Sun Life Personal Health Insurance: Plan Details
This is not a contract. Actual terms and conditions for the Sun Life personal health insurance plan are detailed in the policy issued upon application approval.
Table of Contents
- Applying as a couple/family
- Annual and lifetime maximums
- Emergency travel medical
- Medical history
- Is a medical required to qualify for insurance?
- When do benefits begin and when are customers eligible to claim?
- How are benefits paid?
- Are premiums tax deductible?
- Are premiums guaranteed?
- How do you receive your policy?
Health Care Plans
- Anyone who is 69 years of age or less, is a resident of Canada, and is covered under the provincial health plan in their province of residence. Rates are renewable for age 70+.
- If you are applying as a couple or family then you must choose the same plan and options for everyone.
- Dependants must be under the age of 21 or under the age of 25 if they are in school full-time.
- All annual or lifetime maximums are per person. Annual maximums are based on a calendar year.
- Any unused portion may not be carried forward for use in subsequent years.
- If you make your application during your first 20 weeks of pregnancy, you’re eligible to apply for semi-private hospital coverage. The covered length of hospital stay will be limited to 2 days. When the baby is born, simply contact Sun Life Financial within 30 days of the birth and the baby can be added to your plan for a small, additional premium.
- Emergency travel medicalcoverage contains a 9-month pre-existing conditions clause. Your policy provides details about this clause.
- Based on the medical history of you or your family, coverage may be declined, modified or given a higher premium.
- Applicants are asked a number of health questions on the application form. The need for additional medical evidence will depend on these answers.
- Benefits begin: once approved; once any waiting periods have been satisfied; when coverage is established. Coverage effective date is not limited to the first day of the month with Sun Life.
- With Sun Life’s pay direct drug card, the portion covered by the plan is paid automatically when the card is presented to the pharmacist. The free my Sun Life Mobile app makes it easier for clients with Personal Health Insurance or Health Coverage Choice to submit claims through their smartphone. They can use their smartphone to submit claims and receive their payment within 48 hours, access their drug or travel card and more. If clients don’t have a smartphone, they can access their Personal Health Insurance or Health Coverage Choice plan on www.mySunLife.ca and receive the same fast and convenient service. Specific information about my Sun Life Mobile app is available on sunlife.ca/mobile.
- Pay direct drug cards are not available for Quebec residents under the age of 65.
- All claims can be filled easily using Sun Life Financial claim forms.
- Yes, Sun Life’s Personal Health Insurance offers both coverage and the possibility of saving valuable tax dollars.
- To confirm eligibility you should contact your tax advisor or accountant.
- Yes, premiums are guaranteed for one year from the policy’s effective date.
- Sun Life will mail you a welcome kit directly. This kit includes your policy, pay direct drug card and other valuable information.
|Basic Plan||Standard Plan||Enhanced Plan|
|General Description||Most economical plan for basic coverage.||Coverage for the same health expenses as Basic but at higher levels. Also with vision and emergency travel medical coverage.||The broadest and most generous level of coverage, including orthodontic and restorative dental coverage.|
|Restorative dental||Not available||Not available||
|Orthodontics||Not available||Not available||
|Supplemental health care||
|Vision – Prescription eyeglasses, contact lenses, prescription sunglasses, and laser eye surgery.||No coverage||
|Emergency travel||No coverage||
Semi-private hospital room
|Other services?||Best Doctor’s services||Best Doctor’s services||Best Doctor’s services|
- Is an optional benefit on the basic, standard or enhanced plans.
- 85% reimbursement.
- Up to $180 daily and $5,000 annually.
- Convalescent Hospital: $20 per day up to 180 days per incident.
- Dental coverage is optional for Standard and Enhanced plans.
- The plan includes:
- Exams, diagnosis, tests, x-rays, lab exams.
- Space maintainers for children under 12 years of age.
- Pit and fissures sealant for children under 19 years of age.
- White fillings.
- Scalings, minor extractions.
- Nine month recall visits.
- NOTE: Restorative and orthodontic is included when optional dental is added to the Enhanced plan.