Glossary

Accident

An unintentional happening due to an external, violent, sudden, or fortuitous cause, directly and independently of all other causes, beyond an Insured's control that causes bodily injury to an Insured.

Age

Select the age grouping of the eldest person for whom you are seeking coverage.

Beneficiary

The Policyholder if living, otherwise the Spouse if living, otherwise the Estate.

Benefit Survival Period

Continuous period of time which must elapse between the date the definition of critical condition is met and the date the benefit is payable, as long as the Insured is still living.

Blue Cross^® Life

Blue Cross^® Life Insurance Company of Canada (an independent licensee of the Canadian Association of Blue Cross^® Plans).

Children

All dependent children are covered for $10,000 each with one monthly fee, if selected.

Customary Expenses

Range of usual charges by the service provider with similar expertise and services within the geographic area.

Dentist

A person qualified and licensed as a doctor of dentistry entitled to practice dentistry under the laws of the place where the services are provided.

Dependent

A Policyholder's:

• spouse
• unmarried child up to 18 years of age
• unmarried child under 25 years of age undergoing full time student education
• child who due to physical or mental infirmity cannot leave the care of the Policyholder

Each Dependent must be listed in the Policyholder's Blue Choice^® Application or in a supplemental notice received and accepted by Saskatchewan Blue Cross^®. Any person who ceases to meet any of the above requirements shall thereupon cease to be included under the term Dependent.

Double-Up

Double indemnity for accidental dismemberment and for total and permanent disability.

Dread Disease

Acquired immune deficiency syndrome (AIDS), HIV, leukemia, diphtheria, encephalitis, tuberculosis, typhoid, tularemia, scarlet fever, spinal meningitis, poliomyelitis, tetanus, or rabies.

Drugs

Prescribed pharmaceuticals that:

1. have been approved by the Federal Drug Information Division, Health Protection Branch, for resale by licensed retail pharmacies
2. are dispensed by a licensed pharmacy, or attending Dentist or Physician, and are not available over-the-counter
3. have been assigned a Drug Identification Number in Canada, and
4. have been prescribed by a Physician or Dentist for treatment but not diagnosis

Without limiting the generality of the foregoing, the following are excluded from the above definition: over-the-counter drugs, ingestive vitamins, smoking cessation drugs, atomizers, vaporizers, salt and sugar substitutes, infant formula, dietary food and aids, contact lens care products, contraceptives, fertility drugs, sexual dysfunction drugs, skin cleansers, emollients and soaps, experimental drugs, Rogaine or any other product prescribed to restore hair growth, and any medication prescribed for cosmetic purposes.

Emergency

Medical treatment of an immediate nature required by an Insured as a result of an unforeseen illness or Accident.

Expenses

(see Usual Expenses, Customary Expenses, Reasonable Expenses)

Family Status

Identify the number of persons to be covered. Single – one person; Couple – two persons (two adults, or an adult and dependent); Family – three or more persons (two adults and one or more dependents, or one adult and two or more dependents).

Formulary Drugs

Drugs listed in the Saskatchewan Prescription Drug Formulary.

Hospital

A facility defined as a hospital by the Saskatchewan Minister of Health in which is provided the care and treatment of resident Inpatients with a registered graduate nurse (RN) always on duty, but does not include any facility or institution which is licensed or primarily used as a clinic, continued or extended care facility, convalescent home, rest home, nursing home, home for the aged, health spa, rehabilitation centre or treatment centre for substance abuse.

Immediate Family

The Policyholder's legal or common-law Spouse, parent, step-parent, grandparent, grandchild, in-law, natural or adopted child, legal guardian, step-child, brother, sister, step-sister, step-brother, aunt, uncle, niece, or nephew.

Injury

Bodily harm sustained directly as a result of an Accident.

Inpatient

An Insured who is hospitalized for the purpose of receiving diagnostic treatment or service, and to whom a bed or bassinet is allocated for an overnight stay.

Insured

The Policyholder covered by this policy and his/her eligible Dependent(s).

Insurer

Saskatchewan Blue Cross^®.

Lifetime Maximum

All claims paid under any individual policy with Saskatchewan Blue Cross^® during the lifetime of the Insured.

Long-term Disability

A disability of more than fifty-two (52) weeks duration where minimal or no recovery is expected.

Non-Formulary Drugs

Drugs not listed on the Saskatchewan Prescription Drug Formulary.

Pay-direct

Claim is processed electronically in real time. The service provider immediately identifies the Policyholder's payment, which is limited to the portion of the claim not covered by the Policyholder's plan.

Pharmacist

A person qualified and licensed to dispense Drugs and medicine on a Physician's prescription under the laws of the place where the services are provided.

Physician

A person qualified and licensed as a doctor of medicine who is entitled to practice medicine and/or surgery under the laws of the place where the services are provided.

Policyholder

A person who has applied and paid the appropriate Premium to Saskatchewan Blue Cross^® for the purpose of retaining the coverage benefits of a specific plan offered by Saskatchewan Blue Cross^®, and whose application has been accepted by Saskatchewan Blue Cross^®.

Preferred Hospital Accommodation

A semi-private or private room in a Hospital where an Insured is accommodated as an Inpatient, but does not include long-term care which might otherwise be provided in a nursing home, or private rooms where an Insured Inpatient's family is accommodated.

Premium

The amount of money charged by Saskatchewan Blue Cross^® and payable in advance as consideration for providing the benefits of any of its plans.

Private Duty Nurse

A registered nurse or a licensed practical nurse, registered with the appropriate provincial, state or national association. A relative of the Insured, or a person who normally resides with the Insured, shall not be eligible for any remuneration as a Provider of private duty nursing services to an Insured.

Provider

One who provides services and/or treatment to an Insured.

Reasonable Expenses

Those charges that, in the opinion of the service provider's professional association, are justifiable in the circumstances of the particular case in question.

Short-term Disability

A disability of up to fifty-two (52) weeks duration.

Smoker (Term Life)

Select if any person to be covered is a smoker.

Spouse

A person, insured by Saskatchewan Health, who is legally married to the Policyholder or who has continuously resided with the Policyholder in a common-law relationship for at least twelve (12) months and is publicly represented as such.

The Policyholder requesting coverage for a common-law Spouse must give written notice to Saskatchewan Blue Cross^®. Unless such written request is made, a person legally married to the Policyholder shall be considered to be the insured Spouse. Discontinuance of cohabitation with the Policyholder shall terminate coverage for a common-law Spouse.

Usual Expenses

The usual charge for a service given or supplied by the service provider.