Legislative terms defined

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A program comprised of:

- AMCS - Ad Hoc Services
- AMCS - All Cases
- AMCS - Occupational Management
This is an early-intervention program intended to help the front-line managers in an organization manage their employee’s short-term absences from the workplace. Manulife Case Managers evaluate each absence looking at medical and non-medical influences that may have contributed to the absence. The goal is to ensure the best outcome for employee and employer, and avoid transition to the next phase of the disability management continuum – short-term disability.

This term generally appears in the context of accidents and illnesses that affect covered employees and dependants – especially in relation to health-related coverage and products.
It can also be referred to as A&H (Accident and Health) or Casualty and Disability coverage.
The more familiar industry term is Health Insurance.

An injury sustained as a result of an accident.

Coverage in the event of death or dismemberment due to an accident (the term accident as defined in the contract). If a death is accidental, payment is made to the insured's beneficiary; if bodily injury is accidental (e.g.., loss of limb), insured receives a benefit (usually a percentage of the overall benefit amount) which has been predefined in the contract.

The unexpected and unforeseen cause of an accident. The "means" which caused the mishap must be accidental to be able to claim the benefit described in the policy.

The period of time where expenses accumulate towards satisfying any deductibles outlined in the policy. The plan member generally is responsible for the full cost of these expenses. It is important for these to be submitted as claims so they are recorded against the deductible. Once the required plan deductible has been satisfied, the plan member will begin eligible for reimbursement under the plan in accordance with all other provisions.

This refers to the requirement that an employee must be actively at work on his or her usual and customary basis on the date the employee’s insurance normally becomes effective. The purpose of this requirement is to ensure that an employee who is not well enough to attend work is excluded from the plan until either evidence of health is provided or the employee returns to work on the usual and customary basis.

A team that operates within Manulife’s Small Business Unit. This team focuses on responding to plan advisor inquiries submitted by phone and through e-mail.

This term refers to distinct periods of time when information is added to a plan member’s records established with Manulife. Both plan member and over-age dependant information is collected during the initial enrolment process. Information about a plan member’s dependants is “added on the fly” – meaning that it is only collected when a claim has been submitted.
Dependant and COB information is not verified at the time of a claim.

Performing of functions related to the operation of the group insurance plan (e.g. issuing, amending, billing, claims processing, etc.) once it has become effective.

A type of policy arrangement where the insurance company handles claims administration services for the plan sponsor. Liability for funding of those claims paid under the policy remains with the policyholder.

The individual or firm (third party administration) responsible for administering a group insurance program. The administrator is responsible for all accounting, plan member certificate issuance and claims settlement.

A team that operates within Manulife’s Small Business Unit. This team focuses on responding to plan advisor inquiries submitted by phone and through e-mail.

Advisor means a person or organization working with the plan sponsor to provide advice about their group benefits program. Advisors must be licensed to provide advice and registered with an insurance carrier to be able to discuss products and services with a plan sponsor. The terms “agent,” “consultant,” “producer,” “broker,” and “consulting house” are sometimes used interchangeably and have the same definition as “advisor.” The term Advisor is the preferred term at Manulife Financial.

Stated in the policy, these are ages that restrict coverage to plan members and/or dependants. When the age limit is attained, coverage available prior to the age limit changes. Sometime the coverage is reduced, and sometime coverage is no longer valid or terminated.

A reduction in the amount of insurance on an individual who attains a specified age.

The limitation on benefits when the insured person reaches a specified age.

A term generally used to describe one who is licensed to sell group insurance products, normally represents a single insurance company. See Advisor.

The maximum sum than an insurance company is liable for in any single loss, series of losses, or for the entire duration of a contract.

Under this kind of arrangement, all of the claims paid in excess of a stated percentage of paid premium are pooled, regardless of whether claims can be attributed to significantly costly claims for individual plan members.

Relating to disability coverage, the ASM is the total amount of money payable to a claimant from all sources, including any employment and all public and private insurance plans under which the claimant is entitled to claim benefits. Usually set at 85% of pre-disability earnings, for any amounts exceeding the total ASM, the insurer may apply a dollar-for-dollar deduction against the disability benefit otherwise payable.

Any necessary, reasonable or customary expenses covered by the policy.

One of Manulife Group Benefit’s four market segments. Alpha Plus plans range from 2-24 lives and are administered by the Small Business Unit.

Proprietary quotation software Manulife produces for the Alpha Plus market segment. AlphaQuote enables Advisors to input specifications to the software and obtain instant quotes for clients.

This clause indicates that when there are two or more courses of dental treatment available for a dental condition, Manulife will reimburse the cost of the least expensive treatment that will provide a professionally comparable result, as determined by our Dental Consultant.

A formal document changing the provisions of the group contract and signed jointly by authorized representatives of the insurer and the policyholder.
It may increase or decrease benefits, waive a condition or coverage, or in any other way amend the original contract.

The portion of the amount submitted that may be eligible for whole or partial reimbursement by a plan.

A contract purchased from an insurance company to provide periodic (usually monthly) payments to a person for his or her lifetime.

The risk that an individual will only apply for coverage when they are aware of an adverse health condition and are highly likely to make a claim. For example, a plan member may select health coverage if they become aware they will need large prescription reimbursements, or they may request additional life insurance knowing of a recent diagnosis. The purpose of Medical Underwriting is to reduce the risk of anti-selection in the pool of covered individuals.

The document signed by the plan sponsor requesting/applying for group benefit coverage. It outlines detailed benefit coverage information and forms part of the contract when issued.

A direction to pay benefits to a third party. For example, benefits may be assigned to a dentist, hospital or the health care provider, as permitted in the contract.

The age of a person, the day before he or she reaches a specific age defined in the policy.

A document completed by a plan member’s attending physician that includes medical information about the plan member that will be used during medical underwriting.

The portion on a health and dental claim form that allows the plan member to direct the insurer to pay the claim directly to the service provider.

Life insurance that provides a lump-sum payment to the plan member’s beneficiary.

Coverage for dental services such as routine examinations, cleanings etc. Exact services are delineated in the policy.

The person(s) designated by a plan member to receive Group Life or Accidental Death benefits upon the plan member’s death.

The amount payable by the insurer to a claimant, assignee, or beneficiary under the policy.

A benefit booklet is a document that helps plan members understand their group benefits plan, including instructions on how to submit a claim. The booklet describes specific details of the coverage provided under the plan but does not constitute a contract. The contract terms govern in all situations.

The insurer issues a benefit card to each covered individual. The card specifies that the individual named is covered under the plan document and provides some essential details of the plan. The benefit card does not constitute a contract or proof of coverage where the holder is not eligible.

A formula or rule for determining the disability benefit payable based on the provisions of the policy or ASO plan document. The formula frequently takes into account salary, position, or years of employment at the time the benefit is paid.

The benefit maximum is the highest amount eligible for payment before applying any deductibles, co-insurance or limitations outlined in the policy.

A benefit period is the maximum duration for which disability benefits may be payable.

This outlines the type and amount of insurance selected by a plan sponsor and provides a summary of coverage outlined in the plan documents.

A term used to describe participation, co-insurance, deductibles, maximums, schedule of insurance, the main eligible expenses. Forms part of the ASO Plan Document (for non-insured groups) and Policy for insured groups. There is usually a BSP page for each division within the contract.

In the HealthPro administration system, refers to either health or dental.

A 12-month period over which the maximum accumulates for all plan members. It may be a calendar year, or any other 12 month period as specified in the contract.

A benefit year maximum can apply to certain types of coverage within a plan depending on the contract. It may limit the number of visits to a particular practitioner, the number of times that a specific procedure can receive payment as a claim. It may limit a practitioner or procedure to a specific dollar maximum.

The period before benefits begin (e.g. 3 month probationary period).

A bill group is a grouping of plan sponsors who are billed at the same time using the same bill layout.

A method of grouping plan members used for billing and reporting purposes. Each bill sort group represents a group of members.

Billing a client for claims and expenses for a future period.

Billing a client for their claims and expenses for a past period, rather than a future period. (e.g. Billing for March is done at the beginning of April).

A number used for billing purposes which provides a new location for every bill and expands the level of premium reporting. Manulife bills can provide a sub-total for plan, class and other data element.

The initial premium deposit paid by the prospective policyholder when an application is made for a group insurance policy; It must be equal to the first month's estimated premium. It is applied toward the actual premium when the bill is prepared.

A term used to describe one who places business with more than one company and who also has no exclusive contract requiring that all his or her business first be offered to a single company. This is in contrast to an agent, who normally represents a single company. Manulife refers to all distribution chain partners as plan advisors.

The 365-day period beginning on January 1st each year.

The maximum amount payable as a benefit or group of benefits during a calendar year, delineated in the contract. Maximums usually apply to each individual separately The calendar year maximum is the more commonly used, but sometimes the maximum may run on the benefit year or plan year.

A federally administered pension plan that offers disability benefits to eligible contributors to the Plan. Primary benefits are payable to and on behalf of the disabled contributor. Dependant benefits may be payable either to the disabled contributor or the dependant (e.g. spouse, child) but in either case they are paid on behalf of the dependant.

(CAPSA) The national inter-jurisdictional association of pension regulators whose mission is to facilitate an efficient and effective pension regulatory system in Canada. CAPSA discusses regulatory issues of common interest and develops practical solutions to further the coordination and harmonization of pension regulation across Canada.

A regulatory association representing member companies in the life and health insurance industry and providing information and services to life and health insurance consumers.

(CAP) A plan into which contributions are made on a tax-deferred basis. A CAP may include a defined contribution registered pension plan, a pooled registered pension plan, a group registered retirement savings plan, a registered education savings plan or a deferred profit-sharing plan.

The party (insurer) to the group contract who agrees to underwrite (carry the risk) and provide certain types of coverage and services.

The employee insured under a group plan. Manulife prefers the term plan member.

A reference to a dataset on the HealthPro administrative system that indicates how a group is enrolled and how claims are adjudicated.

A request by an eligible plan member for payment of covered expenses for health, dental, disability benefits. A claim can also be a request to pay out policy proceeds upon a loss (such as a death or disability of the insured).

The time interval between incurred date of a claim and its submission to the insurer for payment. It is also used to mean the time between claim incurred and payment.

The benefit payment payable by the insurer to a plan member, service provider, or beneficiary as outlined in the group contract.

Funds set aside by an insurer to settle incurred but unpaid claims, future claims, and may also include reserves for potential claim fluctuations.

A statement (generally attached to the claim payment or direct deposit notification) that outlines how benefits have been calculated or why benefits have been denied. Sometimes referred to as an Explanation of Benefits (EOB).

Any eligible plan member making a claim.

A policy holder fund where MLI has 1st call on money to cover a financial deficit associated with the plan.

A group of plan members within a plan that have similar characteristics (and who are eligible for the same benefits), that allow the group insurer to determine an appropriate premium rate based on the benefits they receive.

The unique identification number to group/categorize claims; Provides a level of claims reporting.

A clerical error is a mistake in writing or copying data. A clerical error made by the policyholder or Manulife Financial will not invalidate insurance otherwise in force, or continue insurance otherwise terminated under the terms of the policy.

Under a client administered Group Benefits plan, the plan sponsor administers the benefits; This may include maintaining and updating records for the plan members and their dependants (i.e., spouse, child(ren)) and preparing and submitting the premium statement for each payment date to the insurance company.

In this circumstance, Manulife Financial validates the claims and the plan sponsor prepares and submits the premium statement.

A legal document prepared to detail all financial obligations between the plan sponsor and Manulife. Usually applies to plans with unique administration combinations/types.

Unique identification number to distinguish a group. The number is system-generated, used internally only; Clients do not have to provide the internal Client ID number to communicate with Manulife Financial.

There could be multiple policy/contract numbers under the one client ID.

An insurer's attempt to prevent the lapse of a policy or its transfer to another insurer.

Manulife’s claim adjudication system used to settle EHC and Dental claims but not drug claims.

The amount or percentage of expenses the plan covers under a group plan. For example, if a plan covers 80% of the cost of eligible prescription drugs, the remaining 20% is paid by the plan member.

The period during which an employee is continuously employed by the same employer. Continuous employment may be defined in the pension plan (or by law) to include certain periods of absence and/or of employment with an associated or former employer.

(CPI) is a statistical device that measures the change in the cost of living for Canadian consumers. Old Age Security pensions, Canada Pension Plan and Québec Pension Plan payments, and other forms of social and welfare payments are adjusted periodically to take account of changes in the CPI.

(CPP) is a contributory governmental pension plan that provides benefits to workers and their families in the event of retirement, disability or death. The CPP applies in Canada, with the exception of Québec.

The date from when the claimant is deemed no longer able to carry out the duties of occupation (per Contract or ASO Agreement provisions and definition).

The payment made to a beneficiary at the time of death of an insured.

The amount of coverage reduction because of a change in classification due to attainment of a specified age, demotion, salary decrease, etc., as provided by the master policy.

The amount of covered expenses that must be incurred by a plan member each calendar year before benefits become payable by the insurer.

When Manulife has paid out more in claims and expenses than received in paid premium.

A pension plan that defines the pension benefit to be provided based on factors such as years of plan membership and average earnings calculated in accordance with the terms of the plan.

A pension plan that defines the amount of employer and employee contributions (if any) to the pension fund, determined on an individual account basis. The benefit the member will receive on retirement is determined at the date of retirement and is based on accrued contributions and investment income.

Generally, dental services and supplies not covered or in excess of those covered by any Provincial Plan.

Dental associations publish dental fee guides which summarize recommended charges for each dental procedure. Guides are updated annually to account for inflation and other factors.

The spouse and/or children of an insured plan member who meet the eligibility requirements as defined in the contract.

The premium deposit paid by a prospective policyholder when an application is made for a group insurance policy; It is usually equal to the estimated first month's premium and applied toward the actual premium when billed. Also called Deposit or Initial Deposit.

The person(s) or party designated by the insured to receive the proceeds of an insurance policy upon the plan member’s death.

Diagnostic services required to assist the dentist in evaluating the existing condition of a patient's mouth. These services are used to determine what dental treatment, if any, is needed.

A plan setup where the plan member submits a claim directly to the insurer, who verifies eligibility based on information provided by the plan sponsor.

The electronic credit of claim reimbursement expense funds or disability payments from the insurer to the plan member's bank account.

Plan member, over-age dependant and coordination of benefits information is collected at the time of enrolment. Dependant information is collected at the time of the claim and subject to some checking criteria. When a claim is made at a pharmacy, COB information is verified and used to adjudicate the claim. If dependants have other coverage based on COB rules, the claim is declined and the plan member is directed to submit the claim to the other insurer first. Dependant information does not have to match in order for a claim to be paid.

The electronic debit of funds from a plan sponsor or plan member's bank account to pay premiums for benefits.

A physical or mental condition which makes an insured incapable of performing duties based on the specific Definition of Disability in each contract.

A contract benefit or benefit provision that provides some type of compensation for disability.

The future liability set up for claims that are active. This reserve is calculated on a claim by claim basis.

The accidental loss of limb, sight, speech, or hearing.

The dollar amount charged by the provider for dispensing the benefit and/or service (e.g.., pharmacist charges a "fee" for dispensing prescription drugs).

The upper limit of how much the plan will pay for the dispensing fee depending on the contract. The plan member may pay the balance charged over this amount, depending on the contract.

A number to identify specific plan member groups organized by active and retired, different locations, management and non-management.

A term referenced in HealthPro claim payment system that means to auto-adjudicate (without any manual intervention) and pays a claim as soon as it is 'dropped' into the HealthPro system.

A substance intended for use in the diagnosis, cure, treatment or prevention of a disease. There are various terms used to describe drugs. These include drugs, generic drugs, prescription drugs, over-the-counter drugs, depending on the contract.

A restricted list of prescription medications covered under a prescription drug program.

A unique number that identifies a specific drug. Each type, form, strength and package size has a different DIN.

Drug Stop Loss Pooling (DSL) protects the plan sponsor’s EHC renewal rates from the impact of high drug costs. Claims over a certain threshold are removed from experience rating analysis and replaced with a pool charge.

Drug utilization review is a pharmacy benefit management feature that helps protect the health of plan members by seeking to alert the pharmacist to dangerous drug interactions, too-early refills and duplicate drug therapies.

Premium due an insurer that has not been received as of some specified date.

The date premiums become due on a case; also called premium due date.

It exists when an insured is covered under two or more policies for the same exposure to loss. Non-duplication provisions are utilized to control this situation, especially when such double coverage results in over insurance.
See Over insurance.

A pharmacy benefit management feature that determines how many days supply of a drug will be covered per prescription refill, based on whether a plan member uses the drug for a short or long-term medical condition.

Members who are within 10 years of pensionable age are eligible to receive an early retirement pension from the plan (e.g. if the plan's pensionable age is 65, members could choose to retire at any time between the age of 55 and 65). However, the amount of pension may be reduced to compensate for the fact that it is payable for a longer period of time.

The basic salary or wages paid to an employee, sometimes including regular overtime and bonuses. It may or may not include commission income. Basic compensation is often used as a means of establishing an employee's benefits and contributions.

A type of schedule of insurance whereby insureds are classified by wage or salary and the insurance benefits (type and amount) vary by earnings classes.

Information that is obtained to determine a disabled claimant's eligibility for benefits and/or suitability for rehabilitation.

The date on which coverage goes into effect. The term may reference the date a contract, coverage, a particular benefit or an insured plan member, their dependant (ie., spouse or child(ren)) comes into effect.

The electronic transmission of data from the provider to a Third Party (e.g.., transmission of a dental or drug claim).

The electronic debiting or crediting of funds to or from a plan sponsor, plan member, provider or insurer's bank account.

The provision of the group policy which state requirements that the members of the group must satisfy to become insured with respect to themselves or their dependants.

The date on which a member of an insured group becomes eligible to apply for insurance.

The period of time following the eligibility date (usually 31 days) during which a plan member of a group plan can apply for insurance without evidence of insurability.
Also known as Enrolment Period.

A period of time of continuous total disability that the plan member must complete in order to qualify for benefits.

Employee census includes data, such as age, sex, occupation, earnings, and dependency status, relating to the insured persons under a group policy.

An arrangement where the plan sponsor validates plans member eligibility for claims prior to submission of the claim for payment.

These types of arrangements are now very uncommon in view of privacy legislation.

A plan set-up where the plan member submits a claim via the employer, who forwards the claim to the insurer after verifying the eligibility of the person for benefits.

A process to sign up plan members for group benefits.

Form used to sign up plan member for group benefits.

The period during which plan members may enrol in a new group plan without providing evidence of eligibility and before becoming a late applicant.
Also known as Eligibility Period.

ESI Visual Administrator - A claims adjudication system for claims submitted by pharmacies and employee reimbursement claims.

Proof presented through written statements on an application form and/or through a medical examination, that an individual is eligible for a certain type of coverage.

Adjudication is the process of determining whether a claim is eligible for payment.

The average number of years of life remaining for persons of a given age according to a particular mortality table.

This is a cost that is included in the premium rate to cover costs for installing and administering a plan.

The ratio of expenses to earned premiums. May also be called the insurer's retention.

The term used to describe the relationship between the premiums paid to an insurer and the benefits paid out over a fixed period of time, for example, a policy year, or the three most recent complete policy years.

Any statistical analysis of experience for all or any segment of the group business such as a line or a territory; any group of cases, coverage, or benefits, or any single cases, coverage, or benefit. It may include single or multiple experience periods, analysis of past and projection of future trends, plus various descriptive or inferential statistics.

The process of determining the premium rate for a group based wholly or partially on the group's claims experience. Where the group's claims record is worse than expected the premium rate may be increased to compensate; favourable experience may be rewarded with a premium discount.

