Continuous Glucose Monitor (CGM) Direct Claim Submissions now available at pharmacies

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Sun Life is committed to continually improving access to the diabetic supplies plan members need.

What’s Changing

Effective December 16, 2024, eligible plan members can submit expenses for CGMs directly at the pharmacy of their choice.

This change will offer timely, more convenient access to CGMs for plan members and minimize initial out-of-pocket expenses.

It will apply to benefit plans meeting the criteria set out below and be available to plan members and their dependents with a drug card. All existing plan requirements, including coverage criteria and maximums, remain unchanged.

Eligible Clients:

Direct claim submissions will be available to plan members when their benefits plan meets certain criteria which includes:  

• Current coverage allows for drugs and CGMs.
• Extended Healthcare coverage and drug coverage must share the same deductible and maximum amounts (including both annual and lifetime maximums),
• Slide limits and slide types for co-insurance must be the same across extended healthcare and drug coverage.
• Expense limits must be per individual and have the same value for plan members and their dependents.

What you need to know

Below is the key information you need to know as you continue to advise your Clients:

• This is an administrative change only. This means that we won’t modify contract and booklet wording.
• There is no action required on the part of you or your Client.
• We’ll communicate this change to eligible Clients.
• All members who have submitted a claim for a CGM will receive a communication from Sun Life advising them that they can submit future claims directly at their pharmacy. Standard exclusions will apply.

Sun Life remains focused on enhancing the Client experience. We aim to help plan members better manage chronic health conditions to live healthier lives.

Questions? We’re here to help.

Please contact your Sun Life Group Benefits representative.