Hospital Room (Semi-Private / Private)

Hospital room coverage pays for the cost of upgrading from a standard ward room to a semi-private or private hospital room. This benefit allows greater privacy and comfort during inpatient stays.

Plans generally cover the difference between the ward rate and the upgraded room rate, subject to daily and annual maximums. Some basic plans include only semi-private coverage, while others let you add private room options as riders.

Example:

If a private hospital room costs $250 more per night than a ward room and your plan covers up to $200 per night, you pay $50 out of pocket.

What to Watch For:

Hospital room benefits do not cover extra physician charges or uninsured services. Always check maximums and whether pre-approval is required.

Related Terms

Shared Dispensing Fee / Fee Limit

The shared dispensing fee, or fee limit, refers to the portion of a pharmacy’s dispensing charge that your insurance plan will cover. Pharmacies add this professional fee each time a prescription is filled to cover handling, verification, and counselling.

Short-term Disability Insurance

Short-term disability (STD) insurance provides temporary income replacement when you are unable to work for a limited period due to illness, injury, or surgery. It helps protect your income during the early stages of a disability, usually before long-term disability (LTD) benefits begin. This coverage ensures financial stability while you recover and are expected to return to work within a few weeks or months.

Smoking-Cessation Drugs

Smoking-cessation drugs are prescription medications designed to help individuals quit smoking by reducing nicotine cravings and withdrawal symptoms. Examples include bupropion and varenicline. These medications are considered lifestyle-related but medically supported treatments.

Split Modules

Split modules refer to the structure of a health insurance plan that allows members to mix and match different coverage categories, such as drug, dental, and extended health care. Each module operates independently with its own premiums and limits.

Spouse / Partner

A spouse or partner is the person legally married to or living in a committed relationship with the insured plan member or policyholder. In insurance terms, a spouse includes both legally married and common-law partners who meet the eligibility requirements defined by the insurer. Common-law partners are generally recognized after living together continuously for a specific period, often 12 months or longer, in a relationship similar to marriage.

Have questions about your insurance coverage?

Our licensed advisors can help you understand your options and find the right plan for your needs.