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?
- Insurance form completion charges
- Charges for copies of reports
- Missed appointment charges
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
- Look for a mental health provider that charges less.
Your coverage maximum resets every year on January 1.
If you reach the mental health 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 two choices:
- Continue to schedule psychotherapy appointments and pay out of pocket for the remainder of the year (until December 31); OR
- Wait until her coverage maximum refreshes on January 1, and begin psychotherapy sessions again.
