Annual maximum
The ceiling a plan will pay for a benefit in one plan year.
Group Benefits Glossary
30 terms a BC employer actually encounters when buying, renewing or defending a group plan — each explained for what it means for your plan, not as a dictionary definition.
Anti-selection
Those most likely to claim are those most likely to enrol.
ASO (Administrative Services Only)
You fund claims; the carrier only administers the plan.
Coinsurance
The percentage of an eligible claim the plan reimburses.
Coordination of benefits (COB)
Rules for claiming when two plans cover the same person.
Credibility factor
How much weight your own claims carry in pricing.
Deductible
The amount an employee pays before the plan begins reimbursing.
Dispensing fee cap
A limit on the pharmacy fee the plan will reimburse.
Elimination period
The waiting period before disability benefits start.
Evidence of insurability
Medical information required before certain coverage is issued.
Expense load
The insurer's administration, commission and margin.
Experience rating
Pricing a plan on its own claims history.
Flexible benefits plan
Employees allocate credits across benefit options.
Fully insured
The carrier bears the claims risk in exchange for premium.
Generic substitution
Reimbursing at the generic price where one exists.
Health spending account (HSA)
A fixed allowance employees spend on eligible health costs.
LTD offset
Other income sources deducted from a disability benefit.
Long term disability (LTD)
Income replacement for extended inability to work.
Non-evidence maximum (NEM)
Coverage available without medical underwriting.
Paramedical services
Practitioner services outside physician and hospital care.
Participation requirement
The minimum share of eligible employees who must enrol.
PharmaCare integration
Coordinating a private drug plan with BC's public coverage.
Pooling
Spreading catastrophic claim risk across many employers.
Private health services plan (PHSP)
The CRA structure that makes an HSA tax-effective.
Run-off liability
Claims incurred but not yet reported when a plan changes.
Short term disability (STD)
Income replacement for shorter absences, before LTD begins.
Stop-loss
Insurance that caps an employer's exposure under ASO.
Target loss ratio
The share of premium an insurer expects to pay out in claims.
Taxable benefit
Employer-paid premium treated as employee income.
Waiting period
Service time before a new hire becomes eligible.
Why this glossary is short
It is capped at 40 terms by design. A glossary is easy to inflate to several hundred thin pages, and thin definition pages are a liability rather than an asset. Every term here earns its place by carrying something specific to British Columbia or to how a plan actually behaves.
Longer treatments live in our group benefits blog.