Medical Insurance Terminology

BC Medical Services Plan (MSP)

The Government of British Columbia’s plan under Canada’s national health insurance program. It insures medically-required services provided by physicians and supplementary health care practitioners, laboratory services and diagnostic procedures.

Beneficiary

The person who is to receive the insurance proceeds at the death of the insured.

Benefit

The amount payable by the insurance company to a claimant, assignee or beneficiary when the insured suffers a loss covered by the policy.

CareCard/Services Card

The card that you will receive when Medical Services Plan (MSP) coverage begins. Each card has the person’s name and a personal health number on it. This card is required when you go to a doctor, clinic or hospital. You will also need your CareCard/Services Card for prescriptions and when you register children for school. See the card.

Claim

A demand to the insurer by the insured person for the payment of benefits under a policy.

Co-insurance

A provision in a health insurance contract by which the insurer and insured share, in a specific ratio, the covered expenses under a policy. For example, the insurer may reimburse the insured for 80 per cent of covered expenses, the insured paying the remaining 20 per cent of such expenses.

Deductible

The amount of covered expenses that must be incurred and paid by the insured before benefits become payable by the insurer.

Dependent

A person eligible for coverage under another individual's health plan because of that person's relationship with the primary policy holder. Examples of those who may be eligible for dependent coverage include spouses or domestic partners, and biological and adopted children. See policy for exact definition.

Direct billing

A process where the health care provider will bill the insurance company directly, instead of seeking payment upfront and providing a receipt to the patient to submit as a claim to the insurance company for reimbursement.

Direct Deposit

A process whereby claim payments are deposited directly into your bank account (the alternative is receiving a cheque by mail).

Duplicate coverage

When a person has coverage for the same health services under more than one health benefits plan.

This is a BC government plan that helps British Columbians with the cost of eligible prescription drugs and designated medical supplies.

Family Doctors (general practitioners or GPs)

There are two kinds of doctors in BC – family doctors and specialists. Family doctors (also called GPs) take care of most non-urgent medical problems. They can also refer you to a specialist, who is an expert about particular health problems. You should see your family doctor first, who will then refer you to a specialist if you need one.

Graduate Benefit Plan (also known as GSS Benefit Plan)

Supplementary health and dental coverage (dental, eyeglasses, massage therapy, prescription drugs and more) provided for eligible graduate students through the Graduate Student Society and administered by Student Care.

Group Health Insurance Plan

An insurance plan that provides healthcare coverage to a select group of people. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group (e.g. members of a student society)

Health Insurance BC

The name of the government office which administers the BC Medical Services Plan.

I Have A Plan (or StudentCare)

The student health group plans (Graduate Benefit Plan and SFSS Health & Dental Plan), provided through the Simon Fraser Student Society or Graduate Student Society and administered by Student Care.

Insurer

The party to the insurance contract who promises to pay losses or benefits. Also, any corporation licensed to provide insurance to the public.

Medicare (Also known as Provincial Health Care Coverage)

Refers to Canada's national health insurance program, which is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis. Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage.

Network members

This refers to a list of health care practitioners (dental, vision, chiropractor, physiotherapy, massage therapy) available on the Graduate Benefit Plan and SFSS Health and Dental Plan websites and offer student discounts and other services to members of those plans.

Opt In/Opt Out

To make a choice, especially for one thing or possibility in preference to any other.  Example: He opted out of the health insurance plan (= chose not to be a part of it).

Out of Pocket Expense

The portion or entirety of an expense for services that is not eligible for reimbursement and is the financial responsibility of the member or patient. An out of pocket expense may (a) result from a fee for service that exceeds the maximum eligible reimbursement amount or (b) relate to a service that is not a covered benefit in accordance with the provisions of the medical insurance policy.

Over the Counter

Medicines which can be purchased from a pharmacy without a prescription from a doctor (e.g.  mild pain relievers, cough syrup etc.)  Insurance companies typically do not provide coverage for these types of expenses.

Pacific Blue Cross

A private insurance company which offers extended health benefit and personal dental plan benefits to eligible SFU employees (e.g TSSU members).

Personal Health Number (PHN)

Each B.C. resident enrolled with the Medical Services Plan (MSP) is given a CareCard with a unique lifetime identifier for health care called a personal health number.

Policy

The legal document issued by the insurer to the policyholder that outlines the conditions and terms of the insurance. Also called the contract.

Policy Holder (Also called the insured)

The person who owns an insurance policy.

Premium

The payment, or one of the periodic payments, a policyholder is required to make for an insurance policy e.g. monthly premium for the BC Medical Services Plan.

Premium Assistance

Assistance with the payment of premiums to the BC Medical Services Plan for lower-income Canadian citizens or holders of permanent resident status (landed immigrants) who have held that status and been resident in Canada for the past 12 consecutive months.

Prescription

An instruction written by a medical practitioner that authorizes a patient to be issued with a medicine or treatment.

Primary Insurance (also known as Basic Insurance)

A level of medical insurance which typically provides coverage for the medically required services of physicians and surgeons, but NOT supplementary benefits (such as vision, dental, prescription drugs etc).  For most residents of Canada, this level of coverage is provided through our national health insurance program (e.g. the BC Medical Services Plan).

Referral

An instruction written by a medical practitioner to see a specialist or receive a test requiring an appointment.

Secondary Insurance (also known as Extended Health Insurance)

A form of health insurance provided by private companies that provides, in one policy, protection for hospital and medical expenses not covered by MSP or other government programs and usually other health care expenses, such as prescribed drugs, medical appliances, ambulance, private duty nursing, etc. The policy may contain a deductible amount, coinsurance and high maximum benefits.

Supplementary health and dental coverage (dental, eyeglasses, massage therapy, prescription drugs and more) provided for eligible undergraduate students through the Simon Fraser Student Society and administered by Student Care.

SFU clinics that provide access to basic doctor/nurse services, physiotherapy, chiropractor, personal counselling, and health promotion programming for all students.

Social Insurance Number (also known as SIN)

Not to be confused with medical or health insurance. A Social Insurance Number is a number which is required for employees in Canada for taxation purposes. The Social Insurance Number card may be called the SIN Card.

Teaching Support Staff Union (TSSU)

A labour union which represents teaching assistants (TAs), tutor markers (TMs), sessional instructors (SIs) and language instructors (LIs) at Simon Fraser University. 

Temporary Private Health Insurance

Medical insurance which new residents in British Columbia (anyone who is new to BC and plans to be here longer than 6 months) must obtain through a private insurance company while fulfilling the three-month eligibility waiting period for the BC Medical Services Plan.

Walk-in Clinic

Most cities and towns in BC have local walk-in clinics for non-urgent care to see a general practitioner. You don’t need an appointment. Many are open in the evening and on weekends.