Lesson 10

Question 1

beneficiary

Answer 1

a person eligible to receive insurance benefits under specified conditions

Question 2

catastrophic drug plan

Answer 2

a plan that would cover overriding drug costs causing impending financial hardship on individuals

Question 3

deductible

Answer 3

the portion of a benefit that a beneficiary must pay before receiving coverage

Question 4

deregulated

Answer 4

when a service is removed from a province’s or territory’s fee schedule so that it is no longer insured under that jurisdiction’s health plan

Question 5

insured health care services

Answer 5

medically necessary hospital, physician, and surgical-dental services provided to insured indivisuals

Question 6

medically necessary

Answer 6

referring to those services or supplies that are essential to the care and treatment of an illness or injury and that could not have been omitted without adversely affecting the patient’s medical condition or the quality of the health care rendered under generally accepted professional standards of medical practice at the time and place incurred

Question 7

provincial or territorial billing

Answer 7

the process whereby a health care provider submits a claim to a province or territory for insured health services rendered

Question 8

reciprocal agreement

Answer 8

an agreement among provinces and territories (with the exception of Quebec) that allows providers to bill their own ministries for services rendered to insured residents from other parts of Canada (ex. a person from Manitoba visiting a doctor in Nova Scotia).