Pediatric Occupational Therapy Insurance Coverage

Navigating insurance coverage for pediatric occupational therapy (OT) can be confusing for families. At Young Sprouts Therapy, we want to make it easier for you to access the support your child needs. Many Canadian extended health benefit plans include coverage for occupational therapy services for children. This guide will help you understand what is typically covered, how to verify your benefits, and how to make the most of your insurance plan for pediatric OT.

Does My Insurance Plan Cover Pediatric Occupational Therapy?

Most extended health benefit plans in Canada offer coverage for occupational therapy services, including those for children and youth. Coverage details vary by provider and plan, so it is important to check with your insurance company or workplace HR department. Ask about your annual maximums, eligible services, and any requirements for claims. Some plans may require a physician's referral for reimbursement.

Why Occupational Therapy Matters for Children

Occupational therapy helps children develop the skills they need for daily life, including fine and gross motor skills, sensory processing, self-care, and independence at home and school. Early access to OT can make a significant difference in your child's development and confidence. Insurance coverage can help make these essential services more affordable for families.

Insurance Providers That Commonly Cover Occupational Therapy

Many major Canadian insurance companies cover pediatric occupational therapy, including:

• Manulife
• Sun Life
• Canada Life
• GreenShield
• Blue Cross
• Desjardins
• Telus Health
• ClaimSecure
• And more…

Coverage amounts, eligible services, and claim processes may differ. Always confirm your child's eligibility and the therapist's credentials with your provider.

Questions to Ask Your Insurance Provider

To ensure your child's OT sessions are covered, contact your insurance provider and ask:

• Are pediatric occupational therapy services covered under my plan?
• What is the annual maximum for occupational therapy?
• What percentage of the session cost is reimbursed?
• Is there a per-session or per-visit cap?
• Is a physician's referral required for reimbursement?
• How do I submit claims (online portal, mobile app, mail)?
• Are group or school-based OT services covered?

Getting clear answers will help you avoid surprises and ensure your claims are processed smoothly.

How to Maximize Your Insurance Benefits

Once you know your coverage, you can take steps to make the most of it:

• Review your policy and highlight occupational therapy benefits
• Choose a registered occupational therapist (OTR or OT Reg. Ont.)
• Keep all receipts and documentation for claims
• Submit claims promptly and follow your insurer's instructions
• Ask about coverage for virtual or in-person OT sessions

Being proactive can help you stretch your coverage and reduce delays in reimbursement.

How Payment and Reimbursement Works

Most families pay for OT sessions up front. After each session, you'll receive a detailed receipt with all the information your insurance company needs: therapist's name, registration number, service type, date, duration, and amount paid. Submit your claim through your provider's portal or app for reimbursement.

Direct Billing or Reimbursement

Direct billing for occupational therapy is less common, but some clinics may offer it. Most often, you pay first and are reimbursed by your insurer. Always check with your provider about their process.

What to Know Before Booking Pediatric OT

Confirm your coverage before booking your child's first OT session. Some plans have restrictions on the number of sessions, eligible providers, or require a referral. Understanding your benefits up front helps you plan for your child's care and avoid unexpected costs.

Choosing the Right Occupational Therapist for Your Child

Selecting the right OT is important for your child's progress. Look for a therapist registered with the College of Occupational Therapists of Ontario (COTO), with experience in pediatric care. Ask about their approach, experience with your child's needs, and whether they offer in-person or virtual sessions.

Ready to Book Pediatric Occupational Therapy?

Once you've confirmed your insurance coverage, you can book an appointment with one of our pediatric occupational therapists. We're happy to answer any questions about services, pricing, or the reimbursement process. Occupational therapy is an investment in your child's future, and we're here to support your family every step of the way.

Frequently Asked Questions About Insurance & Pediatric OT