Tuesday, September 16, 2025 Understanding Your CLAC Benefits Plan Avoid the surprise of an out-of-pocket expense by knowing about reasonable and customary limits Ontario Construction Healthcare benefits are valuable for promoting personal health and well-being. But when inflation or benefits usage surges, employers and employees can easily experience higher benefits costs due to health insurance premium increases. To keep benefits affordable, insurance companies control costs by setting maximum limits. Most members know that paramedical services, like massage, or osteopathy have annual limits. Under CLAC’s plan, the annual per person limit is $600 for most paramedical specialties. Aside from annual limits, insurance companies also apply per visit maximums, which in the health insurance industry are referred to as the reasonable and customary limits (R&C). Members are often unaware of this per visit maximum, and it can sometimes take them by surprise. Reaching the per visit maximum (the R&C limit) happens when a care provider, like a hotel’s masseuse, charges an amount for the service that is in excess of the insurer’s R&C limit. Reasonable and customary limits serve to Lower the potential impact of benefit plan cost increases to plan members. Encourage the responsible use of benefits. Prevent fraud by setting established limits, which makes fraudulent claims easier to identify and address. Discourage unreasonable fee increases from service providers. (Providers generally set the price of services around the R&C limit to avoid losing customers to competitors over their dissatisfaction with out-of-pocket costs.) Like all insurance companies, the benefits provider that CLAC uses also has R&C limits. Below, for example, is the R&C limit for massage therapy. Note how the limit changes based on the length of the visit. A 30-minute massage has a different limit than a one-hour massage. length of massage service – percentage of R&C to pay up to the per visit maximum* 2025 R&C For example, the insurer will pay up to $34.80 if the massage is 15 minutes or up to $116.00 if it is one hour, etc. 15 min – 30% $34.80 30 min – 60% $69.60 45 min – 75% $87.00 60 min – 100% $116.00 75 min – 125% $145.00 90 min – 150% $174.00 105 min – 175% $203.00 120 min – 200% $232.00 *Subject to the annual maximum of the paramedical specialty, massage therapy R&C limits for various paramedical services and other supplies are shown below. Note how adjustments are implemented when appropriate, not necessarily on an annual basis. The R&C amounts listed below represent a measured unit of service time, if applicable, according to the specialty service. In the case of massage, for example, the amount listed is for one hour of service. Service 2025 R&C 2024 R&C 2023 R&C Acupuncturist $104 $100 $95 Chiropodist Initial $100 $100 $100 Chiropodist subsequent $68 $65 $63 Podiatrist Initial $160 $160 $152 Podiatrist subsequent $85 $85 $85 Chiropractor initial $115 $110 $105 Chiropractor subsequent $75 $75 $75 Eye Exam $160 $158 $150 Massage Therapist* $116 $111 $109 Naturopath initial $230 $221 $210 Naturopath subsequent $189 $182 $173 Osteopath initial $150 $144 $137 Osteopath subsequent $130 $130 $130 Physiotherapist initial $135 $135 $135 Physiotherapist subsequent $94 $90 $87 Psychologist initial $250 $245 $236 Psychologist subsequent $244 $234 $230 Master of Social Work (MSW) $170 $163 $160 Counsellor, Social Worker $170 $169 $163 Psychotherapist $184 $184 $175 Speech Therapist $177 $170 $164 Breast Pump $505 $505 $505 Breast Pump, rental $110 $110 $105 To confirm a current R&C limit, you can always contact the helpful staff on the CLAC Benefits Team at 1-800-463-2522. Avoid the surprise of an out-of-pocket expense by knowing your R&C limits. Check with a service provider before engaging the service. Knowing the limit can help you reduce or eliminate an out-of-pocket expense. In some cases, you may want to talk to your provider about adjusting the service appointment length, or you might choose a care provider whose fees are more in line with the R&C. By using your benefits responsibly, you can promote your and your family’s health and wellbeing, while supporting the value of plan benefits for all members. You might be interested in Why We Work Safely 5 Jun 2026 Standing Your Ground, and Staying Steady on the Job 4 Jun 2026 CLAC Partners with Alberta Government to Advance Skilled Trades Training and Accelerate Certification 4 Jun 2026 Strathcona Mechanical Workers Ratify New Agreement Providing Wage, Scheduling Improvements 3 Jun 2026