What Are Extended Health Benefits?

Extended health benefits (also called supplemental health benefits or group benefits) are additional health coverage beyond what your provincial plan provides. Most Canadians receive extended health benefits through their employer as part of a group benefits package. These plans cover services like prescription drugs, dental care, vision, physiotherapy, massage therapy, and mental health counseling.

What Do Extended Health Benefits Typically Cover in Canada?

Prescription Drug Coverage

Most extended health plans include a drug benefit that covers prescription medications not covered by your provincial formulary. Typical coverage is 80–100% of the drug cost, up to an annual maximum. Some plans use a preferred drug list — you may pay more if your doctor prescribes a brand-name drug when a generic exists.

Dental Benefits

Dental coverage under extended benefits plans is usually split into three levels:

  • Basic dental — Covers routine exams, cleanings, X-rays, fillings. Most plans cover 80% of basic dental up to an annual maximum of $1,000–$2,000.

  • Major dental — Covers crowns, bridges, dentures. Typically covered at 50%, with a separate higher annual maximum.

  • Orthodontics — Braces and aligners. Often covered at 50% of actual costs, with a lifetime maximum of $1,500–$3,000 per insured person.

Vision Care

Extended vision benefits typically cover $150–$400 every 24 months for prescription eyeglasses or contact lenses, plus one eye exam per 24 months. Laser eye surgery (LASIK) may be partially covered under some plans, up to a flat amount.

Paramedical Services

Paramedical coverage reimburses sessions with registered health practitioners, typically including:

  • Physiotherapy — $500–$1,000/year

  • Massage therapy — $400–$800/year

  • Chiropractic care — $300–$600/year

  • Naturopathic medicine

  • Registered dietitian

  • Speech-language pathologist

  • Psychologist or registered psychotherapist

Mental Health Coverage

Since 2020, many Canadian employers have significantly expanded mental health benefits in response to growing demand. Extended plans increasingly include:

  • $1,000–$2,500/year for psychologist or registered psychotherapist sessions

  • Employee Assistance Programs (EAP) with 3–8 free counseling sessions

  • Virtual therapy platforms (e.g., Dialogue, Inkblot) as an included benefit

Other Common Benefits

  • Medical equipment and supplies (crutches, blood glucose monitors, compression stockings)

  • Private or semi-private hospital room upgrades

  • Out-of-country/travel emergency health coverage

  • Ambulance fees

  • Accidental death and dismemberment insurance

  • Life insurance (usually included in group packages)

How to Submit a Claim for Extended Health Benefits

The claims process varies by insurer, but the general steps are:

  • Check your policy — Confirm the service is covered and review any co-payment amounts or annual limits.

  • Get a receipt — Ensure the receipt from your healthcare provider includes their name, registration number, date of service, diagnosis code (for drugs), and amount paid.

  • Submit online or by mail — Most major insurers (Manulife, Sun Life, Great-West Life, Blue Cross) have mobile apps and web portals for direct submission. Pharmacy claims are often processed automatically at the point of sale.

  • Coordinate benefits — If you and your spouse both have coverage, coordinate benefits to maximize reimbursement. Typically you claim from your own plan first, then submit the remainder to your spouse’s plan.

What Happens to Your Extended Benefits When You Leave a Job?

Group extended health benefits end when your employment ends (or after a short grace period, usually 31 days). You have several options:

  • Conversion privilege — Most Canadian group insurers allow you to convert your group coverage to an individual plan within 31–60 days of leaving your job, without medical underwriting. This is valuable if you have pre-existing conditions.

  • New employer coverage — If joining a new employer with benefits, you may be eligible immediately or after a probationary period (usually 3 months).

  • Individual purchase — Compare individual plans from major insurers. Apply within 90 days of losing employer coverage for best eligibility.

  • COBRA equivalent (not applicable in Canada) — Unlike the US, Canada has no federal COBRA law, but provincial laws and insurer policies govern conversion rights.

Health Spending Accounts (HSA) — A Flexible Alternative

Health Spending Accounts (HSAs) are an increasingly popular supplement or alternative to traditional group benefits. An HSA is a tax-free account funded by your employer that you can use to pay for any CRA-eligible medical expense. Advantages include:

  • Flexibility — spend on any eligible medical expense, not just pre-defined categories

  • No “use it or lose it” in many plan designs (unused amounts carry forward)

  • Particularly popular among small business owners and the self-employed

  • Employer contributions are a tax-deductible business expense; employee receipt is tax-free

Extended Benefits for Self-Employed Canadians

If you are self-employed or a sole proprietor without access to employer group benefits, your main options are:

  • Individual health and dental insurance from major insurers

  • Professional or industry association group plans

  • Personal Health Services Plan (PHSP / HSA) — allows self-employed Canadians to deduct medical expenses through their business

  • Group plans through spouse/partner’s employer (if applicable)

A licensed group benefits advisor can help design a cost-effective structure that balances personal tax efficiency with health coverage needs.