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Advisor/Agent

An advisor or agent is a licensed professional who helps individuals and businesses understand, choose, and manage insurance and financial products. In the context of health, dental, life, and disability insurance, an advisor’s role is to assess a client’s needs, explain plan options, and recommend solutions that provide appropriate protection within their budget.

Advisors act as intermediaries between clients and insurance companies. They help interpret policy details, prepare applications, and assist with renewals or claims when needed. Independent advisors often work with multiple insurers, allowing them to compare plans objectively and find the most suitable coverage. In contrast, captive agents represent a single company and specialize in that insurer’s products.

Beyond product selection, advisors also educate clients about policy terms, exclusions, and tax implications. Their work is regulated by provincial insurance councils to ensure ethical standards and compliance with licensing requirements.

Example:

If you are considering a personal health insurance plan after leaving your employer benefits, an advisor can compare medically underwritten and guaranteed issue options from multiple carriers and help you apply for the one that best fits your health and budget.

What to Watch For:

Verify that your advisor is licensed in your province and represents reputable insurance providers. Ask whether they are independent or affiliated with one company, as this can influence product recommendations. Always request a clear explanation of fees or commissions before purchasing coverage.

Related Terms

Insurer

An insurer is the insurance company or organization that provides financial protection to individuals or groups in exchange for premium payments. The insurer assumes the risk of potential loss and agrees to pay benefits for covered claims according to the terms of the policy. Insurers evaluate applications, determine premiums, issue policies, and manage claims through underwriting and administration processes.

Premium

A premium is the amount of money an individual or organization pays to an insurance company in exchange for coverage under an insurance policy. It is the cost of maintaining protection against financial loss and ensures that the insurer can pay claims, manage risk, and cover administrative expenses. Premiums can be paid monthly, quarterly, semi-annually, or annually, depending on the policy and payment arrangement.

Underwriting

Underwriting is the process by which an insurance company evaluates an applicant’s risk to determine whether coverage can be offered, what terms will apply, and how much the premium will cost. It involves reviewing personal, medical, occupational, and lifestyle information to assess the likelihood of future claims. The goal of underwriting is to ensure fairness by matching the cost of coverage to the level of risk presented by each applicant.

Policy (Contract)

A policy, also referred to as a contract, is the legally binding agreement between an insurance company (the insurer) and the policyholder that defines the terms, conditions, and obligations of coverage. It outlines what is insured, the benefits provided, the premium amount, exclusions, and the responsibilities of both parties. Once the insurer accepts the application and the first premium is paid, the policy becomes active and enforceable.

Claim Submission Deadline

The claim submission deadline is the final date by which an insured person must submit a claim to their insurance company for reimbursement of eligible expenses. After this date, the insurer is not obligated to pay the claim, even if the expense itself would have been covered. This deadline ensures timely processing, accurate recordkeeping, and proper financial reporting for both the insurer and the policyholder.

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