Glossary of Terms
Norbram Group Insurance Benefits – Quick Reference Guide
We know employee benefits and insurance terminology can sometimes feel overwhelming. From “coinsurance” to “stop-loss” to “target loss ratio,” the industry is filled with jargon that can make navigating your group plan harder than it needs to be.
To help simplify things, we’ve compiled a clear and concise glossary of the most commonly used employee benefits terms. Whether you’re reviewing a renewal, exploring plan options, or just trying to understand your coverage, this resource will help you feel more confident and informed.
Pays a benefit if an employee dies or suffers a serious injury (e.g., loss of limb, sight, or hearing) due to an accident.
A self-insured setup where the employer pays only for actual claims; the insurer provides administrative support.
The person designated to receive benefits (e.g., life insurance) upon the plan member’s death.
The purpose or strategy behind offering employee benefits (e.g., to attract talent, support well-being, etc.).
A request for reimbursement of an eligible expense.
Comparison of total claims paid vs. premiums collected, used to assess risk and pricing.
The rules for determining which insurer pays first when a person has multiple policies.
How the employer and employee split premium costs.
Dental coverage includes exams, fillings, extractions, etc. Pre-determination is a quote from the insurer before major work begins.
A dependent is a spouse or child. Dependent life insurance pays a benefit if they pass away.
Confidential support for mental health, family, and work-related challenges.
Some benefit amounts require medical evidence; NEM is the limit without needing it.
Grace: time after termination to submit claims.
Waiting: time between hire date and plan eligibility.
Insurance for a group of employees. Advisors help design and support the plan.
Pays a benefit upon death. Premiums may be waived if the employee becomes disabled.
A service offering expert reviews of a serious diagnosis or treatment plan.
The person in your organization who handles plan updates and records.
Sustainability: long-term affordability.
Pooled: risks are shared across many employers to help with high-cost claims.
Premium: amount paid for coverage.
Prorating: adjusting for partial-year enrollees.
Quote: estimate of plan cost.
Allows unused claims or contributions to carry over into the next benefit year (if permitted).
A summary of all covered benefits and applicable limits.
Specialty: expensive, complex meds.
Traditional: brand-name drugs.
Generic: lower-cost, same-effect versions.
Manages the plan’s services but is not the insurer.
Coverage for emergency health care when travelling.
Insurer’s process of evaluating risk to set pricing and coverage.
A group that has never had a benefits plan before.
Employees can decline coverage if they have equivalent benefits elsewhere.
A licensed insurance professional who helps design and manage your benefits plan.
The maximum amount reimbursed for a specific benefit in a calendar year.
Biologics: complex medications made from living organisms. Biosimilars: equivalent versions, often more cost-effective.
Confidential support for employers (e.g., HR, legal, or financial guidance).
The cost-sharing split between the insurer and employee (e.g., 80/20 = insurer pays 80%, employee pays 20%).
The option to switch to individual coverage (without medical evidence) when group coverage ends.
Pays a lump sum if the employee is diagnosed with a covered serious illness.
The amount an employee pays before insurance coverage starts.
Provides income when the employee can’t work due to illness or injury. Short-term (STD) and Long-term (LTD) are common.
Eligibility: when an employee qualifies. Effective: when coverage begins.
Coverage for services beyond provincial healthcare (e.g., prescriptions, vision, travel).
Fully insured: insurer assumes all risk.
Self-insured: employer pays claims directly.
Tax-free account for health-related expenses not covered by the plan.
Claims that have happened but haven’t been submitted yet.
Insurability: proof of health.
Late applicant: someone enrolling after the deadline (may require evidence of health).
Services like physiotherapy, massage, chiropractic, etc.
The minimum number of employees who must join for the plan to stay active.
Taxable accounts for wellness items like gym memberships, childcare, or lifestyle services.
Rate Guarantee: locks in your price for a set period.
TLR: insurer’s expected claims-to-premium ratio.
Coverage that decreases with age (e.g., at 65 or 70).
Annual review of your plan’s usage and premium adjustment.
Protection for employers from unusually large claims.
Virtual healthcare services accessible through the benefits plan.
Used in underwriting to reflect inflation or increased usage.
Manages benefits or funds on behalf of someone else (e.g., a minor).
Coverage for eye exams, prescription glasses, and other visual needs.