Sun Life Benefit Updates for Active Members

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Sun Life Benefit Updates for Active Members2022-10-20T11:42:08-04:00
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The Group Benefits Plan consists of the Health and Dental Plan and the Group Life Insurance Plan with Sun Life Financial. These plans can go through changes and updates from time to time and it is important to keep informed about how these changes may effect you. All up-to-date information will be provided on this page for any changes made.

It’s Fraud Prevention Month – some things you need to know

Health-care Service Provider Delisting
When Sun Life delists health-care service providers, clinics, facilities or medical suppliers (referred to as the “provider” below), we no longer process or pay for claims for services or supplies obtained from that provider. These providers are placed on a Sun Life “delisted providers” list.

Delisted Provider Update
Our list is updated regularly. To view newly delisted providers, you must sign in to your passwordprotected web page through mysunlife.ca and select the message for delisted providers.

We encourage you to check the list periodically. This will help you avoid using a delisted provider, which would result in your claim being declined.

We’ll Keep You Updated
When we delist a health-care service provider, we’ll send you a letter if you’ve submitted a claim for this provider in the last one or two years, depending on the specifics of your plan.

Why Delisting a Provider is Necessary
It’s important that only eligible claims are processed and paid. It allows us to better protect you, your employer and your group benefits plan.

Questions? We’re here to help.
Please contact the Client Care Centre at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET

Update: Changes to Your Dental Coverage – January 1, 2022

Sun Life regularly reviews their dental plans. Based on a recent review, there’ll be a change to scaling and root planing coverage.

Scaling and root planing remove plaque and tartar above and below your gum line. It’s a common procedure that can prevent future dental problems. A dentist or dental hygienist likely does this during regular dental checkups.

How your coverage is changing
As of January 1, 2022, the combined maximum for scaling and root planing per benefit year, will be:
• 10 units for you,
• 10 units for each dependent 13 and over, and
• 4 units for each child 12 and under.

One (1) unit is equal to 15 minutes of treatment. Claims data shows that 95% of claims for scaling and root planing are below 10 units per benefit year. For children, scaling isn’t needed to the same extent as adults. Flossing, for example, is a simpler treatment. That’s why the limit for children under age 13 is lower.

How this change will affect you
This change will only affect you if your dentist is currently charging you or your dependents, per benefit year:
• more than 10 units combined for scaling and root planing (for those 13 and over)
• more than 4 units combined for scaling and root planing (for those 12 and under)

If your dentist is currently charging you less than these limits, this change will have no effect on you.

Understanding your claims
Your claim statement will include an explanation of how your claim was processed . You can refer to this statement for more details on our payment decisions.

Have Questions?
Contact Sun Life by:
• Phone at 1-800-361-6212, Monday to Friday from 8 a.m. to 8 p.m. ET,
• live chat on mysunlife.ca, or
• sending a message by signing into mysunlife.ca.

You can also reach the Pension and Benefits Office by:
• Phone at 1-800-619-7301 ext 233, or
• email at pension [at] presbyterian [dot] ca

Update your Sun Life Group Beneficiary Online

Naming a beneficiary for your group life insurance just got easier! Sun Life has launched an online digital beneficiary platform, enabling members of the group insurance plan to review and make changes to their beneficiary with the click of the mouse. Members of the group insurance plan should complete the following steps:

1. Log in to mySunLife.ca to review your current group insurance beneficiary

2. Make any updates to your beneficiary information by following the on-screen instructions. You can also watch the instructional video below to over the process.

3. Review this information on a regular basis to sure that it is kept up-to-date

Flexibility for Health and Dental Coverage until June 30, 2021
Giving You the Care You Need: Changes to make it easier

We know you may not have access to your regular health-care providers right now. We’ll keep paying health claims up to June 30, 2021, that would normally require:
• additional documentation
• signatures
• referrals
• laboratory information, where we previously had this information on file and it has expired.

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

To make things easier for you, we’re accepting copies of forms. You can print the form, sign it and then submit a photograph of that document. You don’t need to mail us the original. You can send us the forms through the my Sun Life mobile app. You also have the option to send forms to us by mail or fax. It’s a small step that will help you get the continuity of care you need. Please take care and stay healthy!

Is your drug exception form expiring?
Starting in April, we’ll send a letter to you if you have a drug exception on file that is about to expire. The letter will explain the next steps to continue coverage for your drug exception.

Questions? We’re here to help.
Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.

Sleep Apnea: News About Claims

If you or one of your dependents has sleep apnea, please read this update.

