Can employer mental health benefits fully cover a private ADHD clinic assessment in Ontario?

Employer mental health or extended health benefits in Ontario can pay a large share of a private ADHD clinic assessment, but they do not fully cover every invoice for every employee, and OHIP will not pay the private psychologist fee. OHIP covers medically necessary physician and nurse practitioner services; private psychoeducational or ADHD clinic testing is not listed as an OHIP insured physician service. Group plans are private contracts. Some reimburse registered psychologists under a mental health or paramedical maximum, some use a health spending account, and some exclude assessments or pay only short counselling units. Annual dollar caps, per-visit limits, and eligible-provider lists matter more than the clinic's sticker price. Rules, coverage and referral pathways vary by province and can change; confirm the current position with the relevant institution or provincial program. References: https://www.nice.org.uk/guidance/ng87/chapter/recommendations

Different experience, still just mine, and only personal experience. I thought mental health benefits in Ontario meant the whole private clinic fee. The insurer paid the psychology hourly maximum and refused the rest as educational testing. I am sharing my claim result, not a national rule. Coverage clearly varies by plan even inside one company depending on the class of benefits.

This is only my personal experience in Ontario. My employer's mental health benefit covered most of a private ADHD assessment after I submitted a psychologist invoice, but I still paid a leftover amount because of the annual cap. A teammate with a thinner plan got only a few sessions worth. I am not saying every workplace plan will nearly cover it.