Manulife CoverMe

HEALTH & DENTAL GLOSSARY OF INSURANCE TERMS

Here are some of the more frequently used insurance terms. If you can't find a term you would like defined, feel free to call us at 1-877-COVER ME® (1-877-268-3763), Monday through Friday, from 8 a.m. to 8 p.m. ET, or email us any time. We would be happy to help you with any insurance questions you may have. You can also find answers to many of the most commonly asked questions about insurance on our FAQ page.

All definitions provided are examples. Consult your policy for the terms that apply to your coverage.

Accident or Accidental
A sudden, unforeseeable event that causes bodily injuries.

Add-Ons
Available only with a Core plan, Add-Ons enable you to customize your protection to your individual needs by increasing your coverage in certain areas you feel are necessary.

Anniversary Year
The 12 consecutive months following the Effective Date of the Policy and each 12-month period thereafter.

Benefits
The amounts paid to a claimant or beneficiary under the coverage of a policy.

Benefit Year
The 12-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter.

Calendar Year
The 12-consecutive-month period that begins on January 1 and ends on December 31.

Claim
A request for benefit payment under the terms of an insurance policy.

Claimant
The person(s) making a request for payment of benefits under the terms of an insurance policy.

Coverage
Another term for the protection offered under an insurance policy. Coverage is used interchangeably with the terms insurance or protection.

Co-ordination of Benefits
Co-ordination of Benefits is a process designed to eliminate duplicate payments and determine the order for payment of benefits when there is coverage provided under another plan.

Declaration
A statement, signed by the insured, warranting that the information given by him/her is true.

Deductible
The portion of a loss that you are required to pay before your insurance coverage will respond.

Dispensing Fee
The dispensing fee represents the charge for the professional services provided by a pharmacist when dispensing a prescription.

Effective Date
The date when insurance coverage begins.

Eligible Expenses
Expenses that are eligible for payment of benefits, under the terms of an insurance policy.

Emergency
An acute, unexpected or unforeseen illness or accidental injury which results in a sickness or accidental bodily injury of the insured.

Exclusions
Specific causes of death, circumstances and health-related conditions or any other losses for which an insurance policy does not provide benefits.

Generic
A medication sold under its generic name, usually legal only after the patent has expired, or if no patent was issued for the substance. Generic drugs are usually less expensive than proprietary medications.

Group Benefits or Group Health and Dental Benefits
Insurance issued on a group of people under a master contract. It is usually issued to an employer for the benefit of employees.

Insured
The person (or persons) whose risk of financial loss from an insured peril is protected by the policy. Sometimes called the "policyholder".

Lifetime Maximum
The maximum amount of benefits that will be paid for all covered services during the entire time you are insured.

Name Brand or Brand-Name
A medication sold by a pharmaceutical company under a trademark-protected name. Typically more expensive than generic drugs.

Non-Smoker
An insured person who has not used any form of tobacco, including tobacco cessation products, in the twelve (12) consecutive months preceding the date of application for insurance or non-smoker premiums, and who meets Manulife's health standards.

Policy
The legal document issued by an insurance company to a policyholder, which outlines the conditions and terms of the insurance. Also called the contract.

Policyowner or Policyholder
The person who owns the insurance policy.

Premium
The cost of insurance coverage. A premium can be paid monthly, semi-annually or annually.

Provincial Health Insurance Plan
Canada's health care program is made up of provincial and territorial health insurance plans, all of which share certain common features and standards, designed to make sure that all residents of Canada have reasonable access to health care from doctors and hospitals.

Pre-existing Health Condition
An injury, a sickness, or a condition that existed before the date that an insurance policy takes effect.

Reasonable and Customary
The maximum amount a plan or insurance contract will consider eligible for reimbursement, based upon prevailing fees in a geographic area.

Stand-Alone
Flexcare Stand-Alone options allow you to build a plan that will give you hospital coverage, catastrophic coverage or both – without the need to purchase a more comprehensive Core plan.

Underwriting
The process by which an insurer determines whether or not, and on what basis, it will accept an application for insurance.

Have we missed an insurance term that you would like defined?
Let us know by calling 1-877-COVER ME® (1-877-268-3763) Monday through Friday, from 8 a.m. to 8 p.m. ET, or
e-mail more_info@manulife.com any time.