| Benefit year | The period during which your expenses and benefit maximums are tracked. Under the AECOM health plan, the benefit year runs from January 1 to December 31. | Many coverage limits and reimbursement maximums reset each January. |
| Coinsurance | The percentage of eligible expenses paid by the plan after any deductible has been satisfied. For example, many services are covered at 80% under Module B and 90% under Module C. | Determines how much you pay out of pocket when receiving care. |
| Coordination of Benefits (COB) | A process that allows eligible expenses to be submitted to more than one benefits plan, such as your spouse’s plan. | Can reduce or eliminate out-of-pocket costs by increasing reimbursement up to 100% of eligible expenses. |
| Deductible | The amount you must pay before the plan starts reimbursing eligible expenses. Module A includes a $1,000 annual deductible per person. | Plans with a deductible may have lower payroll costs but higher expenses when you need care. |
| Dependent | An eligible spouse or child covered under your benefits plan. Certain children may remain eligible while attending school full-time or if disabled. | Understanding dependent eligibility helps ensure your family remains covered. |
| Diagnostic services | Medical tests such as laboratory tests, MRIs, CT scans, ultrasounds, X-rays, and mammograms used to diagnose health conditions. | Some diagnostic services are covered only under specific modules and may have annual maximums. |
| Dispensing fee | The fee a pharmacy charges for preparing and dispensing your prescription medication. Under the AECOM Canada plan, eligible dispensing fees are limited to $10 per prescription or refill. | If your pharmacy charges more than $10, you may be responsible for the difference unless you use your Health Spending Account (HSA) to cover the excess cost. Comparing pharmacy dispensing fees can help reduce your out-of-pocket expenses. |
| Drug card | A card that allows eligible prescription drug claims to be processed directly at participating pharmacies. | Simplifies prescription purchases and reduces the need to submit claims manually. |
| Drug Identification Number (DIN) | The unique Health Canada number assigned to approved prescription medications. Many covered drugs must have a DIN to be eligible. | Helps determine whether a medication qualifies for reimbursement. |
| Drug substitution | Coverage is generally based on the lowest-cost equivalent medication, often a generic drug. | Choosing a higher-cost brand medication may result in additional out-of-pocket expenses. |
| Eligible expense | A health, dental, or medical expense that qualifies for reimbursement under the plan. Eligible expenses must generally be medically necessary and reasonable. | Only eligible expenses can be reimbursed by the plan or Health Spending Account. |
| Emergency Travel Assistance (ETA) | Travel support services available when you experience a medical emergency outside your province of residence. | Provides access to assistance, transportation support, medical referrals, and emergency coordination while travelling. |
| Emergency services | Medically necessary treatment required because of a sudden illness or injury while travelling. | Emergency services must meet plan requirements to be reimbursed. |
| Extended Health Care (EHC) | Coverage for eligible medical expenses not typically paid through provincial healthcare plans, including prescriptions, vision care, paramedical services, and medical equipment. | This is the core healthcare coverage provided through your AECOM health plan. |
| Health care module | One of AECOM’s three health care coverage options: Module A, B or C. Each provides different levels of coverage and costs. | Choosing the right module helps balance payroll deductions with expected healthcare expenses. |
| Out-of-province emergency coverage | Coverage for eligible emergency healthcare services received while travelling for pleasure of business outside your home province or Canada. | Out-of-province/country medical emergency coverage under the Sun Life plan covers personal travel, unlike the global Business Travel Accident (BTA) benefit. |
| Paramedical services | Coverage under a health benefits plan for services provided by licensed or regulated health practitioners who are not physicians such as physiotherapists, chiropractors, massage therapists, psychologists, and other eligible practitioners, up to the limits specified in your benefits plan. | Can support physical and mental wellbeing and may be covered up to annual maximums. Module B and C have a higher limit for mental health. |
| Prior Authorization (PA) | A process requiring approval from Sun Life before certain medications are eligible for coverage. Refer to the prior authorization drug list for more information | Obtaining approval before filling certain prescriptions can prevent claim denials. |
| Qualified practitioner | A healthcare professional who meets licensing and regulatory requirements recognized by Sun Life. | Claims may be denied if services are provided by someone who does not meet qualification requirements. |
| Reasonable and customary charges | Fees typically charged for similar services within a geographic area and considered appropriate by Sun Life. | If a provider charges more than the reasonable and customary amount, you may need to pay the difference. |
| Reimbursement level | The percentage of an eligible expense paid by the plan. | A higher reimbursement level generally means lower out-of-pocket costs. |
| Telehealth (Lumino Virtual Health) | Virtual access to healthcare services through Lumino Health Virtual Care powered by Dialogue. | Allows convenient access to care without visiting a clinic. |
| Travel card | A card containing information and phone numbers needed to access Emergency Travel Assistance services. You can obtain a copy of the card on your online Sun Life account. | Important to carry when travelling outside your province or country. |