The following are answers to some frequently asked questions about Care at Home insurance. To learn more, contact a Sun Life Financial Services Consultant1.

Care at Home Enhanced is an insurance plan that supplements government healthcare benefits and other personal health insurance policies you may have, to provide additional coverage for services and structural support aids for your home that are not covered by these other plans. Care at Home Enhanced coverage will reduce your out-of-pocket costs, and help you to keep your savings intact.

The Care at Home Enhanced benefits are:

Home care benefit – An expense reimbursement benefit that may be used to pay for a nurse, personal support worker or other eligible support.

Home conversion benefit – An expense reimbursement benefit that helps cover the cost of home structural equipment.

Fracture benefit – A one-time, lump-sum cash payment to assist in your recovery from an accidental fracture.

These benefits allow you to choose the support you need for your personal situation and maintain control of your personal care and living arrangements.

Your independence matters! For many of us, remaining in our home as we get older and move into retirement is an important part of the plan. And as we age, we may eventually need some help to remain safely in our home and maintain our independent lifestyle.

Care at Home Enhanced helps cover the cost of certain in-home services and structural equipment not eligible for coverage with other plans. Care at Home Enhanced can also supplement your existing policies or government benefits.

To be eligible to apply for Care at Home Enhanced, you must be:

  • A resident of Canada
  • Entitled to benefits under a provincial medicare plan or Canadian federal government plan that provides similar benefits
  • Between the ages of 50-74 (plus 364 days) on the date of application

Applying is easy. Leaving your employer plan? Contact a Sun Life Financial Services Consultant1 any business day from 8 a.m. to 8 p.m. ET by calling 1-877-893-9893. Retiring soon? Connect with a Sun Life Retirement Consultant1 any business day from 8 a.m. to 6 p.m. ET by calling 1-866-224-3906. They will walk you through the application process and answer any questions you may have.

And, if you apply for Care at Home within 60 days of leaving your employer, you can automatically qualify with no medical questions asked at the time of application. After 60 days you can still qualify by answering some simple health questions.2

There is a one-year waiting period for the home care benefit; this means you cannot submit a claim for this benefit for one year from the date you purchased your Care at Home Enhanced or Care at Home Standard plan.

Upon meeting the home care benefit claim requirements, you will submit the necessary documentation and receipts for the services of a nurse or other eligible care provider that will help you to maintain safe and independent living in your own home.

You will receive 100% of these eligible expenses, up to the $3,000 annual maximum and $15,000 lifetime maximum.

There is a one-year waiting period for the home conversion benefit; this means you cannot submit a claim for this benefit for one year from the date you purchased your Care at Home Enhanced or Care at Home Standard plan.

Upon meeting the home conversion benefit claim requirements, you will submit the necessary documentation and the receipts for the structural equipment that enables your mobility and enhances your safety in your home. Examples include grab bars, touch-and-release drawers, hands-free taps, walk-in bathtubs and wheelchair ramps.

You will receive 100% of these eligible expenses, up to the $3,000 or $5,000 lifetime maximum, depending on the option you selected.

Your fracture benefit is available immediately after we receive your first premium – there is no waiting period. You are able to claim for one accidental fracture, and the date of the fracture occurrence must follow your policy effective date. Once you claim your fracture benefit as part of your Care at Home Enhanced plan, your fracture benefit will be terminated and your premiums will be reduced to the rate charged for Care at Home Standard.

To be eligible to submit a claim and receive the home care benefit or home conversion benefit, you must meet the following criteria:

  • Be under the continuous care of a physician and following that physician's medical advice
  • Make reasonable efforts to participate in any appropriate rehabilitation program that is available
  • Be unable to perform two or more instrumental activities of daily living
  • Be at a high risk for falling based on the Timed Up and Go or equivalent test

These criteria will be assessed and documented by a healthcare practitioner, such as your physician. Once you qualify to make a claim, and after a 14-day elimination period, you will submit your claim to Sun Life by mail to the address below.

In order to make a claim or for questions regarding your claim or its status, call us at 1-800-669-7921. We will send you the required claim form to be completed.

There are four instrumental activities of daily living – also known as IADLs – that are part of the claims requirement for Care at Home Enhanced and Care at Home Standard home care and home conversion benefits, as outlined below. Your healthcare practitioner will assess your ability to manage:

Food preparation – You are unable to heat and serve prepared meals and do not maintain an adequate diet unless meals are prepared and served for you. Adequate diet means food that meets the standards of the Canada Food Guide.

Ordinary housework – You are unable to participate in light housekeeping tasks without the support of others, indicated by your inability to maintain an orderly living space in your home that allows you to exist in a clean environment. Light housekeeping tasks include doing laundry, making beds, vacuuming, mopping floors, sweeping, dusting, cleaning bathrooms (shower, tub, sink and toilet) and cleaning the kitchen (sink, dishes, fridge and stove).

Transportation – You are unable to travel for basic needs (e.g., clothing, food) including by walking, public transportation, a taxi or your own vehicle without the assistance of others.

Managing medication – When taking medication, you require assistance in remembering to take it, even when prepared in advance in separate dosages.

To qualify to submit a claim for either the home care or home conversion benefit, you must be unable to perform two of the four instrumental activities of daily living noted above AND be unable to successfully perform the Timed Up and Go test as described below, including during the 14-day elimination period.

The Timed Up and Go test is a risk-assessment for falls and frailty and is administered by a healthcare practitioner. The results will indicate your ability to maintain your balance, and ultimately reflect your ability to remain within your own home safely and independently.

