Insured Person
An insured person is the individual covered under an insurance policy who is entitled to receive benefits for eligible claims. In a personal policy, the insured person is typically the policyholder who owns the coverage. In a group insurance plan, the insured person is the employee or member enrolled in the plan, and their eligible dependents may also be covered under the same contract.
How It Works
The meaning of insured person depends on whether the coverage is public or private. Under the Canada Health Act, an insured person is a resident of a province or territory who is eligible for that province or territory's public health insurance, and is sometimes referred to as a beneficiary. This does not include serving members of the Canadian Forces, inmates of federal penitentiaries, refugees covered by the federal government, or people covered by provincial workers' compensation. For these insured persons, provinces and territories must publicly insure the medically necessary hospital, physician, and surgical-dental services known as insured health services. Charging an insured person extra-billing, an amount in addition to what the provincial plan pays for an insured service, is not allowed under the Act. In a private insurance context, the insured person is responsible for providing accurate information during the application process, paying any required premiums, and submitting claims according to the policy's terms.
Example:
If you live in Ontario and hold a valid health card, you are an insured person under the provincial health insurance plan, so medically necessary visits to your family doctor are covered without a charge at the point of care. Separately, if you enrol in your employer's group health and dental plan, you become an insured person under that private contract as well, and listing your spouse and children as dependents makes them insured persons who can claim eligible expenses such as routine dental cleanings or fillings.
What to Watch For:
The tax treatment of premiums can differ from what people expect. For a personally owned disability insurance policy in Canada where the individual owns the policy, benefits are payable to the individual insured, while the premium is treated as a non-deductible personal or living expense. Similarly, for individually owned health insurance in Canada, premiums are generally not deductible from income, because the Income Tax Act treats insurance premiums on policies benefiting the taxpayer or a connected person as personal or living expenses.
