Health and dental

Health and dental

Updated: April 30, 2021

In April 2020, we let you know that we’d temporarily reimburse virtual dental assessments while dental offices were open for emergency treatments only. As a reminder, our standard dental contracts cover emergency dental services, but not virtual assessments.

In consultation with dental associations across Canada, we made a temporary change. We began reimbursing virtual dental assessments using the dental codes recommended by the Canadian Dental Association (CDA), and the Association des chirurgiens dentistes du Québec (ACDQ).

Dental offices in Canada have since reopened for regular visits. However, provinces and territories are now experiencing a third wave of COVID-19 variants. As a result, we’ll continue to reimburse virtual dental assessments covered by these codes for the duration of the pandemic. We’ll continue to monitor the situation, and re-evaluate once the pandemic is over.

Plan members can contact our Client Care Centre at 1-800-361-6212 if they have questions about their claims.

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: June 3, 2021

The Canadian rollout of COVID-19 vaccines is in full swing. You and your employees may have questions about whether getting the vaccine impacts group benefits coverage. Check out our Vaccine FAQ. It covers key questions and concerns about vaccines and benefits coverage.

For more information on COVID-19 vaccines, please visit Lumino Health or the Government of Canada

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 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 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.