The amount of premium returned by an insurer to a group policyholder when the financial experience of the particular group has been more favourable than anticipated.

Premium rates for a group coverage which are based, wholly or partially, on the past claims experience of the group to which they will apply.

EOB is a claim statement explaining what health or dental treatments or services were paid for under their group insurance plan.

Provides coverage for a distinct period of time to the plan member's surviving spouse and dependents, after the death of a plan member.

Medical services, drugs and supplies provided under a group benefit plan in excess of those covered under the Provincial Plan.

The granting of certain benefits under conditions beyond the termination of a plan member's participation in a plan or the termination of the master policy.

Insurance coverage for the plan member as well as his/her dependants (ie., spouse and/or child(ren)).

A type of deductible that may be satisfied by the combined expenses of all covered members rather than an individual family member.

Maximum dollar or unit allowances for dental services that apply under a specific contract.

An adjustment on Renewals based on product code.

A type of schedule of insurance under which everyone is insured for the same benefit(s) regardless of salary, position, or other circumstances.

Plan design that permits an eligible plan member to select their benefits from a range of options to best meet their needs. Typically only larger plan sponsors offer Flex Plans.

is a defined benefit pension plan which allows plan members to make Optional Ancillary Contributions in order to acquire Optional Ancillary Benefits.

Term for an assessment of a disabled claimant's physical restrictions and limitations.

Term for an assessment of a disabled claimant's physical restrictions and limitations.

A drug that contains the same active ingredient but is generally less expensive that its brand-name equivalent.

A drug plan formulary that reimburses drug expenses based on the least expensive generic alternatives of the drug.

An original Manulife System that has now been replaced by ManuConnect. Business that converted from this system is shown on Navigator 2 as Source of Business GFM to differentiate from new business set up on ManuConnect (VNCov).

A specified time (usually 31 days) following the premium due date during which the premium may be paid and during which the insurance remains in force.

When Manulife accepts the existing amounts of coverage for all plan members at the time of Quotation or New Issue without obtaining Evidence of Insurability.

Employer-sponsored benefits.

GRID is a view function that displays the coverage (benefit) information stored in the coverage database.
See CovDB.

GIPSY is the administration system for plan sponsors whose information is maintained in the Coverage Database (CovDB). This is an integrated system, binding information related to premium payment, billing type and plan member data.

An internal database that lists contracts and policies across all blocks of business, as well as the applications used to provide specific services such as plan set-up, health and dental claim administration, life and disability claim administration.

A term used in HealthPro claims adjudication system.

A pension that will be paid to a person for his or her lifetime, with a minimum number of payments guaranteed. For example, if the plan member opts for a five-year guarantee but dies after three years, payment will continue to the survivor or the estate for two more years.

For H.O. Admin (Direct Billed) Groups, Manulife maintains the records on employee coverage, movement, etc. and bills the policyholder for premiums due.

An account where credits (supplied by the plans sponsor) are deposited for plan members to use for paying selected health and/or dental care services and supplies. Eligible expenses are limited by what Canada Revenue Agency deems eligible for tax purposes, which include but are not limited to plan deductibles and/or percent payable amounts, or other services/supplies that are not covered under the Extended Health or Dental Care plan. A HCSA is generally a supplement to the group benefit plan designed to give more flexibility and control to plan members.

Health Service Navigator (HSN) is a health care navigation service designed to support plan members and their eligible dependants facing a critical, chronic or episodic health event.

The service provides a centralized resource for medical and health information and will assist plan members in navigating the Canadian health care system (both public and private), effectively and proactively. When appropriate, HSN also enables users to gain access to “world-class‟ medical second opinion services and treatment facilities.

Health and dental claims adjudication and payment system.

A billing and administration system that provides policy information to Navigator 1.

These are income sources that are to be deducted from the gross benefit in the manner as set out in the Contract or ASO Agreement provisions.

The provision in a group life and/or disability insurance policy which prevents the insurance company from disputing the validity of:

  • an insurance policy once it has been in force for a specified period of time (e.g., two years) as long as premiums are paid, except in the case of fraud.
  • an individual's insurance, on the basis of statements made by the individual in connection with insurability at the time he or she applied for the coverage, once the insurance has been in force for two years during the individual's lifetime, except in the case of fraud.

Date of Loss (Death, Disability, Dismemberment).

Basis which segregates experience based on the date of incural of a claim.

Incurred But Not Paid Claims - Incurred claims which have not been paid as of a specified date (may include both reported and unreported claims).

Incurred But Not Reported Reserve - A reserve of funds Manulife must maintain to cover the cost of claims that have not formally been made yet.

Incurred claims that have not been paid as of some specified date (may include both reported and unreported claims).

Incurred claims equal the claims paid during the policy year plus the claim reserves as of the end of the policy year, minus the corresponding reserves as of the beginning of the policy year. The difference between the year end and beginning of the year claim reserves is called the increase in reserves and may be added directly to the paid claims to produce the incurred claims.

These reserves represent an estimation of claims actually incurred in the policy year but not settled as of the end of the policy year. They may be established as a function of premiums earned, claims paid, or benefits in force, using average factors, or in exceptionally large cases they may be result of a detailed study of that particular policyholder's actual claims. Reserves for known pending claims, generally restricted to Life, AD&D and LTD claims may be added to these claim reserves.

An examination of a disabled claimant by a specialist who is not actively treating the claimant. Manulife requests the examination.

The total volume of insurance in effect on the lives of covered employees at any given time. Measured in terms of cases, lives, premium and amount (volume) of insurance.

The deposit paid by the plan sponsor upon completion of a group insurance application. It is usually equal to the first month's premium payment and is applied as such when the actual premium is calculated. Also called Deposit or Deposit Premium.

The deposit paid by the plan sponsor upon completion of a group insurance application. It is usually equal to the first month's premium payment and is applied as such when the actual premium is calculated. Also called Deposit or Deposit Premium.

A classification of insured persons (described in a group policy) which determines the types and amounts of insurance for which they are eligible under the policy.

A company offering protection through life, health, dental and disability benefits due to the sale of an insurance policy. The Manufacturers Life Insurance Company is an insurer.

as it pertains to Employment Insurance, is the total amount of earnings, in accordance with the Employment Insurance Act, that an insured person receives from insurable employment. Weekly insurable earnings serve to determine the Employment Insurance benefit payable, while the Annual Maximum Insurable Earnings (MIE) serve to determine the maximum annual premiums payable.

A component of the Absence Management Services program.

The Integrated Administration Solutions (IAS) team provides full administration services for all types of benefit programs to our Corporate Account customers.

Internal Wholesalers are sales professionals who are members of the Small Business Unit. Internal Wholesalers work closely with the Account Executives to expand Manulife’s advisor relationships.

A beneficiary designation which may not be changed without the beneficiary's consent.

People defined by the plan member who are entitled to a shared percentage of the proceeds of an insurance policy upon the plan member’s death and as directed by the insured. In the absence of specific percentages, joint beneficiaries receive equal amounts.

A direct canvassing of employers in order to obtain accurate and current information regarding specific occupations. It is usually carried out via telephone and may be coupled with local or national labour statistics. A Rehabilitation Specialist with CRC credentials typically performs the LMS.

It is the termination of the coverage provided in a contract because of the non-payment of premium(s) within the time due. The contract is then cancellable subject only to the insurer’s reinstatement provisions.

A group master contract that has automatically expired, as provided by its terms, due to nonpayment of premium.

A plan member who applies for insurance after the normal 31 day enrolment period, at which point evidence of insurability is required.

A software application (such as Manulife Financial’s Compass system) that is used for the administration, documentation, tracking, and reporting of training programs, classroom and online events, e-learning programs, and training content.

The probable cost of meeting an obligation.

A Life Income Fund (LIF) is a type of RRIF under which the owner of the LIF must withdraw, each year, a minimum amount prescribed by the Income Tax Act (Canada), up to a maximum amount prescribed by the pension legislation. It is now only in Newfoundland where the owner must use the balance of the funds when he/she reaches the age of 80 to purchase a life annuity.

A request by a beneficiary of a Life insurance plan to pay the proceeds of that benefit upon the death of the insured.

The maximum amount payable as a benefit during the plan member’s lifetime. Maximums usually apply to each covered individual separately.

The maximum amount of insurance an insurer will write on one risk. The maximum and minimum ages above and below which an insurer will not issue or offers restricted coverage.

A Locked-In Retirement Account (LIRA) is a type of RRSP where the funds are subject to pension legislation. These funds must be used to purchase a life annuity or be transferred to a LIF, an LRIF or a prescribed RRIF (Saskatchewan only) by the end of the year during which the owner of the LIRA reaches age 71, at the latest. The LIRA is available in all jurisdictions, with the exception of British Columbia and the federal (PBSA). These two jurisdictions provide rather for the locked-in RRSP that is very similar to the LIRA.

The amount held to cover the liability that may result from existing legal action as reported to and calculated by Manulife’s Actuaries.

A locked-in Registered Retirement Savings Plan is a type of RRSP where the funds are subject to pension legislation. These funds must be used to purchase a life annuity or be transferred to a LIF by the end of the year during which the owner of the locked-in RRSP reaches age 71, at the latest. The locked-in RRSP is available in British Columbia and the federal (PBSA). Legislation of British Columbia still provides for age 69 as maturity age instead of age 71. However, the Superintendent of Pensions of B.C. allows locked-in RRSP issuers to defer the transfer of funds held in these vehicles to a LIF until December 31 of the year in which the owner of the locked-in RRSP attains age 71.

A member cannot withdraw in cash the employer’s contributions and his/her contributions with interest. These contributions with interest must be used to provide a pension at retirement.

Disability income insurance that provides long-term benefits to the plan member when income is interrupted for a time because of an illness or accident. Benefits are paid monthly, semi monthly, or weekly, bi-weekly, typically a percentage of salary to a stated maximum or fixed amount.

The LTD benefit provides income replacement on behalf of the plan member in the event that the plan member is totally disabled as defined in the Contract or ASO Agreement.
There is normally a 3 month or longer period of Total Disability required before an insured is entitled to this benefit, and the maximum benefit period is normally age 65 although this can vary each contract defines the maximum benefit period.

The ratio of paid claims to earned premiums.

A Locked-in Retirement Income Fund (LRIF) is a type of RRIF under which the owner of the LRIF must withdraw, each year, a minimum amount prescribed by the Income Tax Act (Canada), up to a maximum amount prescribed by the pension legislation. The purchase of an annuity at age 80 is not required. The LRIF is only available in Manitoba and Ontario as well as in Newfoundland and Labrador. However, LRIFs cannot be purchased in Ontario after December 31, 2008.

Coverage under a dental care plan. Plan that reimburses for major restorative dental services depending on the contract.

A term used to describe a group insurance plan under which the employee is required to participate in the plan as a condition of his or her employment.

The MERIT system produces quotations for new business and amendments. Its manual rating capabilities are also used in developing rates for renewal of self-administered groups. It is used primarily by the Underwriting areas.

ManuConnect is a proprietary administration system that stores employee and plan sponsor information on contracts.

Manulife Financial maintains the records regarding all plan members in the group insurance plan, prepares the premium statements and forwards it to the plan sponsor for payment. The plan sponsor provides the insurer with a monthly listing of plan member changes and pays the premium as billed. The plan member submits claim directly to the insurer for payment and the insurer reimburses the plan member directly for those expenses.

Premium statements prepared by the insurer and sent to the plan sponsor for a certain period of time (e.g.., one month).

Coverage under a dental care plan. Plan that reimburses for major restorative dental services depending on the contract.

An annual survey of small business owners sponsored by Manulife Financial Group Benefits.

A proprietary document assembly/content management system that uses coded benefit details to create plan documents (including booklets, contracts, amendments, administration guides).

An agreement between the insurance company and the contracting party (usually referred to as “the employer.”) The employee is the “life insured” and is not a party to the contract, although legal obligations exist between the insurance company and the lives insured under the contract.

The maximum benefit amount eligible for reimbursement before the deductible and coinsurance is applied.

The maximum benefit amount payable after the deductible and coinsurance is applied.

with respect to the CPP/QPP, is the amount of the Yearly Maximum Pensionable Earnings minus the amount of the Year’s Basic Exemption. It serves to determine the maximum amount of earnings on which contributions are made.

An on-line disability management tool which provides information on diagnoses, medical procedures and recovery times Medical equipment, supplies and services (either for purchase or rent) designed primarily for therapeutic purposes. The list of covered supplies and services may vary depending on the terms of the contract.

Medical equipment, supplies and services (either for purchase or rent) designed primarily for therapeutic purposes. The list of covered supplies and services may vary depending on the terms of the contract.

Pre-formatted questionnaire for a specific condition.

A summary on the Secure Sites that shows all the coverage/benefits for a plan member, his or her dependants, as well as COB information for health and dental coverage. The summary reflects only Manulife eligible benefits information.

A formal document produced as an addition to the standard policy. It allows for coverage or exceptions that would not ordinarily be allowed under the group's regular benefit plan.

A false statement as to a past or present material fact, made in an application for insurance, that induces an insurer to issue a policy it would not otherwise have issued.

The declaration by an employee of an age that is lesser or greater than his or her actual age.

The incidence and severity of sicknesses and accidents in a specific class or classes of persons.

The death rate of each age is determined from prior experience. A mortality study (table) shows the probability of death and survival at each age for a credible unit of population.

The primary life and disability claims management, adjudication and payment system. There are two versions: Navigator 1 will be retired when all the records are moved to Navigator 2.

A plan where the plan sponsor pays the entire cost of the plan.

The maximum amount of life and disability insurance that is specified in the group plan for which a plan member does not have to submit evidence of insurability.

Coverage that protects a person against an off-the-job accident or sickness. It does not cover disability resulting from injury or sickness caused by the plan member's employment. Group health insurance is frequently non-occupational.

Non-refund accounting is an underwriting arrangement where the plan sponsor does not participate in the financial results of the plan: whether a surplus or deficit arrangement. Also known as pooled.

Old Age Security (OAS) is a monthly pension paid to Canadians who are age 65 or over and who fulfil the residency requirements. The pension is adjusted quarterly based on the Consumer Price Index.

Insurance covering death, sickness and accidents which arise from a plan member's employment, as well as those which do not (ie., 24-hour coverage).

A set period of time during which employees may apply for new or increased insurance coverage without supplying Evidence of Insurability.

(OAB) Benefits which are provided by optional ancillary contributions under a Flexible Pension Plan. Optional Ancillary Contributions (OAC) Contributions made under a Flexible Pension Plan in order to acquire optional ancillary benefits.

Additional Life insurance, which the plan member can purchase under the group plan at a group premium rate. Evidence of insurability is usually required. Rates are generally age-banded and may also be gender and smoker-status distinct.

Coverage that reimburses for services that correct the misalignment of the teeth.

Corrective appliances for the feet.

The Office of the Superintendent of Financial Institutions (OSFI) is the entity making sure pension plans governed by the Pension Benefits Standards Act, 1985 (PBSA) comply with this act and are administered in accordance with its requirements.

The portion of eligible expenses (including deductibles and the plan member's portion of the reimbursement percentage) which may be paid out by the plan member before the plan will pay 100% subject to any other plan maximums and limitations.

Dependants who are over the child limited age (generally 18 or 21), and are either full-time students, or functionally impaired. Full-time students under the student limiting age (generally age 25).

Premium that is due to the insurer which has not been paid by the end of the grace period.

Insurance exceeding in amount the probable loss to which it applies. This serious problem can be controlled in EHC and Dental coverage by the contractual use of non-duplication of benefits provisions (e.g. Co-ordination of Benefits). It can be controlled on Disability coverage by integration of all disability payments so they do not exceed a specific percentage of pre-disability earnings.

Medications that are legally available without a prescription, and which do not generally require one.

The term referenced in HealthPro claims adjudication system for a group of client benefit offerings. The client benefit offerings contain the actual benefits that a plan member is eligible for.

Basis which analyzes experience based on the financial transactions and reserve movement during the period.

Benefits based on dollars paid: (standard): dollar amount paid to member is accumulated toward benefit maximum or sliding coinsurance. Benefits based on dollars eligible: (elective): eligible amount of claim (not paid amount) is accumulated toward benefit maximum or sliding coinsurance/out of pocket.

Health practitioners who are not medical doctors. These may include but are not limited to Chiropractors, Osteopaths, Naturopaths, Podiatrists, Chiropodists, Acupuncturists, Registered Massage Therapists/Masseurs (RMTs) Physiotherapists, Psychologists, and Speech Therapists.

A subscriber (plan member) and their dependants.

A ratio determined by the number of insured plan members covered under the group plan in relation to the total number eligible to be covered, usually expressed as a percentage.

(PA) The estimated value of a member's pension benefits accruing in a particular year as determined under the Income Tax Act. For defined benefit plans, the PA is determined by a formula. For defined contribution plans, the PA is the total of all employer and employee contributions for the year. A person's RRSP contribution room is reduced by the value of the previous year's PA.

The periodic amount that a member or former member is or may become entitled to under the terms of the pension plan.

The aggregate value, at any given time, of a person's pension benefit and other benefits that is provided to them under a pension plan.

The period when an employee is prevented from performing the usual duties of his or her occupation or employment, or unable to perform the normal activities of a healthy person of the same age or sex. More than one cause (accident or sickness) may be present during or contribute to, a single period of disability.

A ratio determined by the number of insured plan members covered under the group plan in relation to the total number eligible to be covered, usually expressed as a percentage.

Strategy where an external independent, clinical advisory committee applies scientifically based guidelines to review all new drugs entering the Canadian market to assist in determining eligibility.

A questionnaire sent to a claimant's treating physician(s) to determine the claimant's physical restrictions & limitations.

A set of benefits under a contract, or policy or plan arranged through a plan sponsor or government.

The person or group that is responsible for managing your pension plan and the pension fund. The plan administrator could be the employer, a board of trustee or a pension committee. The plan administrator may hire a third party service provider to manage the day-to-day work but the plan administrator is ultimately responsible.

The individual who administers a group benefits plan on behalf of the plan sponsor.

A plan advisor represents a plan sponsor in their search for insurance coverage. Advisors may or may not sell products of more than one company.

The annual date separating the claims experience under a group plan between one period of time and the next (for client financial accounting purposes). The period of time is normally 12 consecutive months.

An internal code used to identify a plan benefit option for each choice within a benefit.

A unique identifying number assigned to a group that identifies the plan to the insurer.

A document prepared for ASO groups that describes the specific benefits to be provided to plan members by the plan sponsor on a self-insured basis. Note - the plan document does not represent a contract. The contract terms govern.

A person who participates and is covered under a group benefits plan.

Administration area in MLI responsible for validating, adding, and updating Member Data for Home Office administered groups.

A unique identifying number issued to a plan member of a group plan.

The amount of premium the plan member contributes towards the cost of the benefit or the benefit plan.

The plan member eligibility information required by the insurer (e.g.., date of birth, name, certificate number) for claim certification purposes.

Refers to the level of categorization below account/division for plan members with the same set of coverage. A new plan number is issued for each unique set of benefits, across contracts.

An entity such as an employer, association or union that offers a benefit plan such as life, disability, health and pension to its members.

Discontinuation of a pension plan resulting in the cessation of benefit accruals under that plan.

Distribution of the benefits and assets of a pension plan that has been terminated.

The period of time between two contract anniversary dates, usually 12 months in length.

A contract for insured groups only (excludes ASO groups who can only have a contract).

The annual date the policy became effective, normally twelve consecutive months.

(PRPP) A type of pension plan that is similar to a defined contribution plan but employer contributions are not mandatory. A PRPP pools contributions together for investment purposes and for cost efficiency. Administrators of PRPPs must hold a license issued by the Superintendent of Financial Institutions.

The combining of all premiums, claims, expenses, etc., for certain size cases in order to spread the risk.
In a pooled situation the financial report charges the client for claim amounts up to the pooling point, individual claim amounts above the pooling points are charged to Manulife s pool. There are 3 types of pooling arrangements;

  1. Large Amount Pooling,
  2. Aggregate Stop Loss Pooling and
  3. Large Amount Combined with Aggregate Stop Loss Pooling.

Plan member, dependant and co-ordination of benefits information is collected at the time of enrolment. When a claim is made at the pharmacy, the dependant and COB information is verified and used to adjudicate the claim. If the dependant information does not match, the claim is denied. If dependants have other coverage based on COB rules, the claim is declined and directed to the other insurer.

A provision under a dental care plan requiring plan members to submit their proposed treatment program and its cost to Manulife Life in advance of the services being delivered. The treatment plan is evaluated, and the plan member is provided with an estimate of what would be covered under the dental care plan.

Pre-disability gross earnings are the plan member s earnings as defined in the Contract or ASO Agreement before any deductions (e.g. Federal and Provincial income taxes).

Pre-disability net earnings are the plan member s earnings less deductions, both as defined in the Contract or ASO Agreement.

Any physical and or mental condition or conditions that existed prior to the effective date of coverage under a contract.

A restriction on payments on those charges directly resulting from an accident or illness for which the insured received care or treatment within a specified period of time (e.g. 3 months) prior to the date he or she became insured.

Health care professionals who enter into preferred agreements with the insurer, plan sponsors and/or plan administrators to provide their professional services for a set fee. That fee is usually less than the usual and customary fee. The sum owed to the insurer based on the applicable rates and the eligible volumes or number of lives.

The sum owed to the insurer based on the applicable rates and the eligible volumes or number of lives.

Premium returned to a policyholder (usually because of favourable experience; i.e. an experience rating refund).

A statement prepared by the plan sponsor or the insurer to report the premium that is due to the insurer the period.

An assessment levied by a Federal or Provincial government, on the Premium income collected in a particular jurisdiction by an insurer.

A package of benefits that provides coverage for dental services intended to prevent tooth decay, depending on the contract.

The first person designated to receive proceeds of an insurance policy upon the plan member’s death.

Medical information provided for review purposes, prior to adjudicating a claim.

A hospital room with a single bed, as requested by the plan member or required as a condition of treatment.

The length of time a person must wait from the date of his or her entry into an eligible class or application for coverage to the date his or her insurance is effective. Also referred to as the Waiting Period.

Documentary evidence required by an insurer to prove a valid claim exists. For group life insurance, it usually consists of a completed claim for and proof of death (death certificate or acceptable substitute); in EHC for instance, it usually consists of a completed claim form and itemized medical bills.

An internally-assigned number that uniquely identifies a plan member; used for privacy reasons instead of the plan member certificate number on reports that will be distributed externally.

Coverage for plan members and dependants who reside in Canada and are not covered by the Provincial Health Plan.

The period of continuous disability which must be completed by the plan member in order to qualify for benefits.

is a contributory governmental insurance plan that provides benefits to Québec workers in the event of maternity, paternity, parental or adoption leave.

A provincially administered plan that operates like the Canada Pension Plan but for residents of Quebec only.
See Canada Pension Plan.

The offer to a prospective policyholder to underwrite specified insurance benefits at quoted premium rates. The quoted premium rates may be firm or estimates subject to recalculation based on enrolment. Also known as a Proposal.

is a contributory governmental insurance plan that provides benefits to Québec workers in the event of maternity, paternity, parental or adoption leave.

The Quebec Pension Plan (QPP) is a governmental pension plan that provides for benefits to workers and their families in the event of retirement, disability or death. QPP applies in Quebec. The QPP is similar to the CPP.

Is the result of legislation that requires all Quebec residents to have access to basic drug coverage through a Group Benefit plan or RAMQ.

A set of rates that can be used by many plan benefit options. Generally the rate group will be specific for one type of benefit such as health, dental or LTD.

A fee is reasonable and customary if its dollar value falls within the usual range of charges for the same or comparable services (or supplies) made by similar practitioners in an area as determined by Manulife Financial.

Dental procedures which are normally provided on a regular basis, depending on the contract.

A specific contractual provision that deals with an attempt by claimant to return to full time work. The approved claim is terminated at the date of return to work.
If within the recurrent period set out in the contract, the employee becomes disabled again due to same or related medical reasons as in the initial claim, and the disability is medically supported and meets the definition of disability effective at the time of the subsequent work stoppage, then benefits are paid from the first day of disability without the need to complete another elimination period. This provision encourages return to work attempts without penalizing the claimant for trying.

The period during which plan members have the opportunity to choose or reselect benefits. This generally applies to Flexible Benefit programs.

Refund Accounting is the underwriting arrangement under which the plan sponsor participates in financial results of the plan, whether a surplus or deficit occurs.

Part of our Distribution organization, a Regional Group Office is a base for sales and service interactions with plan advisors, as well as existing and prospective clients. Sales Directors, Account Executives and Service Associates are tied to one of these nationally based centres. A Regional Vice President oversees operations of the RGO.

A personal retirement savings account offered by financial institutions. RRSPs are governed by the Income Tax Act which sets the maximum amount of RRSP contributions that can be deducted from an individual's taxable income.

The payment of actual incurred charges as a result of an accident or illness but not to exceed any maximum specified in the plan provisions.

This would have previously been an approved claim, where benefits were stopped and Manulife informed the claimant that no further liability was accepted. Subsequently the claim is approved again and benefits continue as if it had never been closed.

To place in force again or re-activate, without the usual waiting or service period an individual's group insurance or a group contract which has terminated.

Is an arrangement where one insurance company shares the risk with another Specifically, one insurance company is responsible for liability up to a specified dollar amount and the other company is responsible for the balance.

An offer and acceptance of a premium for a new policy term.

The first anniversary date of the contract.

The next year's contract rate.

The date the renewal rates are effective.

The setting the premium rate at a level which will support the emerging claims experience and projected expenses of a specific benefit for the coming period.

Renewal underwriting is the review of a group case and the establishment of the renewal premium rates and terms under which the insurance may be continued.

The liability set up for claims which have passed their elimination period but for which no decision about approval or declination of the claim has been made.

A measure of the timeliness of the receipt of a claim from the date the disability occurred.
Formula is (Claim Received Date) (Date of Disability) + 1

A measure of an insurer's liability, present and future for a particular obligation or a class of obligations.
An estimate of all future payments expected to be made for a claim at a given point in time.

Similar to a Life Income Fund (LIF), however, an RLIF holder may, on a one time basis, unlock 50% of the funds.

