Member
A member is an individual who is enrolled and covered under a group insurance plan, typically through their employer, association, or organization. The member is often referred to as the insured employee or plan participant and receives coverage for benefits such as health, dental, life, and disability insurance. The member may also extend coverage to eligible dependents, such as a spouse or children, under the same plan.
How It Works
In a group insurance contract, the employer or organization is the policyholder while the member is the beneficiary of the coverage. Under CLHIA's group insurance guideline, group insurance means insurance under which the lives or health of a number of plan members are insured under a contract between an insurer and a group policyholder, and that coverage is purchased on a voluntary basis to help protect plan members and their eligible dependents against planned and unexpected life events. Each member receives a certificate of insurance that outlines their benefits, eligibility, and claims procedures. A member can extend coverage to eligible dependents, such as a spouse or children, under the same plan. In return, a member is responsible for keeping their information current with the plan administrator, paying any employee premium contributions, and following the insurer's claim submission requirements.
Example:
If your Canadian employer offers a group benefits plan, you become a member of that plan once you enroll, and you receive a certificate of insurance that describes your coverage. As a member you can submit claims for eligible health and dental expenses, such as a dental cleaning or a physiotherapy visit, for yourself and your covered dependents like a spouse or children.
What to Watch For:
Group coverage you access through an employer is highly accessible because premiums are shared among all members of the group and no medical exam is required. That same arrangement means your status as a member can change: coverage may end if you leave the organization or change your employment status, so review your plan's eligibility rules to make sure you remain an active member.
