Extended health care (EHC) and dental insurance

Health and dental insurance that keeps your finances healthy

The cost of prescription drugs, visiting the optometrist or physiotherapist or a stay in the hospital, can add up. Extended health care (EHC) and dental insurance covers many basic health costs. Help make your trips to the dentist less painful by choosing a plan with dental care.

You’ll use your coverage when you:

  • need prescription drugs1,
  • buy new glasses or contacts,
  • see various medical practitioners like massage therapists, physiotherapists, chiropractors, etc.,
  • have a stay in the hospital (where you’ll want a semi-private or private room) and
  • visit the dentist (if you choose an option with dental care coverage).

Why choose EHC and dental insurance?

  • You can choose single or family coverage.
  • You get savings on the insurance you need, thanks to group pricing.

Extra advantages

View your EHC and dental benefits and claims information quickly and easily.

By visiting mysunlife.ca or by using the my Sun Life mobile app, if you have coverage, you can:

  • see what your health and medical plans cover,
  • submit claims for instant processing,
  • submit a copy of a receipt by snapping a photo, 
  • easily check the status of your claims,
  • call us from within the app for faster help - we'll have your plan details,
  • have your coverage cards handy wherever you go in the app and/or your Apple Wallet,
  • use the drug look-up tool to see how much of your prescription drug costs are covered – maybe we can suggest a less expensive generic equivalent,
  • find health care providers in your area and
  • keep up with product and service updates, special offers and helpful reminders by viewing 'My Notifications'.

Go mobile - download the my Sun Life mobile app on Google Play or the Apple App Store.

You're eligible if you’re:

  • a CAPIC member in good standing or an employee of CAPIC
  • between the ages of 18 and 64 (coverage ends on your 65th birthday),
  • covered under your provincial health insurance (your spouse2 and any dependent children must also have provincial health insurance) and
  • a resident of Canada.

In Quebec, you are required to have RAMQ drug coverage or an equivalent group/association plan to purchase Health and Drug coverage through the CAPIC insurance program. A person not covered under a group benefit plan or through RAMQ, is not eligible for coverage under this policy.

Meet the criteria? You can get EHC and dental insurance for:

  • You

  • You, your spouse,
    your dependent child(ren)

What's the cost?

Our rate sheets can provide you with a quick estimate.

For more information about this coverage, please refer to your CAPIC booklet EHC and dental insurance section.

What are the coverage options?

You can choose single or family coverage. For more detailed descriptions of the benefits offered, please see your benefits booklet, but here is a summary showing coverage per family member covered:

EHC benefit details

Calendar year

January 1 to December 31
Maximum benefit Unlimited, unless otherwise specified.
Proof of good health Required on the initial request for coverage for you and your spouse
Deductible None

Drug card plan

Included (except for Quebec residents)

Prescription drugs

80%

For Quebec residents, the reimbursement percentage is increased to 100% once the out-of-pocket maximum is reached

We’ll cover the following drugs and supplies prescribed by a doctor
or dentist and obtained from a pharmacist:

  • drugs that legally require a prescription,
  • life-sustaining drugs that may not legally require a prescription and
  • diabetic supplies.

There are drugs and treatments that aren’t covered, even when prescribed.

Please refer to your plan booklet for more information. 

Other health professionals allowed to prescribe drugs

We reimburse certain drugs prescribed by other qualified health professionals the same way as if the drugs were prescribed by a doctor or a dentist if the applicable provincial legislation allows them to prescribe those drugs

Québec drug insurance Plan

Any conditions under this plan that don’t meet the requirements under the Québec drug insurance plan are automatically adjusted to meet those Requirements

In-province hospital  100% of the difference between the cost of a ward and a semi-private room, up to a maximum of $100 per day, multiplied by the number of days of the hospital stay
Convalescent hospital 

100% of the difference between the cost of a ward and a semi-private room, up to $20 per day for a maximum of 180 days. This includes for all periods of treatment of an illness due to the same or related causes

Out-of-province
emergency service and Out-of-province referred services

100%

Emergency Travel Assistance included

Time limit – 60 days after the date the person leaves the province where the person lives

Lifetime maximum of $1,000,000 per person for out-of-Canada services

Medical services and equipment

For the services of an ophthalmologist or licensed optometrist – 100%

For orthopaedic shoes – 50%

For all other eligible expenses – 80%

Paramedical services

80% up to a maximum of $375 per person per calendar year per specialty for the qualified paramedical practitioners listed below:

  • psychologists,
  • massage therapists, when ordered by a doctor,
  • speech therapists,
  • physiotherapists,
  • naturopaths,
  • Christian Science Practitioners,
  • osteopaths or osteopathic practitioners, including a maximum of one x-ray examination per year,
  • chiropractors, including a maximum of one x-ray examination each calendar year and
  • podiatrists or chiropodists, including a maximum of one x-ray examination each calendar year.

