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Policyholder

A policyholder is the individual or organization that owns an insurance policy and holds the legal rights and responsibilities associated with it. The policyholder is responsible for paying premiums, maintaining coverage, and making key decisions such as naming beneficiaries, adding or removing dependents, or canceling the policy. In return, the insurer is obligated to provide the benefits outlined in the policy contract.

In individual insurance, the policyholder is typically the same person as the insured. In group insurance, the employer or association acts as the policyholder, holding the master policy on behalf of its employees or members, who are covered under it as plan members. The policyholder receives official policy documents, renewal notices, and correspondence directly from the insurer.

Example:

If you buy an individual health and dental plan, you are the policyholder. If your employer offers group benefits, the employer is the policyholder, while you are a covered plan member under the group contract.

What to Watch For:

Keep your policy documents and premium payment records organized and current. If you are a policyholder, promptly update your insurer about changes in address, dependents, or beneficiary designations. In group insurance, remember that employees cannot make major changes to the master policy - only the employer or plan sponsor can modify coverage terms.

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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