If you have Sun Life benefits, you may be asking, "Does Sun Life cover therapy?" It's a smart question to ask before you book. The honest answer is that it depends on your plan, the type of practitioner and the service. Sun Life plans are set up by employers and groups, so two people with Sun Life cards can have very different coverage. This guide explains what to look for, and how to check your own plan without any guesswork.
We're a counselling clinic, not Sun Life, and we can't see your plan or promise what it pays. This article is general information only.
The short answer, and why it depends on your plan
Sun Life doesn't have one set of benefits for everyone. Your employer or plan sponsor chooses which services are included, how much is reimbursed and what the yearly limits are. That's why a friend at another company may have a very different answer than you do.
Three things decide whether a session is covered:
The type of practitioner you see
The service itself, such as therapy, couples counselling or an assessment
The wording of your plan, including limits and the date it was set up
CAMH points out that some plans only cover services up to a certain amount, and only for certain types of therapists. For example, a plan might include psychologists but not social workers. So it's best to check before the first session, not after.
Which practitioner types plans may include
Sun Life has said that, for new clients on its standard extended health care (EHC) plans, psychotherapists and clinical counsellors were added from May 12, 2024. They sit alongside psychologists and social workers, and coverage limits didn't change. Sun Life's workplace benefits news page describes the update and says claims are assessed on the practitioner's regulated credentials.
This doesn't mean every Sun Life plan works this way. Older plans and custom plans may differ, and your employer sets the limits. Treat it as a good reason to check, not a promise. The only way to know for certain is to look at your own plan.
It also helps to know who the professionals are. The Ontario government's page on regulated health professions explains that psychologists assess and diagnose and also treat, while registered psychotherapists assess and treat emotional, cognitive and behavioural difficulties through therapy. At our clinic, psychologists assess and diagnose, Nurse Practitioners can assess, diagnose and prescribe, and Registered Psychotherapists (RPs) and Registered Social Workers (RSWs) provide therapy.
Titles matter more than you might expect. A word like "counsellor" is used in many ways, and plans can name the specific titles they accept. So don't assume that a person with a title is covered, or that they aren't. Ask Sun Life how your plan words it, and ask any clinic exactly which professional title your therapist holds.
If you want to look at social work specifically, see our page on Sun Life and registered social workers. This post looks at the wider picture.
Shared maximums, what they mean for you
Many plans put several practitioner types under one yearly limit. That's what people mean by a "shared maximum." In plain words, it's one pot of money for the year. If your plan lumps psychologists, social workers and psychotherapists together, a session with any of them draws from the same pot.
Here is what that can mean in everyday life:
If you've already used part of the limit on one type of practitioner, there's less left for another.
Limits often reset on a set date, such as the start of a calendar year or your plan year.
Some plans also set a percentage they reimburse, or a limit per visit.
We aren't quoting any amounts here, because they vary by plan and change over time. Your benefits booklet or online account is where the real numbers are. If your limit runs out, our free consultation is a good time to talk about options, including student therapist sessions at $0 to $80 and Health Spending Accounts, which we accept.
If your plan doesn't include the practitioner type you wanted, that doesn't mean you're out of options. You might ask whether a different type of practitioner is covered, or whether part of the cost is. It also helps to know that individual sessions at our clinic range from $130 to $200, so you can plan around what your plan pays and what it doesn't.
Psychological assessments, and what to ask about them
Assessments are a different service from weekly therapy. In Ontario, psychologists can assess and diagnose. Whether your plan pays for an assessment depends on how it's worded, and some plans treat it differently from therapy. We can't tell you which applies to you.
The word "assessment" can cover quite a lot. NIMH explains that an adult ADHD assessment may include interviews, rating scales and psychological tests. A plan may pay for the whole assessment, some parts or none of it.
When you check, use the exact name of the service, such as "psychological assessment" or "ADHD assessment." Then ask:
Does an assessment count toward my psychology line?
Does it share a maximum with therapy?
Is any paperwork needed, or a particular type of professional?
Assessment fees depend on the service, and we go over them with you in the free consultation. Our team can explain what we offer when you reach out.
Claiming and direct billing
There are two common ways to use your benefits. With pay-and-claim, you pay the clinic and send your receipt to Sun Life for reimbursement. With direct billing, the clinic bills the insurer, and you pay only the part your plan doesn't cover.
We can direct bill many plans, and depending on your plan, your insurance may cover the full session fee. We can't promise direct billing for every plan, and we'll confirm what's possible for yours. Our post on Sun Life direct billing for therapy in Ontario explains the update when it was announced.
If you pay and claim, keep your receipt and ask the clinic what details it shows, since insurers often want specific information on a claim. If we direct bill, you'll know at the start what's expected from you, so there are fewer surprises later. Even with direct billing, it's smart to know your plan first. Sun Life's check your coverage page explains how to look up your plan details online. You can also read your benefits booklet, which lists the practitioners and services your plan includes.
Questions to ask before you book
Whether you call Sun Life or check your account, these questions help:
Which practitioner types are covered, and do they include psychologists, RPs and RSWs?
Is there a shared maximum, and how much of it have I used?
Is there a per-visit limit, or a percentage reimbursed?
Is the exact service I want covered, whether therapy, couples therapy or an assessment?
Do I need a referral or any paperwork? (No referral is needed to see us.)
Can the clinic direct bill, or do I pay and claim?
When does my yearly limit reset?
Before you call, it helps to have these ready: your plan or group number, your member ID, the practitioner type you're thinking of seeing and the name of the service, such as therapy or an assessment. Having them nearby makes the call faster and the answer clearer.
NIMH also suggests asking any therapist about their fees and whether they accept insurance. Its guide to psychotherapies is a helpful read. Write down the answers and the date you asked, in case you need to refer back to them later. If an answer seems unclear, it's fine to ask again, or to ask for it in writing. Plans can be confusing, and you're not expected to be an expert in how yours is worded.
Next step, a free consultation
You don't have to sort this out alone. Book a free 15-minute consultation to ask about our team, our fees and how billing works. Our team can help you check your card before your first session. Our guide to counselling and insurance in Ontario has more background.
Individual sessions are $130 to $200, and couples or family sessions are $170 to $200. There's a $50 one-time new client setup fee, which isn't charged for the free consultation. We don't have a waitlist, and evening and weekend appointments are available. We see clients in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario.