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Dictionary


Accidental death benefit
A benefit in a life insurance policy providing for the payment of an additional amount equal to the face amount of the policy in case of death by accident.
Accidental death and disablement insurance (AD&D)
A form of health insurance that provides payment in the event of death or loss of one or more bodily members (such as hands or feet) or the sight of one or both eyes as a result of an accident.
Administrative Services Only (ASO) Plan
An arrangement under which an insurance carrier or an independent organization will, for a fee, administer a health benefit plan and settle claims but not guarantee payments because the plan is uninsured.
Annual Plan Reviews
A yearly study of a company’s coverage and claims history. This is completed to ensure that the plan is functioning efficiently.
Application
A statement of information made by a person applying for insurance. It identifies the plan and the amount applied for, the life insured and the beneficiary, and provides other data useful in evaluating the risk.
Assignment
In the context of health or dental claims, an arrangement for the employee to assign reimbursement payments to another. For example, a patient can assign payment to the dentist so that the dentist can bill the insurer directly and the patient does not have to pay the dentist up front.
Association group plans
Insurance plans designed for members of a professional association or trade association. Members may be protected under a group policy or by individual franchise policies.
Beneficiary
The person who is to receive the insurance proceeds at the death of the insured.
Claim
A demand to the insurer by the insured person for the payment of benefits under a policy.
Coinsurance
A provision in a health insurance contract by which the insurer and insured share, in a specific ratio, the covered expenses under a policy. For example, the insurer may reimburse the insured for 80 per cent of covered expenses, the insured paying the remaining 20 per cent of such expenses.
Covered expenses (also called eligible expenses)
Specified hospital, medical and miscellaneous health care expenses that will be considered in the calculation of benefits due under a health insurance policy.
CPP
A living benefit product that provides a lump-sum cash payment on the first diagnosis of one of several contractually specified critical illnesses or events.
Deductible
The amount of covered expenses that must be incurred and paid by the insured before benefits become payable by the insurer.
Dependent life insurance
Life insurance for an employee’s spouse or children.
Disability
A physical or mental condition that makes an insured person incapable of performing one or more duties of his or her occupation.
Disability benefit
A benefit added to some life insurance policies providing for waiver of premium and sometimes payment of a monthly income, if the insured becomes totally and permanently disabled.
Disability income insurance
A form of health insurance that provides periodic payments when the insured is unable to work as a result of illness or injury.
Employee assistance plan (EAP), Employee & family assistance plan (EFAP)
A benefit that provides confidential counselling or resources to employees and their family members.
Elimination period
The waiting period an employee must be disabled before disability benefits become payable.
Evidence of insurability, or evidence of good health
A medical questionnaire an employee must complete to disclose medical history.
Extended health care insurance (EHC)
A form of health insurance that provides, in one policy, protection for hospital and medical expenses not covered by government programs and usually other health care expenses, such as prescribed drugs, medical appliances, ambulance, private duty nursing, etc.. The policy may contain a deductible amount, coinsurance and high maximum benefits. Also called extended health benefits (EHB).
Group benefits, group insurance
A benefit plan developed for an employer that could include coverage for life, disability, extended medical and prescription drugs , dental, and critical illness.
Health Spending Account (HSA)
A benefit that covers an employee’s health care expenses. Claims are made against this account to pay for health and dental expenses that are not covered under the terms of the regular benefit plan.
Individual insurance
Insurance purchased on an individual basis, covering only one person or, in some cases, members of his or her family as well.
Insurer
The party to the insurance contract who promises to pay losses or benefits. Also, any corporation licensed to furnish insurance to the public.
Income Protection
A type of benefits plan that looks after injured or sick employees by continuing to pay a portion of their regular income while they are unable to work.
Insurance Underwriter
A business that sells insurance, known more commonly as an insurance company.
JEMS
Johnstone’s Employee Management System, the computer system that Johnstone’s uses to monitor and administer plans.
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Life insurance
Insurance providing for the payment of benefits upon the death, whether by accident or otherwise, of the life insured.
Long term disability (LTD)
A benefit plan that provides income replacement to an employee who has become totally disabled due to illness or injury.
Market Survey
A review of a company’s current benefits package in comparison to benefits offered in the insurance marketplace.
Medical Services Plan (MSP)
The provincial health plan for British Columbia.
Optional life insurance
Additional life insurance that may be offered by the employer.
Plan Administration
The daily management and implementation of a benefits plan. This might include handling claims, adjusting coverage, adding and removing employees, or any number of other procedures.
Plan sponsor
The employer, association, or union which holds the group insurance contract.
Policy (or contract)
The legal document issued by the insurer to the policyholder that outlines the conditions and terms of the insurance.
Policyholder
The person who owns an insurance policy. Also called the "insured".
Premium
The payment, or one of the periodic payments, a policyholder is required to make for an insurance policy.
Short term disability (STD)
A benefit plan that pays an employee an income while he or she is unable to work due to non-work related illness or injury.
Specific Plan
A benefits plan that only addresses one area of coverage. A dental plan is an example of a specific plan.
Taxable Benefits
Employer-provided non-cash compensation that is subject to income tax.
Third Party Administrator
A company other than an insurance company who manages businesses’ benefit plans. Johnstone’s Benefits is a TPA.
Travel insurance
Insurance designed to pay for certain unexpected costs that may arise when you are travelling, such as emergency hospital/medical costs, trip cancellation, lost baggage and accidental death insurance.
Underwriting
The process by which an insurer determines whether or not, and on what basis, it will accept an application for insurance.
Weekly indemnity (WI)
See Short Term Disability.