Protecting your plan members’ privacy

#129

Printer-friendly version

Has this ever happened to you?
A plan member asks you to find out why their medical or dental claim hasn’t been paid, or why it was turned down. You then call us for more information, or ask some other questions on behalf of your plan member, such as:

  • Why was the claim turned down?
  • How much of a plan member’s lifetime maximum has already been used?
  • What bank account was a claim payment deposited to?
  • Was a cheque for a particular claim cashed?
  • Can a particular cheque be cancelled and re-issued on the request of someone other than the plan member?
  • What was the date of the plan member’s last claim for a particular service?

The response you get may be frustrating: “I’m sorry; we can’t answer your questions without the plan member’s express consent.” As an organization that collects, uses and discloses personal information in the course of our activities, Sun Life Financial must ensure that our practices for such activities comply with applicable privacy laws, including PIPEDA and substantially similar provincial legislation.

This means plan members must provide verbal or written consent in order for us to disclose certain information to you. Express consent can be provided as follows:

  • If the plan member is in your office, you can simply put them on the phone and they can provide their verbal consent.
  • The plan member can call our Group Benefits Customer Care Centre and ask the customer care representative to put a note on their file stating that they give us permission to disclose specific information to their benefits administrator.
  • The plan member can also give their consent by fax. The fax needs to include the following:
    • the plan member’s name, policy and certificate number
    • the information they would like Sun Life to give to their benefits administrator
    • the length of time this consent will be valid
  • We can send a consent form to the plan member that they fill out and return to us by mail or fax.
     
    If a plan member prefers that you always contact us on their behalf, they should indicate this in their consent. That way they don’t have to re-send a consent notice every time you request information on their behalf.

Implied consent
We can provide certain information if consent from the plan member is implied, such as:

  • The caller has the member’s name, policy and certificate number, type of claim, when it was submitted, paid and how much. The caller has described a situation that demonstrates the member has come to them for assistance.

But even with implied consent, we can only provide a limited amount of information, such as:

  • whether or not a claim has been processed
  • plan coverage information such as what you would find in the plan member’s benefit book
  • whether or not we have sent the plan member a benefits statement.

We can’t disclose any sensitive or financial information such as amounts reimbursed, whether a payment has been deposited, what the claim was for, etc.

The bottom line
These procedures protect your plan members’ privacy. Before making the call to Sun Life, ask your plan member to give us their written or verbal consent. This helps us serve both you and your plan members more quickly and efficiently.

Questions?

Please contact your Sun Life Financial group representative.