An investment account that can only be established as a result of a transfer of funds from an RLIF. Similar to a Locked-in Registered Retirement Savings Plan, however, the funds in an RLSP can only be transferred back to an RLIF, a pension plan, if that plan permits, or to an insurance company to purchase an immediate or deferred life annuity.

That portion of the premium retained by the insurer for expenses, contingencies, and profits or contributions to surplus.

See Refund Accounting Also known in the industry as Experience rated.

The probable amount of loss foreseen by an insurer in issuing a contract.

A Registered Retirement Income Fund (RRIF) is an arrangement under which the owner of the RRIF must withdraw, each year, a minimum amount prescribed by the Income Tax Act (Canada). A prescribed RRIF (Manitoba and Saskatchewan only) is similar to a RRIF with the exception that certain minimum pension legislation standards are retained, such as protection of spousal rights and creditor protection.

Absence Management Solutions enhances an employer salary continuance program. This means that employer funds the STD portion of their employee's absence from work as an additional benefit. When an employee is totally disabled from completing the duties of their job - their absence and return to work is managed by Manulife but their employer continues to pay them. The pay may be a percentage of their full pay when working but this is up to the individual employer.

A list of the type and amount of insurance coverage for each person covered by the employer under a group plan.

Self Administered Groups are responsible for maintaining the records on employee coverage. They look after determining amount of coverage based on the policy, calculating & remitting premium payments.
Also Known as Employer Certified.

A hospital room with 2 beds.

Maximums, deductibles, sliding coinsurance are shared across drugs and extended health care benefits for plans with pay-direct drugs and other EHC benefits.

Insurance that provides income to the insured plan member when income is interrupted for a short period because of illness or accident. Benefits are paid weekly and are typically a percentage of salary to a stated maximum, depending on the contract.

One of four of Manulife’s market segments catering to the mid-size business market with employers who have 25-399 lives.

Benefits will be initially covered at a contractually defined coinsurance, once members reach a certain dollar threshold, the benefit coinsurance changes (slides) to a second contractually defined coinsurance.

Groups between 2 and 50 plan members.

A celebration of advisors and their small business clients that is held each year during the second week of October.

Split funded means that the client assumes all of the risk for the first agreed upon number of years of each claimant s benefit payment; Manulife assumes all of the risk for each claimant s payments which extend beyond that time period.
For example , the first 3 years are the client s risk and Manulife s beyond the 3 years

Split Recall happens when a client wants different time restrictions based on age (adults versus children).

There must be enough healthy members in a group to balance the unhealthy members so that the claims that are likely to be incurred can be funded. There must be a steady flow of individuals through the group.

The right of an insurance company to recover the amounts it has paid for a disability suffered by an insured employee when a third party is liable for that disability.

This coverage provides eligible dependents of a deceased employee with a monthly benefit. It is payable for a certain period of time as stated in the contract.

Allows members to pay for items that are not generally CCRA-tax eligible.

An investment vehicle that allows individuals to save money and benefit from a tax-free environment on the earnings generated and on withdrawals.

A classification of drug that identifies the drug's most common therapeutic use.

When a third party (such as a professional insurance administrator or a consultant) handles administrative functions including maintaining records regarding the persons covered under the group plan on behalf of the plan sponsor. In some cases, the TPA may also pay claims. In all cases, the underwriting and setting premium rates for insurance coverage remain the insurer's responsibility.

A service provider or vendor who enters into an agreement with Manulife Financial to provide goods and/or services.

The definition of totally disabled can be one of the following: “Any Occ” Coverage - totally disabled means that as a result of sickness or injury, an employee is, during the elimination period and thereafter, unable to engage in any occupation for which he or she is or may become reasonably qualified by education, training, or experience. “Own Occ” Coverage - totally disabled means that as a result of sickness or injury, an employee is: During the elimination period and the subsequent time period specified in the contract, unable to perform the regular duties of his or her own occupation and thereafter, completely unable due to sickness or injury to work at any occupation for which he or she is or may become reasonably qualified by education, training, or experience.

An assessment of work skills acquired during an individual's occupational history to determine if those skills can be utilized in an alternative occupation.
Also known as Vocational Assessment.

Insurance providing benefits for an accident or sickness incurred either on-the-job or off the job, i.e., 24 hours a day.

The process by which an insurer determines whether or not and on what basis it will accept an application for insurance i.e., what risk the insurer will assume by providing coverage to the members in the group.

A member is entitled to a deferred pension under the pension plan after the completion of a certain period of employment or of membership under the plan, and sometimes the attainment of a certain age.
If a member is not entitled to a deferred pension at termination of membership, he/she will be entitled to the refund of his/her contributions, if any, with interest. If a member is entitled to a deferred pension, he/she will be entitled to that deferred pension.

A Plan Sponsor that currently does not have a Group Benefit plan and a Request to Quote has been submitted on their behalf.

Coverage for eye care such as eye examinations, lenses and frames for eyeglasses, contact lenses, or laser eye surgery.

ManuConnect, the go-forward plan administration system used at Manulife Financial.

Source of Business code on Navigator 2 which identifies non CovDB policies that were never on GFM (new business since inception of ManuConnect).

The duration of time that an employee must fulfil between the date of hire and the date of eligibility for group insurance coverage.

The voluntary surrender of a right or privilege known to exist. Employee s may waive coverage for Health & Dental, or other Contract Benefits.

A provision that under certain conditions a person’s insurance will be kept inforce by the insurer without further payment of premiums. It is used most often in the event of permanent and total disability. When a Plan Member has been disabled for an extended period, called the elimination period, (usually 119 days, occasionally longer), the Member may be eligible for the continuation of Life and Long Term Disability benefits without further payment of premiums for as long as he/she remains disabled according to the terms of the contract.

A policy provision that provides for coverage to remain in force without payment of premium while the insured is deemed to be totally disabled. It is not an automatic benefit – the policyholder must purchase it. Waiver of Premium claims are normally received for the following benefits:

  • LTD (Long term disability)
  • with other benefits that may have Waiver of Premium
  • on its own
  • Life (includes optional, dependent, etc.)
  • AD&D (includes optional, dependent, etc.)
  • Survivor Income

Workers Compensation Board
Workers Safety and Insurance Board (Ontario)
CSST (Quebec)
Workers Compensation Commission (Newfoundland)
Workplace Health, Safety and Compensation Commission (New Brunswick)
The agencies that pay disability benefits to employees injured on the job.

This benefit provides an income if short-term sickness or disability prevents the employee from performing his or her regular job. It is also referred to as Short-Term Disability Insurance.

A weekly benefit providing continued income to the plan member in the event that the plan member is unable to work as a result of accident or sickness. Manulife prefers the term short-term disability. (STD).