January 8, 2025
R&C limits refer to the maximum allowable amount that an insurance carrier will reimburse on a particular service or item. This amount usually reflects the typical cost associated with this service or product in a specific geographical region where the charge was incurred.
For example, if a plan member who resides in Ontario submits a claim for a chiropractor initial consultation with a service charge of $200, Manulife, our insurance carrier, will refer to their R&C limits guideline in order to determine the amount of claim reimbursement. If the current R&C limit for this type of service in Ontario is $180 the member would be reimbursed $180 and would be out of pocket the other $20.
Why are R&C limits important?
Higher rates drive higher plan costs. R&C limits are important to ensure claims to your benefits plan are not excessive. Therefore, smart shopping on your part for health-care products and services helps by not only reducing your out-of-pocket expenses, but also helping to reduce benefits plan costs. R&C limits also help reduce the likelihood of benefits fraud or abuse. Together, this means a healthier plan with more sustainable benefits.
How do I find out what my R&C limits are?
To view Manulife’s R&C amounts:
Since R&C limits may change over time without notice, please review this information before starting a new medical treatment or using a new paramedical or medical service provider. OTIP is also there to help. If you have questions about R&C limits, or how they might impact you, call OTIP at 1‑866‑783‑6847.
The information in this document is provided by OSSTF Benefits for general information only. OSSTF Benefits endeavours to have all information current and accurate. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, or suitability of the information included. All information is subject to change without notice.
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