Benefits Dictionary

A  B  C  D  F  H  I  N  O  P  R  S  T


A
 


Accident

Under the Medical Assistance Service outside Canada (Health Plan), this refers to any sudden, unforeseeable, and violent event that:

• directly results from an external cause, independent of the insured person's will;
• leads to bodily injuries;
• prevents the insured person from continuing his or her trip; and
• occurs while this coverage is in effect.

 

 
 

 

Accidental injury

Any bodily injury sustained while the insurance is in force, directly and solely due to an external, sudden, violent and unintentional cause and requiring the care of a physician within 30 days of the accident.

 
 

 

B
 


Basic monthly salary

Under the Long-term Disability Plan, this refers to the monthly salary you would have received before benefits become payable, had you not been disabled.

 
 

 

C
 

Consumer Price Index (CPI)

An annual measure of the change in the cost of living, based on the price increases of a fixed "basket" of goods and services bought by Canadian consumers. The measurement of the CPI is monitored by Statistics Canada.

 
 

D
 


Denturist

A person licensed by the appropriate provincial licensing authority to supply and fit dentures.

 
 

Dependent child

Your unmarried child or your spouse's unmarried child, who:

   
• lives with you or for whom adoption procedures are underway;
   
• lives in Canada;
   
• depends on you for support and is:
   
  under age 18;
     
  under age 26, if he or she is a full-time student at a recognized educational institution; or
     
  of any age, if he or she became totally disabled while covered under the applicable Plan, and has remained continually disabled since then.

 

 
 

 

F
 

 

Family member

Under the Medical Assistance Service outside Canada (Health Plan), this refers to the insured person's spouse, father, mother, child, brother, or sister.

 
 

 

H
 


Hospital

     
• Health Plan
     
  Hospital refers to an institution that:
     
is legally acknowledged as such by the Loi sur l'assurance-hospitalisation du Québec and by the Loi sur le ministère de la santé et des services sociaux;
     
 
 is intended for the care of bedridden patients; and
     
provides the services of physicians and registered nurses at all times.

Units in hospitals that are set aside for convalescent patients are excluded.

•
 Medical Assistance Service outside Canada
     
  Hospital refers to an institution that:
     
provides short-term care;
     
 
 is legally recognized as such in the country where the institution is located;
     
provides care to bedridden patients;
     
  is equipped with a laboratory and an operating room; and
     
  has legally qualified physicians and registered nurses working 24 hours a day.

Rehabilitation homes, convalescent homes, rest homes, chronic care homes and hospital chronic care wards do not qualify as hospitals.

 
 

 

I
 


Illness

•
 Health Plan and Long-term Disability Plan
   
  Any deterioration in health requiring regular, continuous and curative care actively provided by a physician and satisfactory to Industrial Alliance, and whose default would bring deterioration of the person's health.

•
 Medical Assistance Service outside Canada
     
  Any sudden and unforeseeable deterioration in health that:
     
is verified by a competent medical authority;
     
 
 prevents the insured person from continuing his or her trip; and
     
occurs while this coverage is in effect.

 
 

Insured person

You and your dependents under the Plans.

All insured persons must be covered under a government health plan and live in Canada permanently (at least 182 days a year), unless otherwise agreed previously with Industrial Alliance or unless mention to the contrary is made in the Plan in question.   

 
 

 

N
 


Net monthly salary

Under the Long-term Disability Plan, this refers to the monthly salary you would have received before benefits become payable, had you not been disabled, less the following deductions:

•
 your Employment Insurance premium;
   
• your Quebec or Canada Pension Plan contribution; and
   
• any applicable income tax.
 
 

 

O
 


Orthopedic shoes

Under the Health Plan, this term refers to shoes designed and custom-made for the insured person from a mould, when such shoes are required to correct a foot defect. It also refers to deep shoes, open shoes, in-flare or out-flare shoes, or straight shoes required for Dennis Browne splints, as well as adjustments or additions to premanufactured shoes. 

 
 

 

P
 


Physician

A person who is legally authorized to practice medicine.

 
 

 

R
 


Rehabilitation or convalescent home

Under the Health Plan, such terms designate an institution or health unit:

   
•
 legally acknowledged as such; and
   
• intended for the care of bedridden patients.

Nursing homes, homes for the aged, rest homes, chronic care institutions, reception centres, and drug and alcohol treatment centres are excluded.

 
 

 

S
 


School Board

A school board recognized by QPAT.

 
 

Specialist

This refers to a physician licensed by the provincial licensing authority to practice medicine with specialization.

 
 

Spouse

The person who:

•
 became your spouse by a marriage legally performed in Quebec or elsewhere and recognized as valid under the laws of Quebec; or
• if you are unmarried, has been permanently living with you for at least one year and whom you publicly declare to be your spouse.
Your spouse will not be considered a spouse if:
• you get divorced;
• your marriage is annulled; or
• there is a de facto separation of more that three months, if you are not married.

 

 
 

 

T
 

 

Therapeutic or medical appliances

Appliances currently used according to the manufacturer's standards and recognized as specifically for the immediate treatment of a pathological condition following an illness or an accident, such as:

•
 appliances for the control of pain;
• extended physiotherapy and the administration of medication; or
• respiratory assistance and diagnostic devices, excluding orthopedic appliances, stethoscopes, and sphygmomanometers.

 

 
 

 

Totally disabled

A state of incapacity resulting from an illness, including surgery directly related to family planning, an accident, or pregnancy complication, which requires medical care and which:

•
 during the first 48 months of disability: completely prevents you from doing your job or any other similar job from your school board involving similar compensation; and
• after the first 48 months of disability: completely prevents you from performing any gainful employment for which you are reasonably qualified by education, training, or experience, regardless of whether or not that type of job is available.