Hidden Limits in Your Insurance Plan

SPECIAL REPORT: Hidden Limits in Your Insurance Plan

Intro: It’s Not Just What’s Covered — It’s What’s Not Mentioned

Many Canadians look at their benefit coverage and think:

“Great — $500 for massage! That should cover me.”

But here’s the catch: that $500 might come with hidden rules, restrictions, and exclusions that dramatically reduce what you can actually use.

These \”hidden limits\” are rarely explained up front — and can lead to claim rejections, unexpected out-of-pocket costs, or wasted benefits.

Let’s shine a light on the fine print that insurers don’t always make clear.

🔍 Common Hidden Limits You Should Watch For

Hidden Limit	What It Means	Impact
Per-visit caps	Only reimburses up to a fixed dollar amount per session	You may get $40 back on a $100 visit
Shared benefit pools	Massage, physio, and chiro draw from the same yearly max	You may run out faster than expected
RMT-only restrictions	Only services by Registered Massage Therapists qualify	Non-RMT services not eligible, even if massage
Doctor referral required	Some plans need a medical note before claims are paid	No referral = claim denied
Tiered reimbursement	Different coverage levels for different services	Massage = 80%, chiro = 50%
Session limits	Some insurers limit number of visits per year	Example: 10 massages max, regardless of amount left
Non-standard billing forms	Clinics must follow specific receipt format	Incorrect receipts = claim delay or denial

📘 Why These Limits Exist

Insurance companies want to:

• Control rising costs
• Prevent overuse
• Ensure compliance with professional regulations

While these goals are valid, the lack of transparency often causes frustration — especially when patients don’t find out until after a claim is rejected.

🧠 Real Examples from Real Plans

• A Canada Life plan may list $500 for massage, but only $40/session will be reimbursed
• Manulife plans may require a referral after 5 visits, even if your booklet doesn’t clearly say so
• Sun Life plans may pool massage, physio, and chiro into one shared $700/year limit

💡 Knowing these rules in advance can help you stretch your coverage and avoid surprises.

🧾 How to Identify Hidden Limits in Your Own Plan

• Download and read your full benefits booklet, not just the summary
• Call your insurer and ask:
  “Are there per-session limits or referral requirements for massage?”
• Check the provider requirements: must they be licensed? Can they be interns?

💬 Ruby at insurance.rmtclinic.net can scan and interpret your benefits booklet with you.

✅ How to Protect Yourself and Maximize Coverage

• 📆 Book with RMT-certified therapists only (required by all insurers)
• 📥 Always ask for a detailed receipt that includes license number and provider details
• 📋 Request a predetermination for multi-visit care plans
• 📞 Confirm reimbursement cap before you book
• 👨‍⚕️ Get a doctor’s referral proactively if unsure

✅ Action Checklist

• 📖 Read your full benefits booklet, not just the overview
• 🧠 Ask about per-visit caps, shared limits, and provider qualifications
• 🧾 Keep clean, formatted receipts from northtormt.com/ providers
• 💬 Ask Ruby for a benefits walkthrough

🔍 Use northtormt.com/ to find clinics that match insurer rules

✍️ About the Author

Henry Tse is a Canadian business consultant and founder of the RMT Clinic Network Organization. Through years of advising both patients and practitioners, he helps Canadians make sense of their extended health plans so they can get the care they’ve already paid for.