New business service process and standards

How quickly are applications reviewed?

Applications for Personal Health Insurance and Health Coverage Choice are reviewed within five days of being received. Correspondence about the application must occur through the use of fax machines, so please ensure your business fax number is provided on each application. (We are currently unable to connect to the SLF Advisor Site Activity Centre for secure communications for this product line.)

How will I know the outcome of the application review?

Once the application has been reviewed, we will send a fax to you, as advisor of record, that either confirms the policy has been approved for set up or that there are modifications to present to the client. (Modifications may be required on a Personal Health Insurance plan to allow for pre-existing conditions.)

How are policies identified?

There are two numbers that identify a PHI / HCC customer. The first is policy 037000 and is common to all PHI / HCC policies. The second number is a unique certificate number for your client. This second number is assigned when the application is received and will be included in any fax we send to you. To help us provide prompt service, please remember to include 037000 and your client's unique certificate number in all correspondence.

Can there be additional underwriting requirements?

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 fax 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 Personal Health Insurance or Health Coverage Choice policy is issued. The welcome kit includes the policy, premium information and a small number of claim forms.

When the policy is mailed, you, as advisor of record, will receive a fax of the policy particulars page. This page lists the policy start date, who is insured, premiums and any exclusions that may have been agreed to previously.

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, we can be reached at 1-800 SUN LIFE (choose option 1 for English, then options 1, 4 and 2). This number can also be used if you need to speak with an underwriter about an offer to modify coverage.
 

Our claims call centre is available at 1-800 SUN LIFE (choose option 1 for English, then options 1, 4 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 certificate number.

How are claims submitted?

For prescription drug claims in all provinces, clients can use their Pay Direct Drug card. Please note: For PHI clients who reside in New Brunswick or Nova Scotia, and all HCC clients - there is no drug coverage after age 65.

For your dental and supplemental health care claims, easy-to-use forms are also supplied with the client's welcome package and are available on-line (www.sunlife.ca/personalhealth).

For Emergency Travel Medical coverage, call the toll free Travel Assist phone number on the back of either your Pay Direct Drug card or your Travel Assist 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
Attention: Personal Health Insurance