Termination

When you retire or reach age 65, whichever is earlier
Dental benefit details
Calendar year January 1 to December 31
Deductible None
Fee Guide The current fee guide for general practitioners in the province where you live, regardless of where the treatment is received
Preventive procedures 80%
Basic procedures 80%
Major procedures 50%

Calendar year maximum

All dental procedures – combined maximum of $500 per person for the first calendar year of coverage

Preventive and Basic dental procedures – combined maximum of $1,200 per person for each subsequent calendar year

Major dental procedures – $500 per person for each subsequent calendar year

Late applicant limitation

If you and your dependents do not apply for Dental benefits within 31 days of applying for other benefits, you’ll need to wait for one year before you or your dependent are eligible for Dental care benefits. Premiums for this benefit aren’t required during the one-year waiting period

Termination When you retire or reach age 65, whichever is earlier

Learn more by taking a look at your CAPIC benefits booklet.

When does coverage end?

  • Coverage ends at age 65, or
  • The date that any person who isn’t entitled to benefits under a provincial medicare plan or federal government plan with similar benefits (for Quebec: RAMQ equivalent).

Take these three steps to apply:

Exclusions:

No benefits are payable when the claim is for an illness resulting from:

  • any work for which a covered person was compensated that was not done for the Association who is providing this plan.
  • the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
  • teeth malformed at birth or during development.
  • participation in a criminal offence.

Prescription Drugs:

No benefits are payable for the following, even when prescribed:

  • the cost of giving injections, serums and vaccines.
  • treatments for weight loss, including drugs, proteins and food or dietary supplements.
  • hair growth stimulants.
  • contraceptives
  • products to help you quit smoking.
  • drugs for the treatment of infertility.
  • drugs for the treatment of sexual dysfunction.
  • drugs that are used for cosmetic purposes.
  • natural health products, whether or not they have a Natural Product Number (NPN).
  • drugs and treatments, and any services and supplies relating to the administration of the drug and treatment, administered in a hospital, on an in-patient or out-patient basis, or in a government-funded clinic or treatment facility.

Extended Health Care:

No benefits are payable for the costs of:

  • services or supplies payable or available (regardless of any waiting list) under any government sponsored plan or program, except as described below under Integrating with government programs.
  • implanted prosthetic or medical devices (examples of these devices are gastric lap bands, breast implants, spinal implants and hip implants).
  • equipment that we consider ineligible (examples of this equipment are orthopedic mattresses, exercise equipment, air-conditioning or air-purifying equipment, whirlpools and humidifiers).
  • services or supplies that are not usually provided to treat an illness, including experimental or investigational treatments as defined in the contract.
  • services or supplies that do not qualify as medical expenses under the Income Tax Act (Canada).
  • services or supplies for which no charge would have been made in the absence of this coverage.

Dental:

No benefits are payable for:

  • services or supplies payable or available (regardless of any waiting list) under any government-sponsored plan or program unless explicitly listed as covered under this benefit.
  • services or supplies that are not usually provided to treat a dental problem.
  • procedures performed primarily to improve appearance.
  • the replacement of dental appliances that are lost, misplaced or stolen.
  • charges for appointments that you do not keep.
  • charges for completing claim forms.
  • services or supplies for which no charge would have been made in the absence of this coverage.
  • supplies usually intended for sport or home use, for example, mouthguards.
  • procedures or supplies used in full mouth reconstruction (capping all of the teeth in the mouth), vertical dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping teeth and joining teeth together to provide additional support).
  • transplants and repositioning of the jaw.
  • experimental treatments.

1 Charges greater than the lowest-priced equivalent drug aren’t covered unless specifically approved by Sun Life. To assess the medical necessity of a higher-priced drug, Sun Life requires you, your spouse, or your dependent child and the attending physician to complete and submit an exception form.

2 Spouse: Your spouse by marriage or under any other formal union recognized by law, or a partner of the opposite sex or of the same sex who is living with you and has been living with you in a conjugal relationship for at least 12 months. For Québec residents, there is no minimum cohabitation period for common-law spouses if a child is born out of their relationship.
Only one person at a time can be covered as your spouse.

QUESTIONS?

Call us at 1-800-669-7921
Mon to Fri 8:00 a.m. to 8:00 p.m. ET

Sun Life Assurance Company of Canada is the insurer of this product, and is a member of the Sun Life group of companies.