"Do Employee Benefits in Canada Cover CPAP?" Here’s What You Need to Know

"Do Employee Benefits in Canada Cover CPAP?" Here’s What You Need to Know

“Do employee benefits in Canada cover CPAP?” — the short answer is: it depends.

Many extended health insurance plans provided through employers can cover CPAP (Continuous Positive Airway Pressure) equipment and supplies, but coverage levels, requirements, and processes vary widely.

What Is CPAP?

CPAP is a therapy commonly used to treat obstructive sleep apnea. It delivers pressurized air through a mask to keep your airway open during sleep. The term “PAP device” often includes CPAP, BiPAP, or APAP machines.

Because CPAP devices are considered medical equipment, they often fall under the “medical supplies” or “durable medical equipment” category in benefits plans. In Canada, many private and employer-sponsored insurance plans include a medical supplies component.

How Common Is CPAP Coverage Under Employee Benefits?

  • Private / Extended health plans: Many employer-sponsored benefits plans in Canada provide partial or full reimbursement (often 80%–100%) for CPAP equipment and supplies. 
  • Requirement examples: Some insurers (including Medavie Blue Cross) require pre-approval, the doctor’s prescription, your sleep study report, and compliance tracking (e.g. a 30-day usage report). 
  • Limits & frequency: Many plans restrict how often you can claim a CPAP unit (e.g. every 3–5 years) and how frequently you can replace masks, hoses, or filters. 
  • Public / government programs vary by province: In Ontario, for example, the Assistive Devices Program (ADP) covers 75% of the approved price for PAP systems (you pay the remaining 25%). Many other provinces don’t provide blanket CPAP coverage under public health — so private (employee) benefits become especially important.

Because benefits plans and provincial programs differ, having “employee benefits” does not guarantee CPAP coverage — you must check the details.

What CPAP-Related Items Are Typically Covered?

When employee benefits do cover CPAP, these are commonly included:

Item Typical Coverage / Remarks
PAP device (CPAP / BiPAP / APAP) Often covered every 3–5 years (or per plan schedule)
Replacement supplies Masks, tubing, filters, humidifier chambers — often every 6 to 12 months
Repairs & servicing Sometimes included under “durable medical equipment” or “aerotherapeutic supply” limits
Consumables / small parts Cleaning supplies, filters — may or may not be covered depending on plan

Be sure to verify with your insurer exactly which supplies are eligible, at what frequency, and under what conditions.

Key Factors That Affect Whether Your Benefits Cover CPAP

  1. Plan specifics
    “Extended health care” or “medical equipment” components vary. Some plans are generous, others impose tight restrictions.

  2. Pre-approval / prior authorization
    Many insurers require you to submit a request before purchase. Without this, claims may be denied. 

  3. Required documentation
    • Physician or nurse practitioner prescription
    • Sleep study / diagnostic report
    • Compliance or usage report (often 30 days, especially for replacements) 
    • Itemized quote or invoice
    • Sometimes proof of medical necessity

  4. Frequency limits & replacement rules
    Even if your plan covers CPAP, it may limit how often you can get a new machine or replace parts.

  5. Provincial or supplemental programs
    Some provinces offer assistive device subsidies — but they cover only a portion or have strict eligibility. E.g., Ontario’s ADP covers 75% of PAP systems. Alberta currently doesn’t directly fund CPAP in their core programs, so private insurance is more important there.

Step-by-Step: How to Find & Claim CPAP Coverage Under Your Employee Benefits

  1. Review your benefits booklet or plan summary
    Look under “medical supplies,” “durable medical equipment,” or “aerotherapeutic supplies.” See whether CPAP, PAP device, or respiratory equipment is explicitly listed.
  2. Contact your insurer / benefits administrator
    Ask questions (see list below). Get clarity on limits, required documents, and approval procedures.

  3. Get a documented prescription & sleep test
    Ensure your prescribing physician is recognized under your plan. Some insurers reject requests from non-recognized prescribers. Respiratory equipment and supplies benefits list
  4. Obtain pre-approval (if needed)
    Submit the insurer’s machine/CPAP request form—many major insurers provide their own. E.g., Canada Life has a “Positive Airway Pressure (PAP) system” form. Canada Life
  5. Get an itemized quote / invoice from a vendor
    The quote should break down the main unit, mask, tubing, parts, etc.

