Health and dental

Health and dental

Updated: April 13, 2021

Making sure that plan members continue to get the care and treatment they need is our top priority.

We know that plan members may still have limited access to their regular health-care providers. For this reason, it may be difficult for plan members to update prescriptions, referrals and other documents.  Plan members need these documents to support certain health care claims.

For documents expiring before June 30, 2021

If any such documents expire before June 30, we’ll still pay your plan members’ claims. This includes:

  • Prescriptions, nurse practitioner or doctor referrals for paramedical services
  • Drug exception forms, which includes prior authorization and special authorization

As a reminder, we’ll accept copies of drug exception forms

We don’t require original signatures. For example, your plan members can print their forms, sign them and then submit a photograph of that document. They can send them to us using the my Sun Life mobile app. They also have the option to send forms to us by mail or fax. We’ve created this Health & Dental flyer for you to share with plan members.

We’ll apply our usual requirements on July 1, 2021

Starting in April, we’ll send a letter to plan members having drug exceptions on file that are about to expire. The letter will advise the plan member on next steps to continue coverage for their drug exception.

Updated: March 15, 2021

You may be receiving questions regarding COVID-19 vaccines and group benefits coverage. Rest assured there won’t be any effects on coverage. For more information, the Canadian Life and Health Insurance Association (CLHIA) shared this news release.

Updated: December 18, 2020

Earlier this year, we made the decision to extend our over-age student coverage until December 31, 2020.

We’re now further extending our over-age student coverage until the end of the winter school term 2021. For students returning to school in September 2021, plan sponsors may allow coverage to continue through the summer months. This is to help students who qualify remain healthy and safe.

Dependents must meet all of the following criteria to qualify for over-age student coverage:

  • Be a full-time student between the ages of 21 and 25 (26 in Quebec), or the age limit defined in your contract
  • Be a current student or plan to return to an educational institution recognized under the Income Tax Act. Clients can find accredited educational institutions in Canada here.
  • Be dependent on a plan member for support.
  • Have provincial healthcare coverage.

How to update your over-age dependent information

You can identify dependents by running an over-age dependent report on the Plan Sponsor Services site.

Please ask your employees to provide you with an updated proof of studies or have them confirm their dependent’s intention to return to school before September 1, 2021. Then update any over-age dependent information.

For information about students studying abroad, please refer to updates on Out-of-country coverage.

Updated: June 29, 2020

COVID-19 has created new health and safety standards for many health care providers. All health care providers must follow these additional standards as set by their associations, regulatory bodies, and levels of government. Please read this communication for information on personal protective equipment (PPE) and group benefits plans.

Updated June 9, 2020

We know that plan members want to ensure they have enough medication at home during the COVID-19 pandemic. During the early stages of the pandemic, pharmacy regulators, associations and health ministries recommended that pharmacists provided a 30-day supply to Canadians. This was to help ensure there were enough medications available for all Canadians during the pandemic. Over the last weeks, all provinces have re-evaluated their position and have begun lifting the 30 day supply limits, and reserving these parameters for drugs that are in short supply. We support pharmacists using their discretion in dispensing medications. A plan member might receive only a 30-day supply for their medication, even if their prescription is for more. If a plan member has previously filled a prescription, they may receive a different amount than the last time.

Updated June 15, 2020

We know that in-person visits to many health-care providers may not be available during the COVID-19 pandemic. We want to ensure plan members continue to receive the health care they need. Now, we’ll cover virtual services for appointments where they do not need direct physical therapies. We’re extending claims coverage for virtual services performed by:

  • Audiologists
  • Chiropodists
  • Chiropractors
  • Naturopaths
  • Occupational Therapists
  • Osteopaths
  • Podiatrists
  • Psychologists
  • Psychotherapists
  • Physiotherapists
  • Registered Dieticians
  • Social Workers
  • Speech Therapists

The practitioner must be in Canada for us to pay claims. Existing coverage remains the same.

We continue to assess other potential virtual services. We’ll keep you informed of any changes.

Making a claim is easy with a photo of the receipt

You can submit a claim on mysunlife.ca or through the my Sun Life mobile app.

To make a claim for a virtual service:

  • Select the type of service
  • Select the location of service
  • For any virtual appointments, select “virtual visit” as the location of service

We have created this Virtual Care flyer for you to share with plan members.

Updated: April 17, 2020

We’re pleased to provide two new solutions that can help plan members during the current pandemic and beyond.

We’re now covering nurse practitioner prescriptions for specialist referrals and medical expenses. And we’ve put a work-around in place for plan members who can’t print-off online health forms.

This Focus Update explains more. And this flyer on new solutions provides details for your plan members.

Updated April 22, 2020

Right now, dental offices are open only for emergency treatments.

Our standard dental contracts cover emergency dental services, but not virtual assessments. We’ve had discussions with dental associations across Canada.   The Canadian Dental Association (CDA) and the Association des chirurgiens dentistes du Québec (ACDQ) have codes for virtual dental assessments. They are recommending providers use these codes at this time.  For now, we’ve made a temporary change to make the recommended dental codes for virtual assessments eligible for reimbursement. We’ll only reimburse claims for virtual assessments that use the recommended codes. A plan member can call our Client Care Centre if they have any questions about their claim.

When dental offices reopen for regular visits, we’ll no longer reimburse for the services covered by these codes.

Updated April 27, 2020

Ontario is the only province with an Assistive Devices Program (ADP).  This program helps residents with a long-term physical disability pay for assistive devices. These include walkers, wheelchairs, hearing aids and many other aids. Ontario residents can receive a payment equal to 75% of the approved cost of these devices. They must apply to the ADP for this payment.  Here’s how it works:

  • Plan members go to an ADP-approved specialist (such as an occupational therapist).
  • The ADP specialist completes and submits the ADP form to an ADP-approved vendor.
  • The vendor would then submit the form to the ADP to receive their 75% reimbursement and charge the member the balance.
  • Once the ADP approves the plan member’s claim, we would then pay the remaining 25% of the claim’s balance.

With most specialist offices now closed, plan members are often unable to have their ADP forms completed. Until July 31, they should still submit a claim or estimate to us for approval. For eligible claims, we will cover the claim or estimate, even without prior ADP approval.