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Treatment

Treatment refers to any medical, dental, or therapeutic care provided by a licensed healthcare professional to diagnose, manage, or improve a health condition, injury, or disease. In the context of insurance, treatment includes all services, procedures, medications, and interventions that are deemed medically necessary to restore or maintain health. It can range from routine doctor visits and prescription drug use to surgery, rehabilitation, and specialized therapies.

How It Works

Insurance plans use the term treatment to determine eligibility for reimbursement, so a covered treatment must be performed or prescribed by an approved provider such as a physician, dentist, or paramedical practitioner. Under the Canada Health Act, provincial and territorial public health insurance plans must cover all medically necessary hospital, physician, and certain surgical-dental services, called insured health services, where hospital services are insured only if they are medically necessary for the purpose of maintaining health, preventing disease, or diagnosing or treating an injury, illness, or disability. These provincial and territorial plans cover most of a person's health care needs such as hospital and doctor visits, but may not cover other health care or paramedical services like prescription drugs, dental care, and vision care, which workplace or personal health insurance can help pay for. The cost of a treatment may be subject to deductibles, coinsurance, or annual maximums depending on the plan design, and some policies require pre-authorization for certain procedures or impose waiting periods before specific treatments are covered.

Example:

If your dentist fills a cavity or your physiotherapist provides therapy sessions for a back injury, both are considered treatments, and your private or workplace health plan reimburses a portion of the cost based on your dental or paramedical coverage. Because provincial health plans in Canada typically do not cover routine dental or paramedical care, these are the kinds of treatments private plans are designed to help pay for.

What to Watch For:

When checking a private health insurance policy, confirm whether the insurer only covers a percentage of the claim or only covers a maximum annual amount. Some insurers distinguish between medically necessary and elective treatments, covering only the former, so for expensive or ongoing care it is advisable to request pre-authorization to confirm coverage and avoid claim denials.

Related Terms

Provider

A provider is a licensed healthcare professional, facility, or service organization that delivers medical, dental, vision, or paramedical care to patients. In the context of insurance, a provider is any individual or entity authorized to perform covered services and submit claims for reimbursement to an insurer. Providers include physicians, dentists, pharmacists, physiotherapists, chiropractors, optometrists, hospitals, and clinics.

Prior Authorization

Prior authorization is the process through which an insurer reviews and approves certain medical treatments, procedures, or prescription drugs before they are performed or dispensed. It ensures that the recommended care is medically necessary, appropriate, and covered under the policy before expenses are incurred. Prior authorization helps manage costs and ensures the use of safe, evidence-based treatments that align with clinical guidelines.

Health Insurance

Health insurance is a type of coverage that helps pay for medical and healthcare expenses not fully covered by Canada’s public health system. It protects individuals and families from the high cost of prescription drugs, medical services, and treatments that fall outside provincial or territorial government health plans. Health insurance can be obtained through an employer’s group benefits plan or purchased individually from a private insurer.

Healthcare Spending Account (HCSA)

A Healthcare Spending Account (HCSA) is a flexible, employer-funded benefit that reimburses employees for a wide range of eligible healthcare expenses not fully covered by their group insurance plan or a government health plan. It allows employees to use allocated funds toward medical, dental, and vision expenses based on their personal needs. The Canada Revenue Agency (CRA) regulates which expenses qualify under the Income Tax Act, and reimbursements from an HCSA are received tax-free.

Coverage / Benefit

Coverage, sometimes referred to as a benefit, is the range of health or dental services, supplies, or treatments that your insurance plan agrees to pay for under its terms and conditions. Each benefit represents a category of care, such as prescription drugs, dental services, vision care, or paramedical treatments.

Relevant Plans

Plans that relate to Treatment

Alberta Blue Cross - Blue Assured - Basic

Alberta Blue Cross - Blue Assured - Basic

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced

Alberta Blue Cross - Blue Assured - Enhanced

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced+

Alberta Blue Cross - Blue Assured - Enhanced+

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Premium

Alberta Blue Cross - Blue Assured - Premium

Can apply at anytime, at any age.

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