Schedule of Benefits

A "Schedule of Benefits" is a detailed document or section within an insurance policy, particularly in health, disability, critical illness, and other types of living benefits insurances, that outlines the specific coverage and benefits provided by the insurance plan. In Canada, this schedule is an essential part of any insurance policy, offering policyholders a clear and comprehensive overview of what services, treatments, and support are covered, including the extent of coverage and any limitations or exclusions that apply.

Key features of a Schedule of Benefits include:

1. Coverage Details: It lists the types of medical services, procedures, and treatments covered by the insurance policy, such as doctor visits, hospital stays, prescription drugs, medical tests, and surgeries.
2. Benefit Limits: The schedule specifies the maximum amounts payable for different covered services, which can be expressed as dollar amounts, percentages of costs, or frequency of use (e.g., per year, per lifetime).
3. Deductibles and Co-payments: Any required deductibles (the amount the policyholder must pay before insurance coverage begins) and co-payments (a fixed amount paid for a covered service) are detailed in the schedule.
4. Exclusions and Restrictions: The schedule outlines what is not covered by the policy, including specific conditions, treatments, or circumstances under which benefits will not be paid.
5. Eligibility Criteria: It may include information on eligibility requirements for receiving certain benefits, such as waiting periods or conditions that must be met.
6. Claim Submission Guidelines: Instructions on how to submit claims for covered services, including any required documentation and time frames for submitting claims, may also be part of the schedule.

The Schedule of Benefits is a critical tool for policyholders, enabling them to understand their insurance coverage fully and make informed decisions about their healthcare and financial planning. It helps to clarify the insurance contract's terms, ensuring transparency between the insurance company and the insured. Policyholders in Canada are encouraged to review their Schedule of Benefits carefully to grasp the scope of their coverage and any responsibilities they may have under the policy.