We’ll encourage your Clients to speak to you about their options. We’ll be sending Focus Updates to plan sponsors on January 28. For detailed contract changes, click here.

Here are links to the sponsor Focus Updates:

• National Accounts and Sun Solutions
  • Adding R&C only
  • Adding R&C + new child scaling limits only
  • Adding R&C + new adult scaling limits + new child scaling limits
• SunAdvantage – adding R&C only
• Clarica heritage
  • Update to R&C wording + new child scaling limits
  • Update to R&C wording + new adult scaling limits + new child scaling limits

Overview of the changes

Why the changes

Here’s a closer look at each change:

1.    Adding or updating the R&C definition to our dental contracts. Our standard dental contracts don’t list limits for all expenses covered. Carriers commonly use claims admin practices to apply limits to expenses, when those limits aren’t stated in the contract. Defining what’s reasonable and customary lets us limit how often we’ll reimburse for certain procedures under our plans. Sun Life can ask for more information when needed, to ensure the claim is reasonable.   

• Click here for R&C definitions for each Client segment.

For each dental procedure, Sun Life will only cover up to the reasonable and customary charge for the least expensive alternate procedure, service or treatment consistent with accepted dental practice. In no case will the eligible expense be more than the fee stated in the appropriate Dental Association Fee Guide specified in Benefit Details.

2.    Adjusting scaling and root planing limits. For scaling and root planing per benefit year/each year, we’ll cover up to a combined maximum of:

• 10 units for each plan member, and each dependent age 13 and over, and
• 2 units for each child age 12 and under (contract and booklet wording will say “a child under age 13”).

Scaling and root planing is one of the most common dental procedures and an important preventive practice. It involves the removal of plaque and tartar above and below the gum line. The new 10-unit limit for those 13 and over meets most plan members’ needs. Our claims data shows that 95% of plan members already claim below the 10-unit limit. For children 12 and under, scaling isn’t needed to the same extent as those 13 and over. Current limits for scaling and root planing aren’t based on age.

Here’s how we’ll amend contracts for NA/SSOL and Clarica Clients where applicable:

If the Client’s current plan has a limit for scaling and root planing over 10 units per benefit year/each year, we’ll update it to:

• a combined maximum of 2 units for each child under age 13, and 10 units each for any other person.

Clients with contracts that don’t have set limits or are referred to as “unlimited” for scaling and root planing, don’t have this specified in their contract or booklet. We’re modifying their contracts to list the new 2 and 10-unit limits.

If the Client’s current plan has an existing limit of 10 units or less, per benefit year/each year:

• the existing limits will remain the same. The new 2-unit limit for a child under age 13, will apply to all contracts.

3.    Covering one oral hygiene instruction session in a person’s lifetime. Learning how to properly brush and floss your teeth is a basic skill most people learn when they’re young. Most plans only cover this service once every few years. We believe the change to one session per lifetime is a reasonable limit on this practice.

4.    Reimbursing one complete oral exam every 36 months. Many industry providers have this limited to 36 months or longer on their plans. Currently, three out of five dental plans that we offer already have the limit set at 36 months. However, our standard dental plan, as well as SunAdvantage’s OMNIDENT plan, doesn’t. We’re making this change to align our dental plans.

Questions?

If you still have questions about your Clients’ contracts, please contact your Sun Life Group Benefits representative.