Glossary - CMMOTA

Not Sure What to Choose?

A

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).

Accidental Dental

In GreenShield Insurance plans, this benefit includes coverage toward the services of a licensed dental practitioner for dental care to natural teeth when required due to a direct blow to the mouth.

Account holder

This is the person or business designated and authorized by the plan member to transact business on their behalf.

Ambulance Transportation

In GreenShield Insurance plans, this benefit includes coverage for licensed ambulance services by land or air to the nearest hospital equipped to provide the required treatment when medically necessary in emergency situations.

B

Brace

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.)

C

Co-ordination of Benefits

If you have coverage provided by another health insurance plan in addition to your GreenShield Insurance plan, coordination of benefits is the process used to eliminate duplicate payments and determine the order of payments.

Coverage

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.

D

Declaration

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 SERVICES

Orthodontic treatment to straighten teeth and correct the bite

Dentist

A dentist is a health care practitioner who is qualified and licensed to practice dentistry in Canada. (Have you been recently? Don’t forget!)

Dependent

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

The professional fee the pharmacy charges to process your prescription order. The fee includes dispensing your medication, maintaining your health record, working with your prescriber, evaluating your medications for allergies and interactions, and explaining the treatment to you.

E

Effective Date

This is the date your GreenShield Insurance plan starts — the first of the month following the approval of your application. You can use your benefits from that day forward.

Emergency

An acute, unexpected or unforeseen illness or accident, resulting in sickness or accidental bodily injury. (Something we hope won’t happen.)

Extended Health Care

The benefit category that includes coverage towards Professional Services/Registered Specialists, Accidental Dental, Ambulance Transportation, Hearing Aids, Medical Services, Medical Items and Home Support Services.

G

Generic

'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 GreenShield Insurance personal health plan can help to protect you from many out-of-pocket medical expenses.

Guaranteed Acceptance

GreenShield Insurance personal health 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 GreenShield 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!

H

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, GreenShield will notify you in writing and send an offer for coverage that excludes prescription drugs for your pre-existing medical conditions. This evaluation is not unique to GreenShield Insurance products or to GreenShield; it’s a standard process within the individual health insurance market in Canada.

Hearing Aids

In GreenShield Insurance plans, this benefit includes coverage towards hearing aids, repairs, or replacement parts, recommended or approved by the attending legally qualified health practitioner.

Hospital

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.

L

Lifetime Maximum

This is the total amount that will be paid over the course of your life and your GreenShield Insurance plan.

M

Medical Items

In GreenShield Insurance personal health plans, this benefit includes 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)
Prosthetics
Respiratory/cardiology items (such as breathing and heart monitors for infants, compressors, oxygen)

Medical Services

In GreenShield Insurance personal health plans, this benefit includes coverage towards specific diagnostic tests and x-rays, and laboratory tests that are not eligible for coverage under your provincial health plan.

Medical Underwriting

The use of an applicant’s health or medical information to determine whether exclusions will be applied to coverage.

N

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.

P

Physician

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 GreenShield 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 GreenShield Insurance plans, you must be covered by the RAMQ (Régie de l’assurance maladie du Québec) plan.

Private Room

A private room is a hospital room with only one bed. (No roommates.)

Professional Services/Registered Specialists

In GreenShield Insurance personal health plans, this benefit includes coverage towards the services of licensed, certified, and/or registered practitioners recognized by GreenShield:

Chiropractors
Chiropodists
Podiatrists
Naturopaths
Osteopaths
Physiotherapists
Massage therapists
Acupuncturists
Psychologists
Registered social workers
Speech therapists

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.