Generic Substitution

Generic substitution means your plan reimburses prescription drugs based on the cost of the lowest-priced equivalent generic medication rather than the brand-name drug, unless a doctor indicates “no substitution” for medical reasons.

This approach keeps premiums affordable and encourages cost-effective healthcare. Generic drugs contain the same active ingredients and meet the same quality standards as brand-name versions but are usually much less expensive.

Example:

If a brand-name drug costs $80 and its generic version costs $35, your plan reimburses based on the $35 price unless your doctor specifies medical necessity for the brand.

What to Watch For:

Check if your plan requires prior authorization to cover brand-name drugs. Pharmacies may automatically substitute generics unless your doctor marks “no substitution.”

Related Terms

Government Health Insurance Plan (GHIP)

A Government Health Insurance Plan (GHIP) is the publicly funded healthcare program administered by each Canadian province and territory. It provides residents with access to medically necessary hospital and physician services at no direct cost, funded through provincial taxes and federal health transfers. GHIP ensures that all eligible residents receive essential medical care regardless of income or health status, forming the foundation of Canada’s healthcare system.

Grace Period

A grace period is the additional time granted after a premium payment is due during which an insurance policy remains active, even though payment has not yet been received. It provides policyholders with a short window to make late payments without losing coverage. The grace period ensures continuity of protection and helps prevent accidental policy lapses caused by missed or delayed payments.

Group Insurance

Group insurance is a type of coverage that provides benefits to a defined group of people, typically employees of a company or members of an organization, under a single master policy. Instead of each person purchasing an individual policy, the group is insured collectively, which allows members to access broader coverage at lower rates. The employer or organization acts as the contract holder, while individual participants receive a certificate of insurance outlining their specific benefits.

Group Policyholder

A group policyholder is the organization or employer that owns and administers a group insurance plan on behalf of its members or employees. The group policyholder holds the master policy issued by the insurer, manages enrollment, collects premiums, and ensures that the plan complies with contractual and regulatory requirements. In most cases, the policyholder is the employer, while the insured members are the employees and their eligible dependents.

Guaranteed Acceptance

Guaranteed acceptance refers to an insurance plan that does not require medical questions, health history, or evidence of insurability for approval. Coverage is automatically granted to anyone who applies and meets basic eligibility criteria such as age or residency. This type of plan is designed for individuals who may not qualify for medically underwritten insurance due to pre-existing conditions, chronic illnesses, or other health concerns.

Have questions about your insurance coverage?

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