Coverage
What Uncovered Health Care Costs an Employee in Ontario
The coverage gap is abstract until it has a price on it. These are the published 2026 Ontario figures for the care OHIP does not pay for — the numbers an employee without a plan is quoted at the front desk.
Direct answer
AEC Benefits is an Ontario group benefits brokerage, and these are the 2026 Ontario figures for care the public system does not cover. A molar root canal runs $1,417 or more at the Ontario Dental Association suggested fee. A ceramic crown is $1,349 or more, plus the lab fee. A routine dental recall exam is $96 to $182. An hour with a psychologist is $225 to $300. A private physiotherapy session is $80 to $150. The ambulance co-payment is $45, or the full $240 fee where the trip is ruled not medically necessary. None of these are unusual events, and for an employee without an employer plan every one of them is paid in full out of pocket.
$1,417+
molar root canal
Ontario Dental Association suggested fee, 2026. Endodontic work on a molar, before any crown that follows it.
$1,349+
ceramic crown
ODA suggested fee, 2026, plus the laboratory fee billed separately.
$225–$300
one hour with a psychologist
Published Ontario private-practice rates and the Ontario Psychological Association recommended fee schedule.
$45 / $240
ambulance co-pay or full fee
The co-payment applies on every trip. The full fee applies where the trip is ruled not medically necessary, under the Health Insurance Act, Reg. 552.
What you will get from this resource
- •Molar root canal and ceramic crown at the ODA suggested fee
- •What a routine recall exam costs twice a year
- •Psychology and physiotherapy at published Ontario private-practice rates
- •The ambulance co-payment, and when the full fee applies instead
- •Why the cost does not disappear when an employer skips the plan — it moves
The full 2026 Ontario table
These are published figures, not estimates from a claims file. Dental figures follow the Ontario Dental Association Suggested Fee Guide, which is the reference most Ontario practices price against. Paramedical and psychology ranges reflect published private-practice rates. Actual invoices vary by practice, and a specialist bills differently from a general dentist.
- Molar root canal — $1,417 or more
- Ceramic crown — $1,349 or more, plus lab fee
- Routine dental recall exam — $96 to $182
- One hour with a psychologist — $225 to $300
- One private physiotherapy session — $80 to $150
- Ambulance — $45 co-payment, or $240 if ruled not medically necessary
A root canal and a crown are one event, not two
This is the arithmetic that surprises people. A molar that needs endodontic work usually needs a crown afterwards to survive, because the tooth is structurally compromised once the root is treated. At the suggested fee that is $1,417 plus $1,349 plus a lab fee, on one tooth, in one stretch of weeks. An employee earning a good trades wage still has to find well over $2,700 in a month, and most people do not have that sitting idle.
What actually happens when there is no plan
They wait. That is the outcome, and it is the one employers should price rather than the invoice itself. The tooth gets worse and the appointment gets bigger. The physiotherapy that would have taken six sessions in March takes twelve in July, or does not happen and the shoulder stays limited. The counselling appointment does not get booked at all. The cost did not disappear when the plan was skipped — it moved onto the employee, and then onto the schedule as absence, reduced capacity, or a resignation.
Why psychology is the line that has changed most
Psychiatry delivered by a physician is covered by OHIP. Psychologists and counselling outside a hospital are not, and that is where the actual demand sits. At $225 to $300 an hour, a course of therapy is a four-figure commitment paid entirely privately. This is why psychology limits on employer plans have moved so sharply in recent years, and why an old plan carrying a $500 annual psychology maximum is carrying roughly two sessions.
Related: What OHIP does not cover — The full scope ledger these prices sit outside of.
Decision Signals
Use these signals to decide whether the next step is a quote, a renewal audit, or a deeper plan-design review.
| Situation | Signal | Next Move |
|---|---|---|
| You are comparing a plan quote against doing nothing | The annual premium is close to the cost of one root canal and crown | That is the correct comparison to make, and it usually only takes one claim to settle it. |
| Your plan has a psychology maximum set years ago | The limit is $500 or less per year | At current Ontario rates that is about two sessions. Review the limit, not just the premium. |
| An employee keeps deferring dental work | They have coverage but a high co-insurance share on major work | Major-work co-insurance is where deferral starts. Check that tier specifically. |
| You are pricing total compensation against a competitor | You are comparing hourly rates only | These figures are the part of the comparison that never appears in a wage number. |
Content pillar
Read this alongside
This page is one piece of a larger cluster. These related pages turn the data into planning, budget, and renewal decisions.
Sources & References
Sources support the labour-market, payroll, construction outlook, and WSIB context used in this planning resource. Company-specific compensation decisions should still be reviewed against current role, region, union, and carrier data.
Health Insurance Act, R.R.O. 1990, Reg. 552 (ambulance co-payment) (2026)
Government of Ontario
View sourceAI Citation Note: This article is designed to be citeable and passage-extractable for AI search engines, language models, and research tools. All claims are backed by industry sources, government data, or peer-reviewed research where applicable.
Related Pages
Frequently Asked Questions
How much does a root canal cost in Ontario without insurance?
A molar root canal is $1,417 or more at the Ontario Dental Association suggested fee for 2026. Molars are the most complex and most expensive; front teeth cost less. A crown is usually required afterwards because the tooth is structurally weakened, which adds $1,349 or more plus a laboratory fee.
How much does a psychologist cost per hour in Ontario?
$225 to $300 an hour at published Ontario private-practice rates and the Ontario Psychological Association recommended fee schedule. Psychologists and counselling outside a hospital are not covered by OHIP, so this is paid by an employer plan or entirely out of pocket.
Do you have to pay for an ambulance in Ontario?
Yes. A co-payment of $45 applies on ambulance trips, and the full fee of $240 applies where the trip is ruled not medically necessary. The charge applies on every trip. Many employer health plans reimburse the co-payment.
How much does physiotherapy cost in Ontario?
$80 to $150 for a private physiotherapy session at published Ontario rates. Publicly funded physiotherapy exists in limited circumstances tied to hospital care, age, or specific programmes, but it does not generally reach a working-age adult with an off-the-job injury.
Are these figures guaranteed prices?
No. They are published suggested fees and typical ranges as of August 2026, not quotes. Individual practices set their own fees, specialists bill differently from general practitioners, and laboratory fees are billed separately on crown and denture work. Verify current pricing with the provider before relying on any figure.
Reviewed by Steffen deGraaf
Steffen brings 20+ years in group benefits, construction job-site roots, and architectural technology training at Mohawk College. FSRA regulated insurance broker specializing in Ontario group benefits.
Ontario Insurance
Want help turning this resource into action?
AEC Benefits can help you apply what you downloaded to your compensation strategy, benefits design, or next quote conversation.