Plan administration

Plan administration

Updated: May 20, 2021

We’d like to remind you about continuing coverage during COVID-19, and how it may affect plan members on:

  • Temporary lay-offs
  • Statutory leaves
  • Leaves due to illness

Focus Update

Updated: January 5, 2021

Please note, there’s an update to our continuing coverage during temporary lay-offs and how it affects members that were on statutory leave.

Updated: May 14, 2020

Our video – Continuing coverage during Statutory Leaves and Lay offs – hosted by Cindy Govedaris, Assistant Vice President & Senior Counsel, Central Law – gives an overview of when employers can continue coverage under a group benefits plan and highlights issues for employers to consider.

We’ve created a PDF of the presentation for you to share with your colleagues. Please read our Continuation of Coverage FAQ from December 18, 2019 for details.

Updated: May 14, 2020

Updated: March 25, 2020

Please note there is an update to our continuation of coverage Focus Update from March 25, 2020. This applies if you choose to maintain coverage during a temporary layoff:

You may maintain coverage for all benefits (or all benefits, except disability) for up to three months. Your benefit plan may set out a different temporary lay-off period. If so, this period will apply. You must apply your coverage decision equally to all employees within the same class. We know that you may not be able to collect employee contributions at this time. For non-taxable Long-Term Disability benefits, it is important to collect premiums from your employees. For all other benefits, you can remit premiums on behalf of employees. When employees return to work, you can then collect their contributions. For additional guidance, we recommend you consult your tax advisor.

Updated: April 2, 2020

We want to make life claims administration easier.  For now, we’re accepting scanned, signed copies of life insurance claim forms and beneficiary nomination forms.  This means we can pay life insurance claims without the original signed copy.  We’ve put processes in place to handle claim payment where we can’t confirm a beneficiary. 

If you need either of these forms, but don’t have access to them, please contact your Sun Life Group Benefits representative, or contact our life claims office directly. 

Updated: April 16, 2020

These are uncertain times. We understand that you may have concerns about suspect claims made under your benefits plan. We’re here to reassure you. We continuously evolve our investigative strategies to address any new channels for suspect activity. This includes the potential for fraud and abuse related to virtual services offered by paramedical providers.

We have advanced data analytics, external partnerships and an experienced fraud risk management team. Together, these provide the capabilities we need to address new risks and changing trends.

Changing times, changing strategies

To follow physical distancing orders, plan members are now using more virtual services. We’ve also extended coverage for virtual services for some paramedical providers.

When we introduce a new product or service, we develop additional ways to reduce fraud and abuse risks. To address the anticipated rise of plan members using virtual services, we’ve taken the following actions:

  • Communications with regulators. We’ve discussed virtual services with dental and paramedical regulators and associations to confirm the scope of virtual services offered.
  • Increased monitoring. We’ve enhanced our monitoring of medical and dental claims across all plan member and provider submission channels. This monitoring accounts for the new and additional risks introduced in this environment. This includes introducing new fraud detection methods to adapt to the changing environment.
  • Focus on providers and facilities. Our analytic capabilities can identify billing irregularities by provider and facility. This lets us take appropriate action against providers who may take advantage of benefits plans.

In addition to these actions, we continue our regular screening of claims and monitoring of all tips and referrals. We’ll continue asking plan members for additional information when needed to process claims.

Protecting your plan from fraud and abuse remains a priority for us.