February 2007 Focus Update #109

In this issue ...

 

While travelling, help is just a phone call away

Medical emergencies can happen at any time and any place. If your plan members experience a medical emergency while travelling, would they know what to do? We’d like to take this opportunity to remind you and your plan members about Sun Life Financial Group Benefits coverage for out-of-province medical emergencies and, what members should do if and when an emergency happens.

Our coverage is provided under your Group Benefits Extended Health Care plan and is offered in partnership with Europ Assistance USA, Inc., one of the largest and most experienced emergency travel assistance companies in the world. If your plan members and their eligible dependents are covered for travel benefits and suffer a medical emergency while travelling outside their home province, they are required to call Europ Assistance for help immediately. Europ Assistance provides on-the-spot support for accessing medical treatment and other services in a medical emergency.

The attached information sheet for plan members outlines what they need to do and what will happen when they call Europ Assistance. Knowing what to expect will help plan members manage the emergency and will help Europ Assistance provide service quickly and efficiently.

Details about the benefits available under the out-of-province coverage can be found in your Sun Life Financial Group Benefits booklet.

For more information, please contact your Sun Life Financial Group Benefits representative.


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Need medical help while travelling? Call Europ Assistance

No one wants to think about having a medical emergency while travelling, but someday it might happen to you or someone in your family. You and your eligible family members are covered for travel benefits under your Group Benefits Extended Health Care plan. This coverage is provided in partnership with Europ Assistance, Inc., one of the largest and most experienced emergency travel assistance companies in the world. If you’re going on a trip, you should be aware of what to do and what to expect if you experience a medical emergency.

Before you leave

  • Pack your Sun Life Financial Travel Card, which shows the telephone numbers for Europ Assistance. Make sure you’ve printed your name, contract number and member ID number on your card.
  • Take your provincial health card with you or know your number.
  • Review your out-of-province coverage under your Extended Health Care plan. There are some limitations and exclusions to your coverage, check your group benefits booklet for details.
  • Call Europ Assistance to ensure there are no travel warnings for your destination.

What is a medical emergency?
Medical emergency means an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor.

In a medical emergency, call Europ Assistance immediately
Call Europ Assistance even before seeking medical attention. The contact numbers are shown on your Travel Card. If you can’t call immediately, call as soon as possible. Call collect where available. If you can’t call collect let the customer service representative know; they can call you right back. If you have to pay for the call yourself, keep your receipts and submit them to Europ Assistance for reimbursement.

What happens when you call?

1. When you call Europ Assistance you’ll be asked for the following information:

  • Your name, the patient’s name (if different) and your current location
  • Your contract number and member ID number so they can confirm your coverage and benefits
  • Your home address, date of birth, the reason for your trip, your departure and planned return dates and travel method
  • A phone number where you can be contacted and a fax number where you can receive forms – your hotel, hospital or other current numbers
  • A description of the situation (what happened, when, where, etc.)

2. Europ Assistance will give you a file number – write it down for future reference. You’ll need it when you call for updates.

3. You’ll be sent, often by a fax to the provider (e.g. the hospital), a medical release form to sign and return. This authorizes Europ Assistance to gather any information required to monitor your care. If there is no fax number available, the medical release could be sent by
e-mail or regular mail.

4. If you need a referral to an appropriate provider (e.g. hospital, doctor, pharmacy), Europ Assistance will make arrangements for you and call you back with details, usually within the hour. They will explain where you are to go and the time of your appointment. When you arrive, the provider will be expecting you. They will know what procedures are pre-approved and the billing arrangements.

Europ Assistance services:

  • Europ Assistance medical staff must pre-approve all invasive and investigative procedures (e.g. MRIs, CT scans) prior to being performed to determine whether they are emergency services (note that your benefits cover only emergency services). You and the provider will be called with any pre-approvals, usually within two hours of your initial call.
  • Whenever possible, Europ Assistance arranges medical expense payments to a provider. You shouldn’t receive an invoice from a provider, but if you do, don’t pay it; just send it to Europ Assistance.
  • Your medical condition and your treatment and care are monitored throughout the emergency. Europ Assistance stays in contact with your provider and will follow up with you regularly to ensure you’re receiving the care you need.
  • Sometimes based on the medical information and treatment plan provided, Europ Assistance medical staff determines you should be transported home or to a different medical facility to ensure appropriate treatment. All transportation arrangements will be made by Europ Assistance and explained to you.
  • Since Europ Assistance coordinates payment of your expenses with your provincial health care plan, you must complete an Authorization and Release form so they can submit your claim. The form will usually be sent to your home address and will be there when you return home.

What do you need to do?

  • Stay in contact with Europ Assistance according to their instructions until they tell you it’s no longer necessary.
  • Return the Authorization and Release form to Europ Assistance so that they can submit a claim to your provincial health care plan on your behalf.
  • If you incur eligible out-of-pocket expenses, such as prescription drugs, you can send your receipts directly to Europ Assistance for reimbursement.

What if you wait until after the medical emergency to contact Europ Assistance?
Your plan requires you to contact Europ Assistance immediately at the time of the medical emergency. If emergency services are provided when contact could reasonably have been made, then payments could be limited or denied for all expenses related to the emergency. If you wait to contact Europ Assistance, you’ll have to pay all expenses yourself. You may also risk incurring expenses not covered under your plan, which could prove costly. The claims submission and adjudication process is also more time-consuming. Plus you’ll miss having the help and support Europ Assistance can give you in an emergency.

To submit a claim for reimbursement:

  • collect original and itemized receipts showing the services provided and the dates, the diagnosis and the names and addresses of the providers (e.g. hospital, doctor)
  • get your medical records from your providers
  • complete a Sun Life Financial Extended Health Care claim form and submit the claim when you return home

Once Europ Assistance has received your claim, they will send you the Authorization and Release form allowing them to submit your claim to your provincial health plan on your behalf. You cannot be reimbursed until the form is returned.

If you have any questions about your emergency medical coverage or want information about your group benefits coverage, please do not hesitate to contact your benefits administrator. 

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