Does Insurance Cover Psychology in Ontario? A Clear Guide

One of the first questions people ask when they’re considering psychotherapy is whether insurance will cover their sessions. Its a reasonable question. Psychological services can be cost-intensive, and not knowing what you’re entitled to can be a real barrier to reaching out. The short answer is: most insurance plans will cover psychotherapy administered by a Registered Psychologist. The longer answer is worth understanding though.

OHIP and Psychology: What is Actually Covered

Ontario’s Public Health Insurance (OHIP) has very narrow coverage of mental health services. Most people are surprised to find that psychological services delivered by a registered psychologist or psychological associate in private practice are not covered by OHIP. There are limited exceptions. OHIP will cover some mental health services when they are delivered in the context of a hospital or community mental health centre. The trouble is that access to these programs is typically limited: waitlists are usually long, and the range of services offered is narrower than what’s available in private practice.

Extended Health Benefits: The Most Common Route

For most working adults in Ontario, the most accessible source of coverage is an extended health benefits plan through an employer. Plans vary considerably from provider to provider, but most offer some coverage for psychological services. Usually, plans will offer a set dollar amount per calendar year, ranging anywhere from a few hundred to a few thousand dollars.

There are a few things worth knowing about these plans:

1) coverage is almost always tied to the professional designation of the person providing treatment. Some plans cover ‘psychologists’, but may not cover ‘psychotherapists’ or ‘social workers,’ and vice versa. It’s worth reading your plan carefully, or calling your insurance provider directly, to confirm which regulated professions are included.

2) Sometimes, plans require a referral from a physician before they will reimburse for psychological services. Others do not. Again, your benefits booklet or a quick call to your insurer is the clearest way to confirm.

Employee Assistance Plans (EAPs)

Some employers also offer an Employee Assistance Program. These services are separate from extended health benefits. EAPs will typically provide a handful of of sessions at no cost to the employee. Typically, sessions are short-term and solution-focused by design. For some concerns, EAPs are appropriate and sufficient. For others, EAPs are insufficient.

If you have access to an EAP, it can be a reasonable starting point. It’s also worth knowing that EAP sessions are separate from your extended health benefits and won’t draw down your annual psychological services coverage.

Student Plans and Other Coverage

Students at Ontario colleges and universities are often automatically enrolled in a student benefits plan that usually include coverage for psychological services. The amount of coverage tends to be modest in these plans, but they can still meaningfully offset the cost of a few sessions.

Graduate students at universities sometimes have more robust coverage. Similarly, some professional associations, unions, and member organizations also carry group benefits that include psychological services.

Find out What You’re Covered for

Call your member services number (usually on the back of your benefits card). A few-minute call with your provider can clarify a lot. It’s best to ask whether psychological services are covered under your plan, and by which professional designations. It’s also useful to get a sense of what the annual maximums are for the coverage.

If you Don’t Have Coverage

Don’t give up on psychotherapy if you don’t have extended health benefits, or if your coverage doesn’t stretch far enough. It’s still worth reaching out to different clinics directly. Some practices have programs designed to make therapy more affordable. Some offer brief consultations at no charge, so you can make an informed decision before committing.