Starting January 1, 2021, we’ll no longer reimburse for CPAP machines in cases of mild obstructive sleep apnea.

We’ll continue to reimburse Continuous Positive Airway Pressure (CPAP) machines for moderate and severe diagnoses.

The Canadian Agency for Drugs and Technologies in Health (CADTH) recommends lifestyle changes for mild obstructive sleep apnea, rather than CPAP machines.

CADTH defines mild sleep apnea as an Apnea-Hypopnea Index (AHI) of under 15.

Reminder: If you live in Ontario, Manitoba or Saskatchewan, your provincial health plan helps with costs.

If you have moderate to severe obstructive sleep apnea, apply to the province for funding before purchasing a CPAP. Once you have provincial approval for funding, you can buy your CPAP and send your claim to Sun Life.

Questions? We’re here to help.
Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.

A New Way to Submit Digital Extended Health Care Claims
We’ve made it easier for you to submit receipts and other supporting documents for your claims on mysunlife.ca. We’ve aligned our website with our mobile offerings. So you’ll have more ways to send us your claims information digitally.
Now you can:
• Attach receipts and other supporting documents while completing the medical claims submission process
• Attach additional documents to recently completed claims. This includes: – referrals – proof of payment
• Submit estimates and drug forms
• Submit documents requested by our Client Care Centre (CCC) To get started, login to mysunlife.ca. Then follow these steps to send us your documents:
1. Click Submit a claim
2. Go to Claims, found on the main navigation bar at the top of the page
3. Click on Submit documents
4. Select the type of document(s) you’d like to complete and follow the instructions to complete your submission

What type of medical expense can I submit online?
You can claim medical expenses and services online, for the providers listed below. Just access the medical e-claims web page. Your plan may not cover all expenses listed.

Providers
• Acupuncturist • Athletic therapist • Audiologist • Chiropodist • Chiropractor • Christian Science practitioner • Clinical counsellor • Dietitian (registered) • Electrologist • Homeopath • Kinesiologist • Marriage and family therapist • Massage therapist • Medical doctor • Naturopath • Nurse • Occupational therapist • Osteopath • Physical rehabilitation therapist • Physiotherapist • Podiatrist • Podologist • Psychiatrist • Psychologist • Psychotherapist • Shiatsu specialist • Social worker • Speech therapist Institutions • Ambulance • Diabetic supplies • Doctor’s services • Health care products and supplies • Hearing aid and supplies • Hospitalization • Laboratory / diagnostic services • Medical equipment • Nursing home • Orthopaedic supplies • Prosthesis

Questions? Please call Sun Life’s Client Care Centre at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.

Mass Contract Amendment – Nurse Practitioners

We’re pleased to announce that we’re updating your Extended Health Care (EHC) benefit effective, December 1, 2020. Where provincial law allows, we’ll clarify that nurse practitioners (NPs) can prescribe certain supplies and services.

Why we’re making this change We want to help you and your dependents get access to the care you need, when you need it.

Some examples of what a nurse practitioner (NP) can prescribe include certain paramedical services and medical equipment.

New contract wording
We’re adding this wording to the General description of coverage in the EHC section of your benefits plan:
Reference to Doctor may also include a nurse practitioner – If the applicable provincial legislation permits nurse practitioners to prescribe or order certain supplies or services, Sun Life will reimburse those eligible services or supplies prescribed or ordered by a nurse practitioner the same way as if they were prescribed or ordered by a doctor. For drugs, refer to Other health professionals allowed to prescribe drugs.

For ease of reference, the Other health professionals allowed to prescribe drugs is as follows:
Sun Life will reimburse certain drugs prescribed by other qualified health professionals the same way as if the drugs were prescribed by a doctor or a dentist if the applicable provincial legislation permits them to prescribe those drugs.

Your benefit plan already includes this term.

Questions? We’re here to help. Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.

Update: Changes to Sun Life’s dental claims practices

Earlier this year you may have read about Sun Life’s new dental administrative practices for desensitization services and certain exams. These new practices were going to be effective May 24, 2020. Due to COVID-19, Sun Life will be making these updates effective October 4, 2020.

Recall examination vs. emergency/specific examination
A recall examination (exam) occurs when you return to your dental provider for your regular appointment and you receive a cleaning and an exam. A recall exam is different from an emergency or specific exam.

An emergency exam occurs separately from a recall appointment when:
• your dental provider is required to check your pain points or discomfort, and/or
• an infection in a localized area requires immediate treatment.

A specific exam also occurs separately from a recall appointment. We pay for both emergency and specific exams but not as recall exams.

