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Plan Sponsor

A plan sponsor is the employer, association, or organization that establishes and maintains a group insurance plan for its employees or members. The plan sponsor acts as the policyholder, holding the master contract with the insurance company and determining the benefits, eligibility rules, and cost-sharing arrangements for the group. Plan sponsors play a central administrative role by enrolling members, collecting premiums, and communicating plan details to participants.

In most cases, employers are the plan sponsors of workplace benefit programs that include extended health, dental, life, and disability coverage. Associations, unions, or professional organizations may also act as plan sponsors for their members. The plan sponsor collaborates with the insurer or a benefits advisor to design the plan and ensure it meets the group’s needs while remaining financially sustainable.

Example:

If your employer provides group health and dental insurance, the employer is the plan sponsor. They decide which benefits are included, how much of the premium they will pay, and when coverage begins for eligible employees.

What to Watch For:

Plan sponsors are responsible for keeping employee information accurate and ensuring premiums are paid on time. Employees should contact their plan sponsor’s HR or benefits department for help with enrollment, dependent changes, or plan questions. The plan sponsor must also comply with employment and privacy laws when managing benefit data.

Related Terms

Paramedical Disciplines

Paramedical disciplines refer to regulated health professionals who provide therapy or rehabilitation services outside of hospital settings. Common examples include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, psychologists, and speech-language pathologists.

Pay-Direct card / Drug card

A pay-direct card, also known as a drug card, is a plastic or digital card issued by your health insurance provider that allows pharmacies to bill your insurer directly for eligible prescription drugs. Instead of paying the full cost upfront and submitting a claim later, you pay only your portion - such as a deductible or coinsurance - at the point of sale.

Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

Per Person / Per Family

Per person and per family describe how benefit limits, deductibles, or maximums are applied within a health or dental insurance plan. A per person limit means the specified amount applies individually to each insured member, while a per family limit represents the total combined coverage for all members under one policy.

Per-Practitioner Annual Maximum (Paramedical)

The per-practitioner annual maximum is the total amount your plan will reimburse for services from one specific type of provider in a single benefit year. For example, if your plan pays up to $500 for massage therapy annually, once that amount is reached, additional treatments from that provider type are no longer covered until the next year.

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