Glossary

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.

Child/children

Your natural, legally adopted, step or other eligible child* who meets all of the following requirements:

• unmarried,
• not cohabiting in a conjugal relationship with another individual,
• totally dependent on you for support and maintenance,
• one of the following ages:
  • under age 21,
  • under age 26 if a full-time student at an accredited post-secondary institution**,
  • of any age if physically or mentally disabled, but otherwise qualifies under this definition, provided they became disabled for a continuous period while covered by the plan and were under age 21 or under age 25 if a full-time student and you provide satisfactory proof that your child is incapable of self-support as a result of the disability***,
• living in Canada, unless a full-time student elsewhere, and
• not in the armed forces (except for optional and dependent life insurance coverage).

Dentist

A doctor of dental surgery or a doctor of dental medicine licensed to practice and prescribe in the area where services are rendered.

Dependents

Your eligible spouse and children.

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:

• operates primarily for the reception, care and treatment of sick, ailing or injured persons as inpatients,
• provides 24-hour service by registered or graduate nurses,
• has a staff of one or more licensed physicians available at all times,
• provides organized facilities for diagnosis and surgical facilities, and
• is not primarily a clinic, nursing home or convalescent home or similar establishment nor, other than incidentally, a place for alcoholics or drug addicts.

Immediate family

“Immediate family” refers to a spouse (or common-law spouse), parents, grandparents, children over age 18, brothers or sisters.

Life event

Qualifying life event includes:

• A change in your marital status, either a marriage or common-law relationship, or a divorce or separation,
• The birth or adoption of a child,
• The death of a dependent, or
• The loss of benefits coverage under a spousal program.

If you experience a life event, you have 31 days to register the event and make your benefit changes.

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:

• consistent with the treatment of symptom(s) or diagnosed injury, disease, or disability,
• not primarily prescribed or provided for convenience,
• the most appropriate, safe, and cost-effective service or supply, and
• generally recognized as accepted medical practice.

When the plan refers to a health care professional, it means a person who is legally licensed to practice their profession where services are rendered, and includes physicians, pharmacists, dentists, and other professionals as approved by the plan.

Nurse practitioner

A nurse practitioner of medicine who is legally licensed to prescribe drugs and administer medical treatment within the scope of their license.

Pharmacist

A pharmacist who is legally licensed to prescribe drugs within the scope of their license.

Physician

A doctor of medicine who is legally licensed to prescribe drugs, administer medical treatment, and perform surgery within the scope of their license.

Professional counsellor

A therapist or counsellor who is licensed, registered or certified to provide the applicable treatment or counselling.

Proof of good health

Medical questionnaire that you must complete to show the status of your health. Depending on your answers, Canada Life can require a medical examination and any other information.

Reasonable and customary

Canada Life reimburses expenses based on Reasonable and Customary charges. Generally this is the lowest of the following:

• Representative pricing in the area where the treatment is provided.
• Prices shown in the applicable professional association fee guide and the maximum prices established by law.

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:

• Your spouse must live in Canada, unless they are a full-time student elsewhere.
• The plan does not cover any spouse in the armed forces (except for optional and dependent life insurance coverage).
• The plan covers only one spouse at a time.

Stable condition

Any medical condition or related condition (including any heart condition or any lung condition) for which there have been:

• no new treatment or new prescribed medication, and
• no change in treatment or change in prescribed medication (including the amount of medication to be taken, how often it is taken, the type of medication or change in treatment frequency or type), and
• no new symptom, more frequent symptom or more severe symptom experienced, and
• no test result showing a deterioration, and
• no hospitalization or referral to a specialist (made or recommended) or the results of further investigations not yet completed for that medical condition or related condition (including any heart condition or any lung condition).

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:

• the amount that is usually charged for the service or supplies in the area in which the charge is made,
• 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 the Canadian health care,
• 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,
• charges for services and supplies that are incurred while the person is insured,
• charges for services and supplies for the least expensive treatment that is medically adequate.