Paramedical Providers
Mental Health
What is covered?
- 100% of the reasonable and customary (R&C) limit, up to $750 every calendar year (January 1 to December 31)
What is not covered?
- Herbal medications, remedies, supplies and vitamins
- Insurance form completion charges
- Missed appointment charges
- Motor vehicle accident-related treatments
- Occupational disease or injury-related treatments
- X-rays
Eligible practitioners
- Registered Clinical Psychologist
- Master of Social Work
- Psychotherapist (provincially registered)
- Social Worker/Counsellor
This service is covered for in-person or virtual appointments.
Ask your provider if they can submit your claim directly to GreenShield to minimize your out-of-pocket costs at your appointment.
Reasonable and customary (R&C) limit for mental health services
To ensure members are not overcharged, every year GreenShield sets a reasonable and customary (R&C) limit for the cost of a visit for mental health services. Every time you visit a mental health practitioner, the R&C limit is applied.
However…
Some providers charge more than the R&C limit.
And…
The R&C limit is the maximum amount your plan will cover for mental health services.
That means…
If your provider charges more than the R&C limit, you will have to pay the remaining amount out of your own pocket.
You can check your eligibility and coverage limits by logging in to your account at greenshield.ca, emailing GreenShield at customer.service@greenshield.ca or by calling GreenShield at 1-877-266-5494 to use their interactive voice system. You will then see if your estimated payments are fully covered or not.
For Example:
Victor’s psychotherapist charges $180 for each appointment. The R&C limit at the time for this service is $150, which is the maximum amount your plan will pay.
Since Victor will be $30 out of pocket, he has two choices:
- Pay the remaining $30 out of pocket; OR
- Use his Health Care Spending Account (HCSA) to help cover his cost—in full or in part.
Your coverage maximum resets every year on January 1.
If you reach the mental health services plan maximum partway through the year, the full coverage amount will again be available to you on January 1.
For Example:
Melanie goes to psychotherapy sessions to help with her anxiety. Last year, she submitted these claims:
Melanie reached the annual maximum at the end of July. She then had three choices:
- Continue to schedule psychotherapy appointments and pay out of pocket for the remainder of the year (until December 31); OR
- Continue to schedule psychotherapy appointments and use her Health Care Spending Account (HCSA) to help cover her cost—in full or in part; OR
- Wait until her coverage maximum refreshes on January 1, and begin psychotherapy sessions again.
Mental health coverage for dependent children under age 14
What is covered?
- In addition to mental health services coverage of 100% up to $750 every calendar year (January 1 to December 31), there is a psychological assessment lifetime maximum of $500 for each dependent child under age 14.
Eligible Services
- Psychological assessment conducted by a registered Clinical Psychologist.
Your coverage maximum is a lifetime maximum and does not reset at the beginning of the calendar year.
Once the lifetime maximum is reached, additional psychological assessment expenses will not be paid.
For Example:
Tony is the legal guardian of his 11-year-old granddaughter, Angela. Two years ago, Angela had a psychological assessment. Last year, Angela had another psychological assessment.
Since the $500 lifetime maximum was reached after Angela’s second assessment, Tony will be $100 out of pocket. He has two choices:
- Pay the remaining $100 out of pocket; OR
- Use his Health Care Spending Account (HCSA) to help cover his cost—in full or in part.
