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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.

How It Works

An insurer pools risk by underwriting insurance and annuities, collecting premiums, building and investing reserves, and making the contractual payments it has promised, with fees set according to the expected incidence of the insured risk and the expected return on investment. For accident and sickness coverage under Canada's Insurance Companies Act, the insurer undertakes to pay a sum of money toward a person's health care, including dental and preventative care, and in Quebec's Insurers Act that activity is defined as undertaking to make a payment under an insurance contract if a covered risk occurs. Insurers may offer both individual and group products, and they are regulated by federal and provincial authorities to maintain solvency, transparency, and compliance with consumer protection laws.

Example:

Say you buy a personal health and dental policy from a Canadian insurer such as a provincial Blue Cross, Sun Life, or Manulife. That company is your insurer, so it reviews your application, collects your premiums, and pays eligible claims, like a portion of a dental cleaning or a prescription drug cost, according to your policy's terms. If instead you are covered through your employer's group benefits plan, your employer is the plan sponsor while the insurer is the company that administers and guarantees those benefits.

What to Watch For:

Under a group plan, remember that your employer is not the insurer. Your employer is the policyholder or plan sponsor, while the insurer administers and guarantees the benefits. With a personal health plan, you usually pay a monthly premium for coverage, so check your policy to find out whether your insurer covers only a percentage of each claim or only a maximum annual amount. For critical illness insurance, insurers may differ in how they define critical illness and which conditions they cover, and the insurer usually pays the benefit after the diagnosis.

Related Terms

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.

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.

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.

Plan Member

A plan member is an individual who is enrolled in and eligible to receive benefits under a group insurance plan. Typically, the plan member is an employee of a company or a member of an organization that sponsors the group policy. The plan member is covered for the benefits outlined in the plan - such as health, dental, life, and disability insurance - and may also extend coverage to eligible dependents, including a spouse or children.

Relevant Plans

Plans that relate to Insurer

Manulife - FlexCare - ComboPlus Basic

Manulife - FlexCare - ComboPlus Basic

Can apply at anytime.

Manulife - FlexCare - ComboPlus Enhanced

Manulife - FlexCare - ComboPlus Enhanced

Can apply at anytime.

Manulife - FlexCare - ComboPlus Starter

Manulife - FlexCare - ComboPlus Starter

Can apply at anytime.

Manulife - FollowMe - Basic

Manulife - FollowMe - Basic

Must apply within 90-days of employee group benefits terminating.

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