Contract changes to reflect legislative amendments – effective July 1, 2012

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Recent amendments to the Insurance Act in both British Columbia and Alberta will come into force on July 1, 2012 – and we’ll be adding two new provisions to group contracts and employee benefits booklets to reflect these changes.

To facilitate communication of these provisions, we have prepared a Plan Member “Understanding your coverage” communication for you to distribute to plan members. You should also provide this communication to new plan members joining the plan at the time that you provide them with an employee benefits booklet, unless an amendment to your benefits plan has already been made (please refer to the “Actions required” section at the end of this document).

While the changes in legislation apply only to insured plans in Alberta and British Columbia, we are taking this opportunity to amend the wording for all of our insured plans for all provinces as well as plans with both insured and self-insured (ASO) benefits to provide greater clarity and consistency.

Here is an overview of the amendments to the contract and employee benefits booklet.

Limitation periods for legal actions

One legislative change requires insurers to include a limitation period provision in the contract and employee benefits booklet. A limitation period provision describes the time period in which a plan member may commence a proceeding for the recovery of benefits under the plan.

Although Sun Life’s contract and employee benefits booklet already include wording relevant to the commencement of a legal action, the Insurance Act changes require us to revise the applicable clauses as set out below.

The following clause will appear in the Claiming Benefits section of your contract. Please note that under the Legal Actions section the bullet(s) to be included will depend upon the benefits covered in your contract:

 

Proof of Claim 

Sun Life must receive written proof of claim within the time limits shown under each benefit.

For the assessment of a claim, Sun Life may require medical records or reports, proof of payment, itemized bills, or other information Sun Life considers necessary.

From time to time Sun Life may request additional information to support a proof of claim. If the information is not provided within 90 days of the request, the employee may not be entitled to some or all benefit payments.

The employee is responsible for all costs associated with any proof of claim.

Legal Actions

Except where or when applicable legislation permits the use of a different limitation period, every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act or the time set out in such other legislation as may apply to a claim, action or proceeding for insurance money.  

Where or when applicable legislation permits the use of a different limitation period, no legal action or proceeding may be brought against Sun Life:

  • regarding any claims for which no payment has been made by Sun Life, more than one year after the end of the time period in which the initial submission of proof of claim is required by the terms of the contract, or 
  • regarding claims for disability benefits that have been paid by Sun Life for some period of time, more than one year after the last date for which disability benefits have been paid, or 
  •  regarding all other claims for which some payment has been made by Sun Life, more than one year after the last payment made by Sun Life with respect to the claim, or  
  • regarding claims for Coverage during total disability which are initially approved, more than one year after the date you cease to be covered or your premiums cease to be waived.

 

The following clauses will appear in the General Information section of the employee benefits booklet. Please note that, under the Legal Actions section, the bullet(s) to be included will depend upon the benefits covered under your plan:

 

Making claims

Sun Life is dedicated to processing your claims promptly and efficiently. You should contact your employer to get the proper form to make a claim.

There are time limits for making claims. These limits are discussed in the appropriate sections of this employee benefits booklet. If you fail to abide by these time limits, you may not be entitled to some or all benefit payments.

All claims must be made in writing on forms approved by Sun Life.

For the assessment of a claim, Sun Life may require medical records or reports, proof of payment, itemized bills, or other information Sun Life considers necessary. Proof of claim is at your expense.

Legal Actions for insured benefits

Except where or when applicable legislation permits the use of a different limitation period, every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless it is commenced within the time set out in the Insurance Act or the time set out in such other legislation as may apply to a claim, action or proceeding for insurance money.

Where or when applicable legislation permits the use of a different limitation period, no legal action or proceeding may be brought against Sun Life:

  • regarding any claims for which no payment has been made by Sun Life, more than one year after the end of the time period in which the initial submission of proof of claim is required by the terms of the contract, or 
  • regarding claims for disability benefits that have been paid by Sun Life for some period of time, more than one year after the last date for which disability benefits have been paid, or 
  •  regarding all other claims for which some payment has been made by Sun Life, more than one year after the last payment made by Sun Life with respect to the claim, or  
  • regarding claims for Coverage during total disability which are initially approved, more than one year after the date you cease to be covered or your premiums cease to be waived.

Legal Actions for self-insured benefits

No legal action may be brought by you more than one year after the date we must receive your claim forms.  

 

Please also note that for benefit plans with self-insured disability benefits, the following is the Legal Actions for self-insured benefits clause:

Legal Actions for self-insured benefits

No legal action may be brought by you more than one year after the date we must receive your claim forms or more than one year after we stop paying disability benefits.


Rights to copies of documents

The employee benefits booklets for insured plan members living in British Columbia and Alberta must include a clause describing their right to receive from Sun Life copies of documents that relate to their contract and their coverage.

For insured plans, the following clause will be added to the General Information section of the employee benefits booklet:

Accessing your records

As required by legislation, for insured benefits, if you reside in Alberta or British Columbia, you may obtain copies of the following documents:

  • your enrollment form or application for insurance;
  • any written statements or other record not otherwise part of the application that you provided to Sun Life as evidence of insurability.

For insured benefits, on reasonable notice, you may also request a copy of the contract. The first copy will be provided at no cost to you but a fee may be charged for subsequent copies.   All requests for copies of documents should be directed to one of the following sources:
  • our Sun Life Financial Plan Member Services website at www.mysunlife.ca
  • our Sun Life Financial Customer Care centre by calling toll-free at 1-800-361-6212               

 

Actions required:

1. Keep a record of changes:  This Focus Update serves as an amendment to your contract and employee benefits booklet effective July 1, 2012. Please file this notice with your Sun Life group contract for future reference. The next time you amend your benefits plan, the updated wording will be included in your contract and employee benefits booklet.

2. Communicate with plan members:  To help your plan members better understand these changes, we have prepared a communication for you to share with them. In addition, please ensure, if you have not already done so, that all plan members have a copy of their employee benefits booklet.


Questions?

Please contact your Customer Service Administrator at 1-877-786-7227 should you have questions.