Personal Health Insurance Enhanced plan

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 or nurse practitioner
  • drugs to treat obesity

Dental

This is an optional benefit with this plan and includes:

Supplemental healthcare

Paramedical practitioners

• 100% reimbursement
• No per-visit maximum
• Up to $400 per year, per type of practitioner
• Increased coverage for psychology and social worker services to a shared maximum of $1500 per year
• Paramedical practitioners include: acupuncturists, chiropractors, naturopaths, osteopaths, physiotherapists, podiatrists, chiropodists, psychologists, social workers, registered massage therapists, speech language pathologists

Vision care

• 100% reimbursement
• $300 maximum every 2 calendar 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

• Access to mysunlife.ca and the my Sun Life Mobile app lets you manage your personal health insurance plan online.

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 or territorial health and drug 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 or territorial government health and drug 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 at least 30 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.

Find more exclusions and limitations in the Enhanced plan with dental and semi-private hospital room coverage sample policy.