Welcome to the Understanding Extended Health Care guide. This guide is designed to be a one-stop, leading practices resource.
It is thoughtfully designed to help you care for Ontarians by facilitating accurate, efficient and transparent interactions with extended health care (EHC) insurers. It provides you with information, infographics, checklists, a glossary of terms, supplementary reading suggestions and more.
We developed this guide in consultation with the OCA Extended Health Care Advisory Council.
Privately administered EHC insurance comes in individual and group forms. The latter is the most common. Typically employers (plan sponsors) offer it to employees (plan members) as part of their total compensation packages.
EHC coverage products may include EHC insurance, health spending accounts or personal spending accounts. Many people rely on EHC coverage to pay for health services not covered by the publicly administered Ontario Health Insurance Plan (OHIP) or the Workplace Safety and Insurance Board (WSIB).
Most chiropractors deliver some, if not all, of the care they provide to patients through the private health care system. Indeed, an Environics survey the Ontario Chiropractic Association (OCA) commissioned in 2019 found that four out of five chiropractic patients in Ontario pay for their care through private insurance coverage.
Beyond being a crucial source of payment for chiropractic care, EHC administration is a complex and rapidly evolving field. We developed this guide to assist you in understanding:
- How the field is changing
- What this means for your practice
- How you can use this knowledge to support your patients and build relationships of trust and transparency with EHC insurance providers
Organization of the Guide
We organized this guide into ten distinct sections covering a wide range of topics, including how to register with third-party direct billing services; billing and receipts leading practices; virtual care; EHC insurance for products and services and fraud prevention and awareness.
This guide also contains lots of practical checklists, templates, and infographics. There is also a separate Patients Guide, which includes frequently asked questions (FAQs) to help clarify commonly misunderstood issues, as well as an Additional Resources list.
We designed this guide to enhance the support and services we provide to you. We welcome your feedback so we can continue and provide the timely and important information you need as a health care professional.
 Please note, we recognize there are instances where unions and associations also sponsor EHC benefit plans. Likewise, there are situations where an employee is not necessarily enrolled in a benefits plan, and therefore not a plan member. For simplicity, we use “employee” and “employer” throughout this guide.