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Physician

A physician is a licensed medical doctor who diagnoses, treats, and helps prevent illness, injury, and disease. Physicians play a central role in healthcare by providing medical assessments, prescribing medications, ordering diagnostic tests, and coordinating patient care with specialists or allied health professionals. In Canada, physicians are regulated by provincial colleges of physicians and surgeons to ensure professional standards and ethical medical practice.

In health and travel insurance, the term “physician” is specifically defined to mean a doctor of medicine (MD) or doctor of osteopathic medicine (DO) who is licensed and practicing within the jurisdiction where the service is provided. Insurance policies often require that diagnoses, prescriptions, and treatment plans be provided by a physician to qualify for reimbursement. For travel insurance, claims for emergency medical care must generally be supported by a physician’s report or treatment record.

Example:

If you experience severe stomach pain and visit a physician who orders an ultrasound and prescribes medication, your insurance plan may reimburse both the diagnostic test and the prescription costs, provided they meet the plan’s eligibility rules.

What to Watch For:

Ensure that the healthcare provider you see is recognized as a physician under your plan’s definition. Services provided by naturopaths or alternative practitioners are typically classified separately under paramedical benefits. For claims, retain documentation such as physician notes, referrals, and test results, as insurers may require proof that treatment was medically necessary and prescribed by a qualified doctor.

Related Terms

Pharmacist

A pharmacist is a licensed healthcare professional who prepares, dispenses, and provides guidance on the safe and effective use of prescription and non-prescription medications. Pharmacists play a key role in ensuring that medications are used correctly, preventing harmful drug interactions, and advising patients on dosage, side effects, and storage. In many provinces, pharmacists also provide additional healthcare services such as administering vaccines, renewing prescriptions, and offering health consultations.

Prior Authorization

Prior authorization is the process through which an insurer reviews and approves certain medical treatments, procedures, or prescription drugs before they are performed or dispensed. It ensures that the recommended care is medically necessary, appropriate, and covered under the policy before expenses are incurred. Prior authorization helps manage costs and ensures the use of safe, evidence-based treatments that align with clinical guidelines.

Treatment

Treatment refers to any medical, dental, or therapeutic care provided by a licensed healthcare professional to diagnose, manage, or improve a health condition, injury, or disease. In the context of insurance, treatment includes all services, procedures, medications, and interventions that are deemed medically necessary to restore or maintain health. It can range from routine doctor visits and prescription drug use to surgery, rehabilitation, and specialized therapies.

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.

Extended Health Care Insurance

Extended health care insurance (EHC) is supplemental coverage that helps pay for medical expenses not covered by your provincial or territorial health plan. It protects you from out-of-pocket costs associated with services such as prescription drugs, vision care, medical equipment, hospital upgrades, emergency travel medical care, and paramedical services like physiotherapy or chiropractic treatments.

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