If your benefits include a health spending account, you may be wondering whether you can use it for therapy. It's a fair question, and the honest answer is that it depends on your plan. This guide explains what a health spending account is in plain terms, what to ask before you book, and how receipts usually work, so you can plan with confidence. We can't promise what any plan will pay, and nothing here is tax or benefits advice.
If you'd like to talk through your situation, we're happy to help. We accept Health Spending Accounts, and our admin team can answer questions about receipts and billing in the free 15-minute consultation.
What a health spending account is, in plain terms
A health spending account (HSA) is a benefit, often from an employer, that gives you a set amount of money each year to put toward eligible health costs. Different insurers use different names, such as health care spending account (HCSA), but the idea is similar.
Canada Life describes its healthcare spending account as an amount in credits each year that you can use for eligible medical expenses that aren't covered by your workplace benefits or provincial health care plan. It also says unused credits can't be taken as cash, but some accounts let you carry them forward. Medavie Blue Cross says its Health Spending Account lets you claim reasonable medical expenses not reimbursed by a public or private health care plan, including amounts above plan maximums.
Those are examples from two insurers. Your own plan may work a little differently, so your plan booklet is the best place to start.
Therapy and counselling as possible HSA expenses
Many people ask whether therapy "counts." The truthful answer is that it depends on your plan. Each plan decides what it will reimburse, and rules can change from one employer to the next.
It can help to know why plans have rules at all. The Canada Revenue Agency (CRA) explains that, for an employer's plan to be treated as a private health services plan, among other conditions, all or substantially all of what it pays for must be expenses eligible for the medical expense tax credit. That is one reason plans may limit what counts. It doesn't tell you what your own plan includes.
So please treat any list online, including this one, as a starting point. The only reliable answer comes from your plan booklet or your plan administrator.
Practitioner types people often ask about
Plans can word this part in different ways. Some may list provider types by title, such as psychologist, registered psychotherapist or registered social worker. Others may use broader wording, and some may set limits. We can't tell you which titles your plan accepts.
At our clinic, Registered Psychotherapists (RPs) and Registered Social Workers (RSWs) provide therapy, and psychologists provide assessments and diagnosis. When you check with your plan, you can ask, "Does my HSA cover sessions with a registered psychotherapist or a registered social worker?" and "Is there a list of accepted provider types?" Then you'll have a clear answer in your own words.
How to check your HSA before you book
A few quick questions can save you a surprise later. Here's a handy list to take to your plan administrator or to look for in your booklet:
What's my current balance? And does it reset on a certain date?
Is counselling or psychotherapy an eligible expense? And are there any limits?
Are there provider requirements? For example, does the plan list accepted titles?
What's the claim deadline? Many plans have one, and you'll want to know it.
What happens to unused credits? Canada Life notes that some accounts allow carry-forward. Others may not.
Do I need anything from a provider? Some plans ask for extra paperwork.
How do I submit a claim? Through an app, a website or a form?
Keep a note of the answers and the date you asked. It makes things easier if a claim is questioned.
Receipts and claims
Receipts are the key to most claims. Medavie's page on submitting a claim says a receipt for your payment is always required, an itemized statement may be required for certain benefits, and the requirements vary by plan. Your own insurer or administrator will have its own rules.
For tax purposes, the CRA says a receipt should show the purpose of the payment, the date, the patient and, where it applies, the professional who gave the service, according to its medical expense tax credit folio. That's a helpful guide to what a good receipt includes, though your plan may ask for more.
Some people pay for the session first and then submit a claim. Depending on your plan, we may be able to bill the insurer directly. Direct billing is available for many plans, and you can read about it on our direct billing page. If you aren't sure how your plan works, ask about it in the free consultation.
How HSAs fit with regular insurance benefits
Many people have both regular benefits and an HSA. The two insurers above describe the HSA as covering costs that other coverage doesn't. Canada Life says its account is for expenses not covered by workplace benefits or provincial health care, and Medavie says its account covers expenses not reimbursed by other plans.
So a common idea is to use your regular benefits first and your HSA for what's left. Please don't treat that as a rule, though. Order, limits and what counts all depend on your plan, so check how yours works before you pay for a session.
If you also plan to claim therapy on your taxes, the CRA says that generally you can claim only the part of a medical expense that you haven't been, and won't be, reimbursed for. It explains this on its page about eligible medical expenses. For anything tax-related, check with the CRA.
If a claim isn't approved
Sometimes a claim comes back with a "no," and it can feel discouraging. Try not to take it personally, because it's often about the plan's rules, not about you or your need for support. A few steps can help:
Ask for the reason. Find out which rule applies, such as a limit, a provider type or missing information.
Check what's missing. Sometimes a claim just needs an itemized statement or a clearer receipt.
Ask whether you can resubmit. If more information would help, find out how to send it.
Tell us. If you have questions about your receipt, ask our admin team, and we'll do our best to help you understand it.
A decline doesn't mean you can't get support. It may mean you want to look at other options, like student therapist sessions at $0 to $80.
What therapy costs at our clinic
We believe cost information should be easy to find. Individual sessions with our Registered Psychotherapists and Registered Social Workers are $130 to $200, and couples or family sessions are $170 to $200. Student therapists offer sessions for $0 to $80. There's a one-time $50 setup fee for new clients, and it isn't charged for the free consultation. Psychologist fees depend on the service, and we go over them with you in the free consultation.
Depending on your plan, your insurance may cover the full session fee. You can find more on our cost page and our insurance coverage guide. We see clients in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario.
Next step
You don't need to have all the answers about your plan before you reach out. Book a free 15-minute consultation and ask us about your health spending account, receipts and billing options. We'll help you work out what to check with your plan, and you can decide from there.