CLHIA-ACCAP

Canadian Life and Health Insurance Facts, 2014 Edition

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31 insurance plan where an employee plan member who leaves the plan can convert their group insurance to an individual insurance policy. Coordination of benefits. Families with two working adults may be covered by more than one health or dental plan. If your primary plan doesn't pay the full amount of an expense, you can submit a claim to the other plan for the balance. In this way, you can receive up to 100% of your expense. Contract. An insurance contract is the legal agreement with your insurance company that sets out the terms of your coverage. The contract usually includes your application, the policy, and any changes made later to the policy. Covered expenses. See "Eligible expenses". Creditors' group insurance. A type of insurance that helps to pay down or pay off your loan or credit card or cover your payments in certain situations, such as if you die or become disabled. It can be offered through financial institutions, auto dealers, mortgage brokers, retailers, or credit card companies when you take on debt. Creditor protection. If you have unpaid debts, the people you owe the money to (your creditors) may legally have access to your other assets, such as property, investments or valuables, to pay off the debt. This may happen through your bankruptcy or other legal proceedings. The funds in your insurance policies may be protected from creditors in certain circumstances. For example, if you make certain beneficiary designations or if the policy is registered (such as a "Registered Retirement Savings Plan"). However, the protection may not apply if you put your money into an insurance policy to avoid paying your creditors. Critical illness insurance. A type of insurance that pays you a lump sum if you are diagnosed with a serious illness such as cancer, heart disease requiring surgery, heart attack or stroke. The exact illnesses covered are listed in your policy. You can buy this type of insurance on its own or may be able to add it to a life insurance policy or group plan. D Deductible. Deductibles are common in health insurance plans. The deductible is the amount of a covered expense that you pay before your insurance company makes any payments. The deductibles apply to you and to any dependents covered under the plan. Examples might be $50 per person per year or $5 for each drug prescription. Deferred annuity. A contract that pays you income at regular intervals, starting at a future date. The date can be in a specified number of years or at a specified age. Defined benefit pension plan. A workplace pension plan that pays you a set benefit amount when you retire. Benefits are based on a formula that takes into account things like your salary, how long you were a member of the plan and how much you and your employer contributed to the pension plan. Defined contribution pension plan. A workplace pension plan where the amount you contribute is fixed but the benefit amount you receive on retirement is not. Your benefits are based on the amount you and your employer have contributed, plus investment earnings. Dental insurance. A type of insurance that provides coverage for dental expenses. It's usually provided as part of a group plan, but you can also buy it on its own. Disability income insurance. A type of insurance that makes regular payments (usually monthly) to replace income if you become disabled and unable to work. It's usually provided as part of a group plan, but you can also buy it on its own. Dividend. See "Policyholder dividend". Double indemnity. See "Accidental death insurance". E Eligible expenses. Expenses that are covered under a health or dental plan. Depending on the coverage provided, you may have to pay a share of the expenses. (See "Deductible" and "Coinsurance".) Eligibility period. The length of time you must be a member of a group before qualifying for coverage under the group plan. For example, an organization whose health and dental plan has a 90-day eligibility period would require 90 days of qualified employment before coverage could begin. Elimination period. In disability insurance, you have to be continuously disabled for a certain amount of time before making a claim. This amount of time is the elimination period (sometimes referred to as a "waiting period"). You will not receive benefits for the elimination period. Endowment insurance. A type of life insurance that pays you a set amount if you live to the maturity date of your policy. If you die before that date, your insurance company pays the set amount to your beneficiary. Evidence of insurability. The information an insurance company uses to decide whether or not to insure you. It's often called "proof of good health". The information may include medical, lifestyle, smoking and other personal information. Exclusions. Things that are not covered by an insurance policy. They can include: certain medical conditions you had before you applied for the insurance, or high-risk activities such as sky-diving. You can sometimes buy extra insurance to pay for risks that would not otherwise be covered. Exempt policy. A life insurance policy where the savings growth does not exceed limits set under income tax law. In an exempt policy, the investment earnings on cash value are not subject to annual taxation. Extended health care insurance. A type of insurance that pays for hospital and medical expenses not covered by your provincial health plan. Expenses typically include prescription drugs and medicines, semi-private or private hospital rooms, ambulance services, and hospital and medical expenses you incur outside Canada. It can be part of a group plan or you can buy it on its own. Extended term insurance. An option in a permanent life insurance policy that allows you to extend the period you're covered without having to pay additional premiums. It uses the cash value in your policy but your insurance coverage stays the same. How long the policy continues depends on how much cash value is available. (See "Non- forfeiture options".) F Face amount. Also called the "sum insured", the face amount is the amount stated on your policy that your insurance company guarantees to pay when the insured person dies. It does not include amounts payable under accidental death coverage or other special provisions. Financial needs analysis. When you buy insurance, an advisor may help you decide how much insurance you need by completing a financial needs analysis. This looks at your current financial and personal situation and goals to help decide how much insurance you need. It can include things like taking care of dependents and paying off loans. Flexible premium policy or annuity. A type of life insurance policy or annuity contract where you can vary the amount of

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