The test times your ability to:

  1. Stand up from a standard arm chair
  2. Walk to a line 3 meters away on the floor at your normal pace
  3. Turn
  4. Walk back to the chair at your normal pace
  5. Sit down again

An adult who takes more than 12 seconds to complete the TUG test is considered to be at a high risk for falling.

Your premiums are based on the age you were when you applied for your coverage. Care at Home rates are assessed annually and may result in a premium increase. Any premium increase will be applied at your next policy anniversary. You will receive a minimum of 30 days' notice of all premium increases.

The coverage limit for the home care benefit is $3,000 annually, with a lifetime maximum of $15,000.

The home conversion benefit offers a choice between a $3,000 or $5,000 lifetime maximum. You will be asked to select the lifetime maximum option when you apply.

If you have an accident resulting in a broken bone, the fracture benefit lump-sum cash payment may be used to pay for the in-home care necessary to help with your recovery. Or it can cover the cost of seasonal home maintenance such as shovelling snow or maintaining your property while you recover from the accident. You have control over how this cash benefit is used.

This is a one-time cash benefit and the fracture benefit component of your policy will be terminated upon receipt of cash payment.

Type of Fracture: Spine

  • 2+ vertebrae
  • one vertebrae
  • compression

Benefit Amount

  • $5,000
  • $2,000
  • $1,000

Type of Fracture: Cranium

  • depressed fracture
  • other

Benefit Amount

  • $5,000
  • $2,000

Type of Fracture: Pelvis
Benefit Amount: $3,000

Type of Fracture: Hip
Benefit Amount: $3,000

Type of Fracture: Femur
Benefit Amount: $1,000

Type of Fracture: Tibia
Benefit Amount: $1,000

Type of Fracture: Fibula
Benefit Amount: $1,000

Type of Fracture: Patella
Benefit Amount: $1,000

Your Care at Home Enhanced coverage will terminate on the earliest of:

  • The premium due date, subject to the 31-day grace period, for non-payment of premiums
  • The date the maximum benefit amount has been paid for all benefits
  • The 1st of the month that either falls on or follows the day that you cancel the policy
  • The date you are no longer a resident of Canada
  • The date you are no longer covered by a provincial medicare plan or Canadian federal government plan
  • The date of your death

LifestageCareTM is a national, bilingual service provided by Sykes Assistance Services Corporation, available 24 hours a day that provides access to unbiased information about local, qualified healthcare and personal care providers to meet the needs of your entire family. There is no waiting period to use this benefit; as soon as you receive your Care at Home policy number, you can begin using LifeStageCare. (Sun Life reserves the right to cancel this service at any time.)3

CustomerPerks® is a discount program provided by Venngo Inc. that provides you with access to savings on health and wellness products. Simply visit sunlife.venngo.com and enter your Care at Home Enhanced or Care at Home Standard insurance ID number found on your welcome letter to set upyour account. (Sun Life does reserves the right to cancel this service at any time.)3

We can help! If you have a question about your coverage, call 1-800-669-7921.

Leaving your employer plan? For questions regarding options for your employer group plan, contact a Sun Life Financial Services Consultant1 any business day from 8 a.m. to 8 p.m. ET. Call 1-877-893-9893.

Retiring soon? For information and assistance on new or existing retirement income plans, connect with a Sun Life Retirement Consultant1 any business day from 8 a.m. to 6 p.m. ET. Call 1-866-224-3906.

Care at Home Fracture is an insurance plan that provides, upon approval of your claim, a one-time, lump-sum payment if you have an accident that results in a broken bone or fracture. The amount paid is based on the type of accidental fracture that occurred.

The fracture benefit is available as stand-alone coverage under Care at Home Fracture, but can also be purchased as part of the Care at Home Enhanced plan.

Your independence matters! For many of us, remaining in our home as we get older and move into retirement is an important part of the plan. And as we age, we may eventually need some help to remain safely in our home and keep our independence.

If you have an accident resulting in a broken bone, the fracture benefit lump-sum cash payment may be used to pay for the in-home care necessary to help with your recovery. Or it can cover the cost of seasonal home maintenance such as shovelling snow or maintaining your property while you recover from the accident. You have control over how this cash benefit is used.

Type of Fracture: Spine

  • 2+ vertebrae
  • one vertebrae
  • compression

Benefit Amount

  • $5,000
  • $2,000
  • $1,000

Type of Fracture: Cranium

  • depressed fracture
  • other

Benefit Amount

  • $5,000
  • $2,000

Type of Fracture: Pelvis
Benefit Amount: $3,000

Type of Fracture: Hip
Benefit Amount: $3,000

Type of Fracture: Femur
Benefit Amount: $1,000

Type of Fracture: Tibia
Benefit Amount: $1,000

Type of Fracture: Fibula
Benefit Amount: $1,000

Type of Fracture: Patella
Benefit Amount: $1,000

To receive your fracture benefit payout, you will need to provide a radiologist's report documenting the fracture, along with your claim form. The radiologist's report will include an x-ray of the broken bone, identification of the broken bone and date of the x-ray, along with your name and date of birth.

In order to make a claim, call us at 1-800-669-7921. We will send you the required claim form to be completed.

Your fracture benefit coverage will terminate on the earliest of:

  • The premium due date, subject to the 31-day grace period, for non-payment of premiums
  • The date the maximum benefit amount has been paid
  • The 1st of the month that either falls on or follows the day that you cancel the policy
  • The date you are no longer a resident of Canada
  • The date you are no longer covered by a provincial medicare plan or Canadian federal government plan
  • The date of your death

Footnote