Annual Drug Maximum

The annual drug maximum is the highest amount your health plan will pay for eligible prescription drugs during a benefit year. Once you reach this limit, additional drug expenses are your responsibility until the plan renews. This feature helps insurers manage costs while providing predictable protection for routine prescriptions.

Maximums can vary widely between plan tiers - from $500 in basic plans to unlimited coverage in premium options. Certain medications, such as high-cost biologics, can quickly use up this maximum, making it essential to know your yearly allowance.

Example:

If your annual drug maximum is $1,500 and your total eligible prescriptions cost $1,800 in a year, the plan pays $1,500 and you pay $300.

What to Watch For:

Check if your plan distinguishes between brand and generic drugs and whether provincial programs contribute before your private plan.

Related Terms

Accident

An accident is an unexpected, sudden, and external event that causes bodily injury, occurring independently of any illness or pre-existing condition. In the context of health and dental insurance, an accident typically refers to physical harm resulting from an unforeseen incident such as a fall, collision, or blow to the body. Accidents are distinct from sickness or degenerative conditions because they are caused by an identifiable event rather than a gradual process.

Accidental Death and Dismemberment Insurance (AD&D)

Accidental Death and Dismemberment Insurance (AD&D) provides a tax-free lump-sum payment if you die or suffer a severe injury as the direct result of an accident. It is designed to offer financial protection for you and your family in the event of an unexpected, accidental injury or loss that causes death, dismemberment, or permanent disability.

Accidental Dental

Accidental dental coverage pays for the repair or replacement of natural teeth damaged due to an accidental blow to the mouth or jaw. This benefit is distinct from routine dental coverage because it applies to emergencies caused by external physical impact, not decay or normal wear.

Actuary

An actuary is a professional who specializes in analyzing financial risk and uncertainty, particularly in the fields of insurance, pensions, and investments. Actuaries use mathematics, statistics, and financial theory to calculate premiums, reserves, and probabilities of future events such as illness, disability, or death. Their work ensures that insurance plans remain financially stable and that companies can meet future claim obligations while staying competitively priced.

Advisor/Agent

An advisor or agent is a licensed professional who helps individuals and businesses understand, choose, and manage insurance and financial products. In the context of health, dental, life, and disability insurance, an advisor’s role is to assess a client’s needs, explain plan options, and recommend solutions that provide appropriate protection within their budget.

Have questions about your insurance coverage?

Our licensed advisors can help you understand your options and find the right plan for your needs.