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Glossary |
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Brain death
Irreversible unconsciousness with total loss of brain function
and complete absence of electrical activity of the brain, even though
the heart is still beating. |
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Child
Your natural, legally adopted, step or other eligible child1
who meets all of the following requirements:
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unmarried; |
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totally dependent on
you for support and maintenance; |
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one of the following
ages: |
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under age 21 (under
age 23 for accident insurance coverage); |
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under age 26 if full-time
student at an accredited college or university (under age 25
for life and accident insurance coverage)2; |
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of any age if physically
or mentally handicapped, provided he or she became handicapped
while covered by the plan and you provide satisfactory proof
that your child is incapable of self-support as a result of
the handicap3; |
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living in Canada, unless a full-time student elsewhere; and |
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not in the armed forces (except for optional and dependent life
insurance coverage). |
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Please note that proof may be required.
| 1 |
The plan can also include
your common-law spouse’s child (for health, dental
and travel coverage), a foster child (for life and accident
insurance coverage), and any child who lives with you
and totally depends on you or your spouse for support
within the terms of the Income Tax Act (for health, dental,
travel and life insurance coverage). |
| 2 |
For life insurance coverage,
the child must be a regular, full-time student at an accredited
institute of learning. For accident insurance coverage,
the child must be a full-time student attending an educational
institution or on vacation from such institution. |
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For life and accident
insurance coverage, the child must also be incapable of
self-sustaining employment and totally depend on you for
support and maintenance. |
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Dentist
A doctor of dental surgery or a doctor of dental medicine licensed
to practice and prescribe in the area where services are rendered. |
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Dependents
Your eligible spouse and children. |
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Earnings
Gross earnings (guaranteed earnings instead, for part-time employees),
excluding bonuses, overtime and commissions.
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Exceptions
- When optional life and accident insurance begins
If you apply for any optional life insurance within 31 days following
your eligibility date, a portion of the coverage (up to $30,000
for yourself, up to $30,000 for your spouse, and $10,000 for each
child) will come into effect on the first of the month after Johnson
receives your application. The difference, if any, will take effect
once the insurer approves your proof of good health.
If you apply for any optional accident insurance, coverage will
come into effect on the first of the month after Johnson receives
your application. |
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Hospital
A facility that is licensed to provide active treatment for sick
or injured patients. It does not include rehabilitation hospital,
mental institution, convalescent hospital or home, an institution
used primarily for treatment of a specific illness or disease, a
nursing home, a chronic care facility, a home for the aged, a rest
home or any other facility that provides similar care. Beds set
aside for chronic care in a hospital are not covered.
Regarding accidental injury or death benefits
For in-hospital confinement monthly income, hospital means a legally
constituted establishment that meets all of the following conditions:
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operates primarily for the reception,
care and treatment of sick, ailing or injured persons as inpatients; |
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provides 24-hour service by registered
or graduate nurses; |
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has a staff of one or more licensed
physicians available at all times; |
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provides organized facilities for
diagnosis and surgical facilities; and |
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is not primarily a clinic, nursing
home or convalescent home or similar establishment nor, other
than incidentally, a place for alcoholics or drug addicts. |
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Immediate family
“Immediate family” refers to a spouse
(or common-law spouse), parents, grandparents, children over 18,
brothers or sisters. |
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Medically necessary
A service or supply provided or prescribed by a health care professional
to prevent, diagnose, or treat an injury, disease, or disability
that is:
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consistent with the
treatment of symptom(s) or diagnosed injury, disease, or disability; |
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not primarily prescribed
or provided for convenience; |
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the most appropriate,
safe, and cost-effective service or supply; and |
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generally recognized
as accepted medical practice. |
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to a health care professional, it means a person who is legally
licensed to practice his or her profession where services are
rendered, and includes physicians, pharmacists, dentists, and
other professionals as approved by the plan. |
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Mission statement
The Trustees are mandated to act in the best interest
of the plan and its beneficiaries.
To achieve this objective, the Trustees are committed
to the following qualities:
| Proactiveness |
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Identify and analyse
group insurance trends and best practices |
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Make recommendations
to optimize the plan’s cost-effectiveness and long-term
sustainability |
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| Transparency |
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Inform parties
of all decisions |
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Educate beneficiaries
on the plan and their role |
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| Integrity |
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Adhere to the
Trust document at all times |
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Respect all legal
documents and requirements |
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Permanently
and totally disabled
Under accident insurance coverage, permanently and totally disabled
means your complete inability to engage in any occupation for which
you are qualified by education, training, or experience for the
rest of your life. |
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Physician
A doctor of medicine who is legally licensed to prescribe drugs,
administer medical treatment, and perform surgery within the scope
of this license. |
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Professional
counsellor
A therapist or counsellor who is licensed, registered or certified
to provide the applicable treatment or counselling. |
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Proof of good
health
Medical questionnaire that you must complete to show the status
of your health. Depending on your answers, Great-West Life can require
a medical examination and any other information. |
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Spouse
The person to whom you are legally married, or the person of the
same or opposite sex with whom you have been living in a common-law
relationship for at least 12 months.
Also note:
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Your spouse must live
in Canada, unless he or she is a full-time student elsewhere. |
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The plan does not cover
any spouse in the armed forces (except for optional and dependent
life insurance coverage). |
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The plan covers only
one spouse at a time. |
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Totally disabled
Under long-term disability coverage, totally disabled means:
During the qualifying period and the following 24 months
of disability, illness or injury must render you physically or mentally
incapable of performing the essential duties of your normal occupation.
If during this period another occupation becomes available for which
you are qualified, and you are mentally and physically able to perform
the essential duties of this job, you must accept it. Otherwise,
benefits will end.
After the qualifying period and the following 24 months of disability,
illness or injury must render you physically or mentally incapable
of being gainfully employed for:
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any occupation for which
you are or may become qualified by education, training or experience;
and |
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any occupation that
pays 75% or more of the current monthly earnings for your normal
occupation. |
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Usual cost
The usual cost of covered services and supplies that are medically
necessary to treat an illness, injury or pregnancy.
The plan will only cover:
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the amount that is usually
charged for the service or supplies in the area in which the
charge is made; |
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services and supplies
that are needed to diagnose or treat an illness, injury or pregnancy
and that are recognized by the Canadian Medical Association
as effective and appropriate and based on accepted standards
of Canadian health care; |
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services and supplies
that the plan is legally allowed by the government to cover.
The plan will not cover services or supplies that are covered
by the government plan in the insured person’s home province; |
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charges for services
and supplies that are incurred while the person is insured; |
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charges for services
and supplies for the least expensive treatment that is medically
adequate. |
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