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Health Insurance Dictionary

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Acupuncture –An alternative medicine treatment involving having thin needles inserted into the body. This is used to treat many ailments including nausea, stress, pain, and addiction. While some may find it effective, its uses are not fully understood. May not be covered under some plans, or only partially covered.

Annual Maximum–The total amount available for a certain treatment or item that replenishes every year. For example, if your massage therapy provision allows for $500 per person, every benefit year, your claims will be payable at a reasonable and customary amount until that $500 has been reached.

Artificial Appendage –This can mean an artificial limb, but also devices that fit on your limbs such as braces and tensors. A physician’s note is usually required when claiming these items.

Chiropractic – A treatment that focuses on the musculoskeletal system, with emphasis on the spine. A licensed practitioner will adjust your spine by placing you in different positions while gently pressing on your spine, causing it to crack, alleviating pressure.

Colostomy / Ileostomy – A surgical procedure where the large intestine or colon empties its contents into a bag on the outside of the body. This is usually required because of colon cancer or incontinence that cannot otherwise be treated. Some plans may cover supplies such as bags and wafers.

Copayment–The amount of any bill that you have to pay after your insurance plan has paid the eligible portion. For example, if your plan pays $200 for glasses every 24 consecutive months, and you buy a pair for $350, your copayment fee would be $150.

CPAP Machine – A machine used to help people with sleep apnea breathe while they are asleep. Some insurance plans will cover the cost of a rental or purchase with a physician’s referral. Some plans may also cover the mask and tubing equipment.

Deductible – The amount you must pay every year before your insurance plan kicks in and pays any expenses. We are pleased to confirm that none of the health insurance plans we offer have deductibles!

Dispensing fee – When filling prescription drug requests, the pharmacy will charge a dispensing fee. This fee is included in your medication coverage. Some plans may have a cap on the amount of this fee.

Homeopathy–A form of natural or alternative medicine. Its remedies are often sold as supplements, or dilutions of active ingredients. Homeopathic treatment and remedies are generally not covered by any health insurance plan.

Massage Therapy – A therapeutic manipulation of the muscles and tissues of the body. A registered massage therapist rubs and massages your body, focusing on the back muscles and spine. Many health insurance plans will cover a portion of your massage therapy as long as you have a doctor’s referral.

Naturopathy – An alternative medicine that focuses on non-invasive self-healing. The naturopaths take a holistic approach and do not actually administer medication of any sort. Some plans will cover the services of a naturopath if they are licensed in the province where the service was rendered.

Orthopaedic Shoes – Shoes prescribed by a doctor to ease the effects of a medical condition (such as bone deformities, injuries and a few conditions caused by diabetes) or to prevent the medical condition from worsening or causing other health problems. A physician’s note is needed. Due to the cost, it’s recommended that you submit a cost estimate first.

Orthotics – Similar to orthopaedic shoes, but removable. These are inserts made from molds of your feet that you put in your shoes. A physician’s note is required.

OTC drugs – Over the Counter (OTC) medication is not prescribed by a physician and can be purchased (literally) over the counter.

Oxygen tank – Equipment that allows you to breathe oxygen from a tank. These are typically required for people with lung diseases such as emphysema. The rental of oxygen tanks is covered by some plans.

Physiotherapy – Therapy in which a person builds their strength and motor function through movement, exercise, and manual manipulation. This is a common therapy used after an injury such as a sports injury. A physiotherapist can help a person re-learn how to walk and move regularly.

Psychology – A form of therapy that includes counselling and working through personal issues including mental health, relationships, diagnoses for specific mental disorders, and learning about one’s way of thinking. This therapy is covered by many plans as long as it is performed by an individual who is a licensed psychologist. Some plans may cover the services of a registered social worker.

Premium – The total amount you pay every month for your health insurance plan.

Prescription drugs – Medications that have been prescribed by your physician. If your plan includes drug coverage, a drug card will likely be issued. Controlled substances may require a doctor’s note explaining why they are required and for how long they will be needed.

Reasonable and Customary – A set total cost that a treatment should not exceed. For example, the reasonable and customary rate for a one hour massage may exceed the limit set by your plan. Your plan may only reimburse the reasonable and customary portion of the amount.

Viscosupplementation – When you have osteoarthritis, your joints lose their lubrication, making it harder for your limbs to function. Viscosupplementation is the injecting of lubrication in your joints to make up for what they do not have. Injections such as Synvisc are not covered by any health insurance plan unless otherwise stated.

Vision Care – Treatment involving your eyes. Eye exams are covered by most health insurance plans. Glasses and contact lenses may also be covered up to a certain amount every two years, depending on the plan. Some may also consider reimbursement for laser eye surgery. Visual field testing and other extra exams are not covered.

2 Responses

  1. How much coverage do I have for massage therapy per year. I understand it’s an hour but how often.

    1. Hi Donna, I have checked our database and it doesn’t seem that you are a client of ours so it isn’t possible for us to look at your benefits. I suggest you take a look at your ID card and there should be a number on the back of it for claims inquiries. Thank you

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