Our most comprehensive coverage

Personal Health Insurance Enhanced plan is our most comprehensive coverage. It offers the highest prescription drug maximum as well as optional dental coverage that includes restorative and orthodontic care. You can consider our most popular plan, Personal Health Insurance Standard plan, if you feel this plan is more coverage than you want.

You should consider this plan if:

  • You don't have health benefits through your employer, you're losing your group coverage or your current coverage is not enough
  • You want catastrophic drug coverage, emergency travel medical coverage and the option for dental coverage that includes restorative and orthodontics

Plan details:

Prescription drugs

  • Pay-direct drug card (except Quebec)
  • 80% reimbursement for the first $5,000 of annual eligible expenses (that means up to $4,000 of expenses will be paid), 100% reimbursement for the next $245,000 of annual eligible expenses
  • $250,000 annual maximum of eligible expenses can be claimed
  • No deductible
  • Includes smoking cessation drugs ($250 lifetime maximum)
  • Includes oral contraceptives
  • Excludes:
    • contraceptives (other than oral)
    • fertility drugs
    • dietary supplements, vitamins
    • over-the-counter medications, even if prescribed by a physician
    • drugs to treat obesity

Dental care

This is an optional benefit with this plan and includes:

  • 80% reimbursement
  • $750 annual maximum
  • Recall visits every 9 months
  • 3-month waiting period before coverage begins
  • Preventive dental coverage includes:
    • Examinations and diagnosis
    • Tests, x-rays and lab exams
    • White fillings
    • Space maintainers for children under 12 years of age
    • Scaling, minor extractions
    • Pit and fissure sealant for children under 19 years of age
  • 50% reimbursement
  • $500 annual maximum
  • 1-year waiting period before coverage begins
  • Restorative dental coverage includes:
    • Endodontics
    • Periodontics
    • Oral surgery
    • Crowns
    • Onlays
    • Bridges
    • Dentures (and repairs to dentures)
  • 60% reimbursement
  • $1,500 lifetime maximum
  • 2-year waiting period before coverage begins
  • Orthodontic coverage includes:
    • Interceptive, interventive or preventive orthodontic services other than space maintainers
    • Comprehensive orthodontic treatment, using a removable or fixed appliance or combination of both. This includes diagnostic procedures, formal treatment and retention

Supplemental healthcare

  • 100% reimbursement
  • $500 maximum every 5 years
  • 100% reimbursement
  • $2,000 per fracture or injury
  • 100% reimbursement
  • Ground or air ambulance services
  • 100% reimbursement
  • $5,000 annual maximum

The following items have a combined $5,000 annual maximum:

  • Orthopaedic shoes and orthotics, limited to $200 in a calendar year
  • Splints and crutches, limited to $500 in a calendar year
  • Casts
  • Braces
  • Wigs and hairpieces, limited to a lifetime maximum of $500
  • Oxygen
  • Diagnostic laboratory tests and x-ray examinations
  • Blood glucose monitor, limited to $300 per each 5-year period
  • Rental, or purchase at our option, of durable equipment required for use in the patient's home and is approved by us. Eligible durable equipment includes, but is not limited to, items such as:
    • wheelchairs, to a $4,000 lifetime maximum
    • walkers
    • hospital beds, to a $1,500 lifetime maximum
    • traction kits
    • artificial limbs or other prosthetic appliances, breast prostheses up to $200 per year
  • For Quebec residents only, medically necessary MRIs, ultrasounds, CAT and CT scans
  • 100% reimbursement
  • Combined $10,000 annual maximum and combined $30,000 lifetime maximum

*In-home nursing includes services of registered nurses, registered practical nurses or registered nursing assistants.

Paramedical practitioners

  • 100% reimbursement
  • No per-visit maximum
  • Up to $400 per year, per practitioner
  • Paramedical practitioners include: acupuncturists, chiropractors, naturopaths, osteopaths, physiotherapists, podiatrists/chiropodists, psychologists, registered massage therapists, speech language pathologists

Vision care

  • 100% reimbursement
  • $200 maximum every 2 years, includes $50 maximum per year per eye exam
  • 1-year waiting period before coverage begins
  • Includes coverage for: prescription eyeglasses, prescription contact lenses, prescription sunglasses and laser eye surgery

Emergency travel medical

  • 100% reimbursement
  • $1 million lifetime maximum
  • Coverage provided for the first 60 days of a trip
  • Covers travel outside of your province or outside of Canada
  • Available until the age of 80
  • If you have a pre-existing medical condition where symptoms have appeared or required medical attention, hospitalization or treatment (this includes changes in medication or dosage), and existed during the 9 months before your trip, expenses related to this condition are not included.

Semi-private hospital room

This is an optional benefit with this plan and includes:

  • 85% reimbursement
  • Coverage up to $200 daily and $5,000 annually
  • Convalescent hospital:* $20 per day up to 180 days per incident

If you are pregnant at the time of application, we will pay for up to 2 days of hospitalization due to pregnancy.

*Convalescent hospitals are facilities licensed to provide convalescent care and treatment for sick or injured patients on an in-patient basis.

Additional services

  • Best Doctors® services are available to help you understand your medical condition and treatment options so you can make informed decisions about your healthcare.1
  • Access to mysunlife.ca and the my Sun Life Mobile app lets you manage your personal health insurance plan online.

1Best Doctors isn't part of the policy. We can't guarantee its availability. It may be withdrawn at any time.

BEST DOCTORS® and other trademarks shown are trademarks of Best Doctors, Inc. Used under license.


Age requirements

  • Coverage is available for new applicants age 69 and under and is renewable for customers over 70.
  • You and everyone included in your application must be age 69 or under on the date you apply.

Eligibility

You are eligible for coverage if:

  • You are in Canada when you complete and submit the application
  • You and your family members are residents of Canada and have provincial healthcare coverage
    • Quebec residents must also have and continue to have group drug coverage provided by an employer, through membership in an order or association or through the Régie de l'assurance maladie du Québec (RAMQ). A person not covered under a group benefit plan or through RAMQ is not eligible for coverage
  • Your dependent children are under age 25 (dependent children aged 21 to 24 must be full-time students)

You are not eligible for coverage if:

  • You had or have any of these illnesses or conditions
  • You are currently awaiting doctor recommended tests or investigations
  • You have a pending surgery

More information:

  • You must also apply to your provincial government health plan first, then submit a claim to us for the unpaid portion.
  • All annual or lifetime maximums are per person and based on a calendar year (January 1 to December 31).
  • We may change rates each year. If we do change the rates, we'll send you written notice 45 days before the change.
  • Waiting periods begin on the date the policy becomes effective.
  • This page does not form part of your policy. If there are any inconsistencies between the content on this page and your policy, the terms of your policy will apply. Your policy includes exclusions and limitations of coverage.

Sample policies

Read examples of text that can appear in a policy. Not all the provisions apply to every policy – it is simply for your reference. When we issue a policy it governs the legal relationship between us and the client. An actual policy can have provisions that are somewhat different from those that you've read here.

  Basic plan with semi-private hospital room coverage

  Standard plan with semi-private hospital room coverage - Quebec

  Enhanced plan with dental and semi-private hospital room coverage