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Generic Substitution

Generic substitution means your plan reimburses prescription drugs based on the cost of the lowest-priced equivalent generic medication rather than the brand-name drug, unless a doctor indicates “no substitution” for medical reasons.

This approach keeps premiums affordable and encourages cost-effective healthcare. Generic drugs contain the same active ingredients and meet the same quality standards as brand-name versions but are usually much less expensive.

Example:

If a brand-name drug costs $80 and its generic version costs $35, your plan reimburses based on the $35 price unless your doctor specifies medical necessity for the brand.

What to Watch For:

Check if your plan requires prior authorization to cover brand-name drugs. Pharmacies may automatically substitute generics unless your doctor marks “no substitution.”

Related Terms

Guaranteed Acceptance

Guaranteed acceptance refers to an insurance plan that does not require medical questions, health history, or evidence of insurability for approval. Coverage is automatically granted to anyone who applies and meets basic eligibility criteria such as age or residency. This type of plan is designed for individuals who may not qualify for medically underwritten insurance due to pre-existing conditions, chronic illnesses, or other health concerns.

Government Health Insurance Plan (GHIP)

A Government Health Insurance Plan (GHIP) is the publicly funded healthcare program administered by each Canadian province and territory. It provides residents with access to medically necessary hospital and physician services at no direct cost, funded through provincial taxes and federal health transfers. GHIP ensures that all eligible residents receive essential medical care regardless of income or health status, forming the foundation of Canada’s healthcare system.

Annual Drug Maximum

The annual drug maximum is the highest amount your health plan will pay for eligible prescription drugs during a benefit year. Once you reach this limit, additional drug expenses are your responsibility until the plan renews. This feature helps insurers manage costs while providing predictable protection for routine prescriptions.

Coverage / Benefit

Coverage, sometimes referred to as a benefit, is the range of health or dental services, supplies, or treatments that your insurance plan agrees to pay for under its terms and conditions. Each benefit represents a category of care, such as prescription drugs, dental services, vision care, or paramedical treatments.

Health Insurance

Health insurance is a type of coverage that helps pay for medical and healthcare expenses not fully covered by Canada’s public health system. It protects individuals and families from the high cost of prescription drugs, medical services, and treatments that fall outside provincial or territorial government health plans. Health insurance can be obtained through an employer’s group benefits plan or purchased individually from a private insurer.

Relevant Plans

Plans that relate to Generic Substitution

Alberta Blue Cross - Blue Assured - Basic

Alberta Blue Cross - Blue Assured - Basic

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced

Alberta Blue Cross - Blue Assured - Enhanced

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced+

Alberta Blue Cross - Blue Assured - Enhanced+

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Premium

Alberta Blue Cross - Blue Assured - Premium

Can apply at anytime, at any age.

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