  6. Submit your claim with supporting documentation
    Include prescription, diagnostic report, quote, proof of pre-approval, and anything else insurer requires.

  7. Track or appeal as needed
    If denied, ask for a written explanation and consider an appeal or resubmission with missing documents.


Questions to Ask Your Benefits Provider 

  • Do I have coverage for a CPAP / PAP machine under my plan?
  • What percentage will be reimbursed (e.g. 80% or 100%)?
  • Is pre-approval or prior authorization required before purchase?
  • Which supplies and accessories (masks, tubing, filters, humidifiers) are included?
  • How often can I replace the CPAP device, mask, tubing, filters, etc.?
  • What forms or documents (prescription, sleep study, compliance report) are needed?
  • Do I need to buy from a specific approved vendor or supplier?
  • What is the deadline for submitting a claim
  • How are repairs or servicing handled under the plan?

Note: Some providers, like Medavie Blue Cross, explicitly require pre-approval if you want coverage for CPAP / BiPAP devices.

Sample Case: Canada Life

If your employer’s plan is under Canada Life, they provide a formal PAP device request form. Canada Life Your doctor fills it, you include your diagnosis and device quote, and the insurer reviews for coverage eligibility.

Insurance Company Contact Info

CLICK HERE for a list of contact info for major insurance benefits providers in Canada.

Sample Email Template to Provider: Confirming CPAP Coverage Under Employee Benefits

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Subject: Inquiry About CPAP Equipment Coverage Under My Employee Benefits Plan

Dear [Insurance Provider / Benefits Administrator Name],

I hope you’re doing well. I’m reaching out to confirm whether my extended health benefits include coverage for CPAP (Continuous Positive Airway Pressure) equipment and related supplies.

Could you please clarify the following details about my plan?

  1. Do my benefits cover the purchase of a CPAP, BiPAP, or APAP machine?

  2. What percentage of the cost is reimbursable (e.g. 80%, 100%)?

  3. Are replacement supplies such as masks, tubing, filters, and humidifier chambers also covered?

  4. How often can I replace each of these items under my plan?

  5. Is pre-approval or prior authorization required before I purchase my equipment?

  6. What documentation is required to submit a claim (e.g. prescription, sleep study, quote, invoice)?

  7. Are there preferred or approved vendors I should purchase from?

For context, I’ve recently been prescribed CPAP therapy following a sleep study and would like to make sure I meet all requirements before proceeding with my purchase.

If possible, please send me any relevant forms or links related to PAP device coverage (such as pre-approval or claim forms).

Thank you for your time and assistance.
Kind regards,
[Your Full Name]
[Policy Number or Employee ID (if applicable)]
[Your Contact Information]

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✅ Tips:

  • CC your HR or benefits administrator if your insurance is through your employer.
  • Attach your doctor’s prescription and sleep study summary if you already have them (this often speeds up pre-approval).
  • Keep the tone polite and factual — avoid adding unnecessary medical details.

What If My Employee Benefits Don’t Cover CPAP Fully — Alternatives & Supplements

  • Provincial assistive device programs
    In some provinces, like Ontario, the government ADP program helps reduce your cost of PAP systems by covering a portion (e.g., 75%). Ontario
  • Government or social assistance
    If you qualify for disability support or income assistance, some provinces provide breathing device aid. E.g., in BC, the ministry sometimes funds breathing devices if other resources can’t cover costs. Province of British Columbia
  • Health spending accounts / supplemental benefits
    If your employer offers a Health Spending Account (HSA) or supplemental benefit fund, you might allocate funds toward CPAP costs.
  • Tax deduction / medical expense claims
    In Canada, you may include out-of-pocket CPAP costs in your medical expense tax credit when filing taxes (if you pay beyond insurance).
  • Use a payment plan option
    Some CPAP suppliers offer payment-plan options via Klarna or other flexible payment platforms

Final Thoughts

If you search “Do My Employee Benefits Cover CPAP Canada?”, the answer is: often yes — but only if your plan includes medical equipment or respiratory supply coverage, and you follow the insurer’s procedures carefully.

To maximize chances of successful reimbursement:

  • Confirm coverage early
  • Gather all necessary documents (prescription, sleep study, quotes)
  • Get pre-approval if required
  • Buy from an approved vendor
  • Submit your claim promptly and accurately

If you'd like help drafting an email or call script for your benefits provider, or help locating your insurer’s CPAP request form, I’d be happy to assist.