Desensitization with a routine hygiene appointment
During a hygiene appointment, your dental provider might apply a varnish to reduce sensitivity. There’s no needle involved. We don’t consider this eligible for an additional fee when claimed with scaling or root planing. We’ll decline the fee for desensitization if performed in conjunction with these services.

Understanding your claims
Your claim statement will include an explanation of how we processed your claim. You can refer to this statement for more details on our payment decisions.

Questions? We’re here to help.
Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET

New Access to Insurance Coverage Information

As a plan member with optional insurance benefits, you will now be able to see your coverage details on mysunlife.ca.
This includes:
● Basic and Optional Life
● Critical Illness (CI) and Optional CI
● Accidental Death & Dismemberment, if administered by Sun Life.

The link to this information is on the my Coverage page. As a plan member, you can access this page by clicking on Coverage information on the mysunlife.ca home page.
The details highlighted are:
● Policy name, number and effective date
● Current coverage amount
● Benefits you do not have but may be eligible for

As a plan member, you can also access coverage calculators and videos. These tools will provide you with health and wellness information.

FREQUENTLY ASKED QUESTIONS (FAQ)

Update for EHC and OOC coverage during the COVID-19 outbreak, Sun Life will be treating Coronavirus (recently named COVID-19) as any other medical emergency. Meaning, there is no exclusion to treating someone because this is a pandemic vs. another type of medical emergency.

In addition, we will be applying the following administrative exception to OOC claims incurred on or after February 1, 2020 related to the Coronavirus, subject to all limitations in the contract.

1. For plan members travelling outside of Canada who are placed under quarantine under medical orders (i.e. by a medical doctor or public health official) we are considering them eligible under our OOC and Emergency travel assistance benefit from the onset of the quarantine period. We will waive the medical orders requirement for this illness only, if the plan member is travelling in an area that has been identified by the World Health Organization (WHO) as a high risk for COVID-19.

If included in the plan, we will cover expenses for accommodations, meals, and replacement of a lost return ticket back to their home province caused by the delay, subject to any limitations in the contract.

NOTE: The limitation in the contract for meals and accommodation expenses is that we will pay a maximum of $150 per day, up to 7 days per covered person, for meals and accommodation.

2. If plan members travelling in an area that is identified by WHO as high risk, are not permitted to return home to Canada because public health officials have placed the area in quarantine due to COVID-19, we will cover these expenses:
a. accommodations and meals,
b. replacement of a lost return ticket back to their home province caused by the delay.

These expenses must be included in the plan, and are subject to any limitations in the contract, including maximums and the plan’s travel period.

NOTE: The limitation in the contract for meals and accommodation expenses is that we will pay a maximum of $150 per day, up to 7 days per covered person, for meals and accommodation.

Question:
Sun Life indicates that they will “waive the medical orders requirement for this illness only”. What does that mean?
Answer:
For our Out-of-Country (OOC) coverage under Extended Health Care (EHC) the “medical order requirement” means that in order for medical expenses to be covered, the member must meet the definition of “medical emergency” under the contract. We define “medical emergency” as an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor. Plan members ordered into quarantine or lock-down who are not showing symptoms of COVID-19 would not to meet the definition of “medical emergency”.

Question:
When should a member call Allianz?
Answer: 
If a member is travelling and has symptoms of an illness, whether it is COVID-19 or not, they should call Allianz using the numbers on their Travel Card.

Question:
How do I get my travel medical card?
Answer:
You can access your card in the following ways:
• From your desktop computer:
1. Sign in to mysunlife.ca
2.Under Benefits, click Coverage information
3.Under the ‘Take me to’ menu selection, choose Print travel card and click Print

• From your smartphone:
1. Download the my Sun Life mobile app
2. From the Benefits menu, choose Coverage card. Note: Your travel card will be available on your phone ‒ you don’t need to print it.
3. You can save both your coverage and travel cards to the Wallet section of your iPhone for quick and easy access, even when you’re offline.

If you have any questions, please contact Sun Life at 1-866-881-0583, Monday to Friday between 8 a.m. and 8 p.m., Eastern time.
Allianz has posted information on their corporate website about COVID-19 and coverage limitations.

Question:
Does this information apply to Sun Life plans?
Answer:
Members should refer to Sun Life information sources (such as member benefits booklet, mysunlife.ca or mobile app) to verify the coverage they have under their Sun Life plan. Allianz call centre associates have Sun Life specific scripting for plan members who call the numbers on their SLF Travel Card. Any information located on the Allianz website is not in reference to Sun Life products.

