Think of this page as a dictionary of terms you might be wondering about. From “Account Holder” to “Semi-private room”, we’ve got you covered.
Accident or Accidental :
This is an unintentional, sudden or unforeseeable event, influenced by an external cause that inflicts bodily injuries (directly and independently of any other cause).
Account holder :
This is the person or business designated and authorized by the plan member to transact business on their behalf.
A brace is a rigid or semi-rigid device or appliance that can be attached to any part of your body. (Note: this isn’t the same thing as braces, which are used to fix dental defects, deficiencies or injuries.)
Co-ordination of Benefits :
If you have coverage provided by another health insurance plan in addition to your SureHealth insurance plan, coordination of benefits is the process used to eliminate duplicate payments, and determine the order of payments.
Having “coverage” indicates that you are entitled to make a claim against your eligible benefits.
Custom-made Boots or Shoes :
If you have a condition that won’t allow you to wear off-the-shelf footwear, custom-made boots or shoes may be required. To make them, a unique cast of your feet are made, and the shoes are fabricated using 100% raw materials.
Custom-made Foot orthotics :
Custom foot orthotics are used to relieve foot pain related to biomedical misalignment to your feet or lower limbs. Like custom-made boots and shoes, these are made from raw materials based on a 3D model of your foot.
A statement signed by you, declaring that what you say is true.
Dental Care :
BASIC SERVICES include coverage towards:
- Preventive cleaning
- Routine examinations, x-rays
- Fillings and extractions
- Fluoride treatment for children
COMPREHENSIVE BASIC SERVICES include coverage towards:
- Endodontic treatment – root canal therapy
- Periodontal treatment – scaling and root planing, occlusal adjustment, equilibration
- Denture repairs, rebasing, relining
MAJOR SERVICES include
- Crowns and onlays, dentures, bridgework
- Orthodontic treatment to straighten teeth and correct the bite
A dentist is a health care practitioner who is qualified and licensed to practice dentistry in Canada. (Have you been recently? Don’t forget!)
Dependents are the people in your family. This could be a legally married spouse, or a partner you have lived with and presented publicly as a common-law spouse for more than 12 months. Dependents could also be unmarried natural children under the age of 21 who live with you, provided they are not regularly employed. A child over the age of 21 can be considered a dependent if they became dependent on you before their 21st birthday for reasons like mental or physical disability, and are considered a dependent as defined under the Income Tax Act.
Dispensing Fee :
This is the fee charged by a pharmacist when dispensing a prescription. (Hey, we all have to make a living.)
Effective Date :
This is the date your SureHealth insurance plan starts - the first of the month following the approval of your application. You can use your benefits from that day forward.
An acute, unexpected or unforeseen illness or accident, resulting in sickness or accidental bodily injury. (Something we hope won’t happen.)
Extended Health Care :
MEDICAL ITEMS include coverage towards:
- Aids for daily living (such as hospital style beds, IV stand, trapeze, bedpan)
- Braces, casts, catheters and ostomy supplies
- Compression stockings
- Diabetic supplies
- Custom made boots or shoes, custom made foot orthotics
- Mobility aids (such as canes, crutches, walkers, wheelchairs)
- Respiratory/cardiology items (such as breathing and heart monitors for infants, compressors, oxygen)
'Generics' are medications sold under their generic, sometimes scientific, name, usually after a patent has expired. (Or if no patent was ever issued in the first place.) Equally as strong and effective, generics are usually less expensive than their branded counterparts.
Government plan :
A government plan is a plan or program provided by your province or territory that provides coverage for (or towards) basic health-related services. It could include health insurance plans that cover trips to the doctor and emergency medical care, and assistive devices programs as examples. Often, government plans only cover you when you get the care or service in your own province.
Group Benefits or Group Health and Dental Benefits :
Some companies offer a health benefits plan to their employees. These are usually known as group benefits, group health and dental plans or group coverage. If you’re losing your group benefits soon, a SureHealth insurance plan can help to protect you from many out-of-pocket medical expenses.
Guaranteed Acceptance :
SureHealth insurance plans that don’t require completion of a health questionnaire offer guaranteed acceptance. This means that your acceptance and your coverage are guaranteed (as long as GSC receives your initial payment). That’s right, there are no medical questions or exams when you apply. Best of all, these plans are designed to cover pre-existing medical conditions – up to the stated maximums, of course. And applying is quick and easy – really!
Health Questionnaire :
If the plan you choose requires completion of the health questionnaire, you need to disclose any medical condition, injury or illness that occurred or existed on or before the date of your application. Your health information will be evaluated. If your and/or your family’s health is such that exclusions will be applied to the plan benefits, GSC will notify you in writing and send an offer for coverage that excludes prescription drugs for your pre-existing medical conditions. This is called a counter-offer. The counter-offer also includes alternative SureHealth plan options for you to consider.
This evaluation and counter-offer process is not unique to SureHealth insurance products or to GSC; it’s a standard process within the individual health insurance market in Canada.
A hospital is a licensed active treatment facility, recognized under the Public Hospitals Act or Ministry of Health. In general, this doesn’t include federal hospitals, private hospitals, rest, nursing or convalescent homes, long term or chronic care facilities, health spas, hotels, or centres for treating alcohol or drug addiction.
Lifetime Maximum :
This is the total amount that will be paid over the course of your life and your SureHealth insurance plan.
Medical Items :
With SureHealth insurance plans, medical items include aids for daily living (like hospital style beds, IV stands, a trapeze, a bedpan), braces, casts, catheters and ostomy supplies, compression stockings, diabetic supplies, custom made boots or shoes, custom made foot orthotics, mobility aids (like canes, crutches, walkers, wheelchairs), prosthetics, and respiratory/cardiology items such as breathing and heart monitors for infants, compressors and oxygen.
Medical Underwriting :
The use of health or medical information to evaluate an applicant’s acceptability for coverage.
Name Brand or Brand-Name :
Usually more expensive than their generic counterparts, these are medications sold by a pharmaceutical company under a trademark-protected name.
A physician is a doctor who is licensed to practice medicine in the area where his/her services are provided.
Pre-existing Health Condition :
An injury, illness, or condition that existed before the effective date of your SureHealth insurance plan.
Prescription Drugs :
Prescription drugs approved for use in Canada that require a prescription by law and have been prescribed by an authorized medical practitioner are eligible for coverage.
Brand name drugs may be covered if no generic equivalent exists.
Smoking cessation products and drugs for the treatment of obesity, infertility and erectile dysfunction are not covered.
For Quebec residents: To be eligible to apply for the SureHealth plans, you must be covered by the RAMQ (Régie de l’assurance maladie du Québec) plan. Your prescription drug claims must be submitted to RAMQ first. When RAMQ reimburses a portion of the drug cost, unpaid balances (including co-payments and deductibles) will be co-ordinated so that you may be reimbursed up to 100% of the eligible expense incurred. If the drug is not covered by RAMQ, the standard co-pay applies.
Private Room :
A private room is a hospital room with only one bed. (No roommates.)
Provincial Health Insurance Plan :
(Canadian residents eh?) Our national health care program is made up of provincial and territorial health plans to ensure you have reasonable access to doctors and hospitals. Being provincial, most only cover you when you get the health-related care or service in your own province. Provincial health insurance plans cover the basics, but certainly not all of your health care needs.
Recall Frequency :
Recall frequency represents the time between routine dental examinations. (Been to the dentist lately?)
Semi-private room :
A semi-private room is a hospital room with two treatment beds. (Only one roommate.)