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Dictionary


The following are definitions of frequently used insurance terms:

Accident: An unexpected or unforeseen happening or event involving an external force causing loss or injury

Accidental Bodily Injury: Any bodily injury, which is caused solely by external, violent means and independently of all other causes

Benefit Percentage (Co-insurance): The percentage of Covered Expenses that is payable by the Plan

Covered Expenses: Expenses that will be considered in the calculation of payment due under various benefits

Deductible: The amount of Covered Expenses that must be incurred and paid by you or your dependents before benefits are payable by the benefit plan provider

Dependent Your spouse, legal or common-law OR Your natural child, legally adopted child, or step-child that lives with you OR A developmentally or physically disabled Dependent, regardless of age, provided that you provide satisfactory proof to Alberta Benefits Ltd. of the Dependent Child’s disability OR Your unmarried children under age 21 or under age 25 if they are full-time students (Note: children under age 21 are not covered if they are working more than 30 hours per week unless they are full-time students)

Government Plan: Any plan of insurance provided by or under the administrative control of any government or agency thereof in accordance with any law (other than the Employment Insurance Act of Canada) or any plan providing insurance coverage pursuant to the regulatory power of any government.

Hospital: An institution legally constituted in the jurisdiction in which it is located, excluding any institution which is, other than incidentally, a nursing home, a domiciliary care home, of a home for the aged.

Also, an institution that employs registered nurses who are in attendance and on duty on a 24-hour basis, and is equipped with facilities for: the diagnosis and treatment of sickness and injury; and surgery, except that surgical facilities are not required if the medical care or services are rendered in Canada in connection with nervous or mental disease or disorder.

Insured: You or your Dependent insured for the benefit or benefits for which the term is used, excluding:

  • any person not residing in Canada
  • any person who is not approved by Alberta Benefits Ltd (if a late applicant)
  • any person on active full-time service in the armed forces of any country

Reasonable and Customary Charges: Charges for care, services or supplies of the level usually furnished for cases of the nature and severity of the case being treated and which are in accordance with representative fees and prices in the locality in which they were rendered as determined by Alberta Benefits Ltd.

Stop Loss Insurance: Catastrophic health claims over the Stop Loss Deductible of $10,000. This is the maximum amount per calendar year that the employer is responsible for any one person. Thereafter, the Stop Loss Insurance pays for the eligible claims for the remainder of the year.