How to Read and Understand Your Benefits Booklet
Intro: Your Insurance Plan Isn’t a Mystery — If You Know What to Look For
Most Canadians have extended healthcare benefits through their employer — yet few actually understand what their benefits booklet says.
If you’ve ever opened your insurance PDF and thought:
“Do I need a referral? What’s a co-pay again? What’s covered exactly?”
You’re not alone. The good news is, you don’t have to be a lawyer to decode it.
Let’s break down the key terms, sections, and red flags so you can use every dollar of your benefits with confidence — and never miss out again.
📘 What Is a Benefits Booklet?
It’s the official document that outlines:
- What’s covered under your health plan
- How much coverage you have per service
- What steps are needed to claim it
Usually provided by insurers like Sun Life, Manulife, Canada Life, GreenShield, and more — the booklet can be 10–60 pages long, depending on your group or employer plan.
🔍 Key Sections to Look For (And What They Mean)
| Section Title | What It Tells You |
| Extended Health Benefits | The umbrella coverage including massage, chiro, physio, etc. |
| Paramedical Services | Specific allowances per practitioner (e.g., $500/year for massage) |
| Eligibility | Who’s covered (you, spouse, dependents) and under what terms |
| Coordination of Benefits | If you can use another plan (like your spouse’s) |
| Co-Pay / Co-Insurance | How much you must pay out of pocket per visit |
| Deductible | The amount you pay before coverage kicks in (usually $0 for paramedical) |
| Coverage Limits | Max amount per year/service or per visit |
| Reimbursement Details | Submission deadlines, what’s required (receipts, referrals) |
📊 3 Numbers to Know Inside Your Booklet
- Annual Limit per Service
– Example: Massage Therapy = $750/year - Coverage Percentage
– Example: 80% covered = You pay 20% per visit - Per Visit Cap
– Some plans only pay up to $60/session even if your massage costs $100
💡 Tip: Some plans look generous at first glance, but only reimburse $20–$40 per visit if you don’t check the fine print.
🧾 What to Look for in the Fine Print
- Doctor’s referral required? Some plans need a note for massage therapy.
- Claim submission deadline? Miss it, and you could lose reimbursement.
- Shared family pool? Your $500 may be shared with your partner or children.
- Direct billing allowed? Some insurers don’t allow it, meaning you must pay up front and get reimbursed.
💬 Not sure what your plan says? Ruby at insurance.rmtclinic.net can help read and explain your benefits booklet for you.
✅ How to Use Your Booklet the Right Way
- Download a copy and highlight key limits (paramedical, chiro, physio, etc.)
- Ask your HR department to clarify any confusing sections
- Use RMTClinic.net to find clinics that match your insurance plan’s coverage
- Bookmark your insurer’s login portal to track claims and coverage in real-time
🧠 Pro Tip: Match Clinic Services to Your Plan Before Booking
Not every clinic offers insurance-eligible services.
✅ Use RMTClinic.net to search only RMTs and clinics recognized by major insurers.
Let Ruby guide you to clinics that:
- Understand your specific plan
- Direct bill your provider
- Offer detailed receipts that match submission requirements
✅ Action Steps
- 📑 Upload your benefits booklet for review → RMTClinic.net/insurance
- 🔍 Search insurance-friendly RMTs → RMTClinic.net
- 💬 Ask Ruby to explain your plan in plain English → insurance.rmtclinic.net