Question:
The government of Canada Travel Advisory (Travel Health Notices) recommends avoiding non-essential or all travel to my destination. Am I still covered for OOC medical emergencies and emergency travel assistance if I travel to a place where there is a travel warning?
Answer:
Our standard out-of-country emergency travel assistance covers members regardless of destination or level of risk. We strongly urge members to heed the advice of the government of Canada for travel advisories, however we do not exclude coverage in such situations. It is important to note that resources in these countries in time of pandemics can become extremely limited. These events are beyond the control of Allianz and Sun Life, but Allianz will do its utmost to assist plan members if they have a medical emergency.

Question:
What happens if I am stranded in a country, on a cruise ship that is locked down, or put in quarantine due to COVID19, and will exceed the trip duration limit
on their coverage?
Answer:
In this specific situation, your OOC coverage would continue beyond the trip duration limit in the contract, until the lock-down or quarantine has ended (as long as the event began before the trip duration limit expired). If you did need emergency medical care for any reason, you would have it until their emergency has ceased.

Question:
I had to cancel my trip because of COVID19. Does my group EHC plan cover it?
Answer:
Not under EHC. The standard OOC coverage under EHC does not include trip cancellation and interruption insurance. The member should refer to any other travel insurance they may have purchased before travelling.

Question:
Will my EHC plan pay for a COVID-19 testing?
Answer:
If a member wishes to have a COVID-19 test performed on an elective basis our EHC coverage will not reimburse this expense. However, we will
continue to cover any medically necessary expenses incurred while travelling outside Canada, in order to manage the medical emergency, as per the terms of
the contract.

Question:
Can I buy a larger supply of my medication, or get a refill of my medication early, in case I am quarantined?
Answer:
At this time, there are no changes to how much or how often you can buy your medication. You can check with your pharmacy to see if they offer a delivery service. Most pharmacies can quickly deliver prescriptions straight to your home.

Question:
Does Sun Life cover the cost of face masks or hand sanitizer?
Answer:
At this time there have been no changes to your coverage due to the Coronavirus threat. We have reviewed the coverage details and these items are not covered.

Question:
If I am quarantined while I am on my trip and miss my flight home, will my plan cover accommodation / a new ticket?
Answer:
We’ll treat illness related to Coronavirus like any other medical emergency. This means there is no exclusion due to this being a pandemic vs. another type of medical emergency.

Question:
What do I do if I need food and water and I am not allowed to leave my house…will my plan cover that?
Answer:
At this time there have been no changes to your coverage due to the Coronavirus threat. These items are not covered.


Refer to your employee booklet for all the limitations identified in the contract.

Changes to Sun Life’s dental claims practices

Effective May 24, 2020, Sun Life is updating its dental administrative practices for desensitization services and certain exams.
Recall examination vs. emergency/specific examination
A recall examination (exam) occurs when you return to your dental provider for your regular appointment and you receive a cleaning and an exam by your dentist. If your dentist submits a specific or emergency exam with recall services, it is still considered a recall exam. The office should bill you for a recall exam, not a specific exam.

Sun Life considers an exam to be an emergency when:
◆ it occurs separately from a recall appointment, and
◆ your dentist is required to check your pain points or discomfort, and/or
◆ an infection in a localized area requires immediate treatment.

A specific exam is an exam that’s requested by a patient, to address issues outside of an emergency or recall exam.

Desensitization with a routine hygiene appointment
If a tooth is sensitive during or after deep scaling or root planning, your dental provider might put a chemical on the tooth. The provider usually applies desensitization as a varnish. There is no needle involved, so Sun Life considers this desensitization as part of the fee for your cleaning.
These rules apply to services performed by a general dentist or dental hygienist.

Understanding your claims
Your claim statement will include an explanation of how we processed your claim. You can refer to this statement to better understand payment decisions.

Please speak with your dentist if you have questions about their services.

Health-care Service Provider Delisting

When Sun Life delists health-care service providers, clinics, facilities or medical suppliers (referred to as the “provider” below), we no longer process or pay for claims for services or supplies obtained from that provider. These providers are placed on a Sun Life “delisted providers” list.

Delisted provider update
Our list has been updated. To view the newly delisted providers, you must log in to your own password protected web page through mysunlife.ca and select the message for delisted providers.

We encourage you to check the list periodically so that you don’t unknowingly use a delisted provider, which would result in your claim being declined.

Why delisting a provider is necessary
It’s important that only eligible claims are processed and paid. It allows us to better protect you, your employer and your group benefits plan.

Questions?
Please contact the Client Care Centre at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.

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