Common questions

 

What are the differences between the basic, standard and enhanced Personal Health Insurance (PHI) plans?

  Basic Standard Enhanced
Prescription Drugs $750 annual maximum
60% reimbursement
$100,000 annual maximum.
70% reimbursement on the first $7,000 of eligible expenses.
100% reimbursement on the next $93,000 of eligible expenses.
$100,000 annual maximum.
80% reimbursement on the first $5,000 of eligible expenses.
100% reimbursement on the next $95,000 of eligible expenses.
  Up to $5.00 paid per dispensing fee Reasonable and customary  
Extended health provision 60% reimbursement 100% reimbursement  
  No deductible No deductible No deductible
Dental - preventative 60% reimbursement 70% reimbursement 80% reimbursement
Dental - restorative No coverage No coverage 50% reimbursement,
$500 annual maximum
Dental - orthodontics No coverage No coverage 60% reimbursement,
$1,500 lifetime maximum
Semi-private hospital room (in Canada) No coverage 85% reimbursement  
Vision care No coverage 100% reimbursement  
Emergency travel-medical No coverage 100% reimbursement
$1 million lifetime maximum
Up to 60 days per trip
 

For a more comprehensive list of what each plan covers, please visit the plan details section for Personal Health Insurance (PHI) located under the insurance section.

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Why do I need RAMQ coverage?

In Quebec, if you don’t have access to group or association PHI coverage, you need to enroll with RAMQ (RAMQ will be the first payor).  SunAffinity offers coverage for services not available through RAMQ.  For more information on RAMQ, please click on this link: www.ramq.gouv.qc.ca

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Can I cancel at any time? Do I have to have coverage for a set minimum amount of time?

You may cancel your PHI coverage at any time. Please be aware that the coverage may not be re-instated once cancelled.  If you decide to cancel, all you need to do is provide us with your written request to cancel coverage, and it will be terminated on the first day of the following month.

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Do I have to wait a specific amount of time before I can submit claims?

No. Eligible claims will be reimbursed on or after the effective date of coverage.

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How does the deductible work? Do I have to pay it all up front or is it divided up amongst the family members?

The deductible is applied individually against the eligible expenses of each person only once in any plan year.

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At what age does my coverage terminate?

Once issued, the plan is renewable each year for life.  For any of your covered eligible dependents, coverage ends on their 21st birthday (25th birthday if a full-time student or 26 for Quebec residents).

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How does the Pay-Direct prescription drug card work?

As most pharmacies across Canada (excluding Quebec) participate in an electronic network that processes eligible prescription drug claims at point of sale, all you have to do is present your card.

For all three plans; basic, standard and enhanced, the dispensing fee reimbursement is 100 per cent but is limited to a maximum of $5.00 per prescription.

Please note: the basic plan provides for a 90% reimbursement of eligible prescription drugs, while the enhanced plan provides for a 100% reimbursement of eligible prescription drugs.

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