How Reasonable and Customary Limits Impact Your Group Benefits
When you use your group benefits, you expect it to cover the cost of health services like massages, physiotherapy, or medical equipment. But sometimes, you may find your reimbursement is lower than expected. A common reason.
Reasonable and Customary (R&C) limits.
At Curry Group Benefit Solutions, we believe that understanding R&C limits — and how to navigate them — can help you maximize your benefits and keep more money in your pocket.
What Are Reasonable and Customary (R&C) Limits?
R&C limits are the maximum amounts that your group benefits plan will reimburse for specific services. These limits are based on:
- Typical costs charged by service providers in your province
- Industry pricing trends that are reviewed and updated regularly
If your provider charges more than the R&C limit, you are responsible for paying the difference.
Example:
If your plan's R&C limit for a massage therapy session is $100 but your therapist charges $120, your plan will reimburse only $100 — and you’ll pay the remaining $20 yourself.
Why Do R&C Limits Exist?
R&C limits are in place to:
- Help control claim costs for everyone
- Keep group benefit plans affordable and sustainable over time
- Protect the plan against inflated service prices
Services such as paramedical care (massage therapy, chiropractic care, physiotherapy) and medical equipment are where R&C limits are most noticeable, since fee guidelines aren’t standardized like they are for physicians and dentists.
How to Make the Most of Your Coverage
To avoid unexpected out-of-pocket costs:
- Ask upfront: Always confirm a provider’s fees before your appointment.
- Shop around: Compare fees between clinics or service providers when possible.
- Be pharmacy smart:
Did you know that the cost of a prescription includes three parts? - Drug cost: The pharmacy’s purchase price
- Markup: Additional margin set by the pharmacy
- Dispensing fee: A professional fee for preparing and providing the medication
Dispensing fees can vary significantly between pharmacies. Two pharmacies may sell the same drug but have different dispensing fees, impacting your total cost.
Quick Tips to Lower Your Health Costs
✅ Compare pharmacy dispensing fees before choosing where to fill your prescription
✅ Ask providers if their fees fall within your plan’s R&C limits
✅ Be proactive when selecting medical equipment or services
Small steps like these can lead to meaningful savings over time — and ensure you're using your benefits as effectively as possible.


