New business service process and standards - PHI and HCC

How quickly are applications reviewed?

Applications for Personal Health Insurance (PHI) and Health Coverage Choice (HCC) are reviewed by the Administration Team within 5 days of being received. The Administration Team sends PHI applications to the Underwriter Associate Team.

How will I know the outcome of the application review?

Once the application has been reviewed, we will send a notification to you, as advisor of record, that either confirms

  • your client has been approved
  • we're missing information, or
  • if a PHI application, that there are modifications to present to the client. (Modifications may be required on a Personal Health Insurance plan if there are pre-existing conditions.)

If we postpone or decline an application for Personal Health Insurance we will notify you of our decision, although we may not be able to share all the reasons for it. To protect your client's privacy we're unable to share certain information.

Can there be additional underwriting requirements for PHI?

At times, there may be additional medical questions that need to be answered before our underwriter can decide if it is appropriate to offer insurance. In these situations, we will send a notification to you, as advisor of record, that outlines the information needed and from whom. (Much of the information we need can be obtained from the client. Occasionally, questions may be asked of a physician.)

Where will the policy be mailed?

A welcome kit is mailed directly to the client when a PHI or HCC policy is issued. The welcome kit includes the policy, premium information and claim forms.

When the policy is mailed, you, as advisor of record, will receive a notification. This notification lists the policy start date, who is insured, premiums, policy anniversary and waiting period.

What other supports are available?

We have two teams available to help answer questions about PHI/HCC policies.

Our administration team provides support with issuing and servicing PHI/HCC policies. If your client needs to change payment arrangements, moves or requires an amendment to their policy, they can reach us at 1- 877 SUN-LIFE (1 877 786-5433) (choose option 1 for English, then options 2, 2 and 2). This number can also be used if you have an underwriting inquiry.

Our claims call centre is available at 1-877 SUN-LIFE (1 877 786-5433) (choose option 1 for English, then options 2, 2 and 1) to help answer any claims questions that your client may have. This team can also determine if an expense would be eligible for reimbursement before treatment begins. Clients may call directly for this information and will be asked for their policy number (037000) and identification number.

How are claims submitted?

For prescription drug claims in Quebec, clients can submit their drug claims via a paper claim form and for all other provinces, clients can use their Pay Direct Drug card.

For dental claims, easy-to-use forms are supplied with the client's welcome package and are also available for the client on-line at www.sunlife.ca/personalhealth: How do I make a claim. Dental offices can also submit claims electronically.

For supplemental health care claims, easy-to-use forms are supplied with the client's welcome package and are also available for the client on-line at www.sunlife.ca/personalhealth: How do I make a claim.

For Emergency Travel Medical claims, clients need to call the toll free Europ Assistance USA Inc. phone number listed in their 'Travelling Soon?' brochure.

Where to send paper applications?

By mail:
Sun Life Assurance Company of Canada
Personal Health Insurance
227 King St S
P.O. Box 1601 STN Waterloo
Waterloo ON N2J 4C5

By fax: 
1-866-487-4745