance policies they accept, but it is important to know within an insurance provider, each group and individual plan varies in what services and professionals they cover. It is helpful to check with your own plan before you receive services to ensure coverage.

 

b. What is my insurance coverage for therapy?

Once you’ve confirmed you have insurance coverage for therapy and with whom, knowing your total benefit amount will help you determine the number of sessions you have covered dependent on the cost, and any out-of-pocket expenses you will need to pay.

 

Benefits either cover the full cost up to a maximum amount, a dollar portion of the cost of the session, a percentage of the cost of the session, or a limited number of sessions. The total amount covered per year ranges from $500 to $12,500 and the portion or percentage covered per session usually ranges from $50 to $200 or 25% to 100%. If you don’t have 100% coverage, you might pay your therapist the whole amount and submit for partial reimbursement, or if you have direct billing that covers a portion of the service, you can pay your therapist the outstanding payment.

 

Some insurance benefits don’t limit the coverage by cost, but rather by number of sessions. For example, RCMP members are permitted 6 sessions annually, with the possibility of applying for another 6 sessions.

 

c. Does my insurance coverage have any specifications?

Insurance providers sometimes differentiate their coverage between treatment, assessment, and documentation services. You may have a certain amount for each service, or your coverage may only apply to treatment, not documentation.

 

Some insurers specify whether coverage applies to individual, couple, family, or group therapy. You may have a certain amount for each service, or your coverage may only apply to certain services.

 

Some insurers cover partners and dependents. You can use your own insurance, or you might also have access to a partner’s insurance, or a parent’s insurance if you are a minor or in post secondary education and still qualify as a dependent. If you have more than one benefit, you can receive coverage first from your own primary insurance, then coverage for any remaining balance from your secondary insurance.

 

Sometimes your insurance requires you have a prescription from a doctor for therapy to be covered. If you find this out after attempting to submit for direct billing or reimbursement, you are usually allowed to get a prescription that will retroactively cover the sessions that have already occurred as well as future sessions.

 

d. When does my insurance coverage renew?

Most benefits plans renew with the calendar year in January, however, some rollover in the summer, with your employment anniversary, or with the company’s fiscal year. Knowing when your benefits renew or rollover can help you plan when you will have access to your full coverage amount again.

e. Do psychologists and therapists offer direct billing for insurance?

At Therapy Alberta, we can direct bill most insurance companies as they are increasingly offering this service for mental health therapy. You can give your policy and plan numbers to your therapist who can submit an e-claim for the service cost and receive payment directly from the insurance. If your plan covers 100% of your session, you don’t pay anything out of pocket. If your plan covers a certain dollar amount or percentage, you pay the remaining balance directly to your therapist and receive a receipt for that amount.

 

Some insurance providers that offer direct billing in Alberta include:

  • Alberta Blue Cross

  • Alberta School Employee Benefit Program (ASEBP)

  • Alberta Retired Teachers’ Association (ARTA)

  • Beneva

  • Canada Life (formerly Great West Life)

  • Chambers of Commerce Group Insurance Plan

  • CIMUP

  • D.A. Townley

  • Desjardins

  • Equitable Life

  • First Canadian

  • Green Shield Canada

  • GroupHEALTH

  • GroupSource

  • Industrial Alliance Insurance and Financial Services (iAFinancial Group)

  • Johnson Group

  • Manion

  • Maximum Benefit

  • Medavie Blue Cross

    • Canadian Armed Forces (CAF),

    • Immigration, Refugees and Citizenship Canada (IRCC),

    • Royal Canadian Mounted Police (RCMP), and

    • Veterans Affairs Canada (VAC)

  • RWAM

  • SSQ Insurance

  • The Claims Xchange/Nexgen Rx

  • UV Insurance

 

Occasionally, a provider typically allows direct billing, but a particular employer’s plan does not allow electronic submission. In this case, you will need to pay and submit for reimbursement.

 

Sometimes, a provider will allow electronic billing, yet only offer payment to the insured provider, not directly to the professional. In this case, you are responsible to pay, however your therapist can submit your receipt and you will receive the reimbursement.

Other companies still provide mental health coverage but do not allow therapists, or certain therapists, to direct bill. You will need to pay your therapist directly, receive a receipt, and submit your receipt for reimbursement with your insurance. Most companies reimburse by direct deposit in a few days. Members are encouraged to appeal their provider to begin offering the convenience of direct billing for psychologists and therapists!

 

Some of the better-known insurance providers that don't offer direct billing but do reimburse clients for services include:

  • SunLife

  • Manulife

  • CINUP

  • Cowan

  • Johnson

2. Can I use Health Spending Accounts (HSA) for therapy?

With a group HSA, your employer makes an annual contribution to your HSA which you can use to cover health expenses. Typically, you pay for approved health services and submit your receipt for reimbursement. 

You can also access a private or self-employed HSA or Cost Plus or Private Health Services Plan (PHSP) for small businesses in Canada to cover approved health expenses.

3. Can I use insurance for therapy after a Motor Vehicle Accident (MVA)?

If you have been injured or distressed from a Motor Vehicle Accident as a driver, passenger, or pedestrian, you are entitled under Section B Insurance Accident Benefits to all necessary psychological services within two years of the date of accident. You may need a prescription from a medical doctor, and your assigned insurance adjustor may require initial and follow-up assessment reports to approve the number of treatment sessions proposed to facilitate recovery.

 

If you have exhausted your MVA Insurance or have passed two years since the accident, sometimes MVA lawyers will pay for therapy until a legal settlement or court resolution.

 

4. Can I use disability insurance for psychological therapy?

If you have short-term or long-term disability insurance for a physical or mental illness, you may be entitled to coverage for psychological services. You are encouraged to request mental health therapy services even if they are not offered to you. Your assigned case manager or worker may require initial and follow-up assessment reports to approve the number of treatment sessions proposed to support your recovery or wellbeing.

 

If you have questions or need any assistance in your search for a therapist, please contact us here.