Claims

• If you are looking for detailed information on types of extended health benefits, click here.
• If you are looking for detailed information on dental claims, click here.

Making Benefits Claims

For most UBC Extended Health and UBC Dental expenses, there are two ways you can submit a claim: online or by mail.

Whichever UBC employee group you belong to, most Sun Life vision care, paramedical, dental claims and prescription drug claims that have not been submitted by pay-direct drug card can be made online through the Sun Life Members website. For some procedures (e.g. claims where the original receipts are required), you will need to submit a paper claim.  If you make an online claim, you will not have to send in your receipts, but you must keep all receipts on file in case of audit. Sun Life audits one in eight claims, and all claims over $700.

Not all claims are submitted through the paper process or through the Sun Life Members website. When you use your pay-direct drug card for prescription drugs, the pharmacy may submit on your behalf and you are only required to pay what the plan does not cover at the point of purchase. Some dental claims are also treated in the way (depending on the way your dentist handles claims).

If you are looking for information about UBC Life Insurance claims, click here.

For information about UBC Income Replacement Plan/Disability Benefit Plan (Long-term Disability) claims, click here.

To file a claim under the Retirement and Survivor Benefits Plan, click here.

How to submit an Extended Health or Dental claim online

1. Login to the Sun Life Members website using your Access ID and password. If you don’t have an Access ID, contact Sun Life at 1-800-361-6212 to sign up.
2. Select “my claims”.
3. Submit an e-claim or paper claim, depending on your expense.

Filing online is a greener, more efficient way to process your claim, and in most cases, you will receive payment sooner.

How to submit an Extended Health or Dental claim by mail

1. Download an Extended Health or Dental Care claims form by visiting the Forms section of the UBC Benefits website
2. Complete the form by typing directly into the highlighted fields OR by printing a hard copy of the form. Remember to sign your claim form and attach your receipts.
3. Mail your completed claim form and receipts to the address indicated on the form.

Reimbursement for Extended Health or Dental Claims

There are two ways to receive payment for your extended health or dental expenses: by direct bank deposit or by mailed cheque.

In most cases, direct deposit ensures that you receive your payment sooner than if a cheque is mailed to you through Canada Post. To sign up for direct deposit:

1. Login to the Sun Life Members website using your Access ID and password. If you don’t have an Access ID, contact Sun Life at 1-800-361-6212 to sign up.
2. Select “my claims”.
3. In the right navigation menu, select “Direct deposit” and follow the instructions.

In general, you can expect the following processing times for payment, once Sun Life receives your claim:

Type of Claim	Processing Time
Extended Health paper claims	95% are processed within seven calendar days
Dental paper claims	95% are processed within seven calendar days
Dental e-claims	100% are processed within seven calendar days
Vision care e-claims	0 days. These claims are processed online and reimbursements are direct deposited within 24 to 48 hours.
Dental pre-authorizations	94% are processed within seven calendar days

Details on Extended Health Claims

Prescription Drugs

When you purchase prescription drugs from a pharmacy, use your Sun Life pay-direct drug card and the pharmacy will charge you only for the amounts not covered by the plan. When you pay this way, you won’t need to submit a paper claim to Sun Life for reimbursement.

If you don’t have your pay-direct card with you, or you have not yet received the card (Sun Life will mail your card(s) to your home address within approximately three to four weeks from the date you submit your enrolment forms), pay the full price for your prescription, and use an Extended Health Claim form to submit a paper claim to Sun Life, along with your receipts.  Another option is to submit your claim online through the Sun Life Members website.

To avoid any surprises around reimbursement, contact Sun Life Financial at 1-800-661-7334 to check that the prescription drugs are covered by your benefits plan. You must provide the UBC group number (25205) and your certificate number (seven-digit UBC employee number) when calling Sun Life. You may also be asked to provide the Drug Identification Number (DIN), which can be found on your prescription receipt or by contacting your pharmacy. 

Vision Care

Pay first, then make a claim to Sun Life. To be reimbursed, you can either submit a paper claim using an Extended Health Claim form to Sun Life, or online through the Sun Life Members website.

Emergency Medical Claims – Out-of-Province/Country

If you must seek emergency medical care while outside of BC, you, or someone with you, must call Europ Assistance’s 24-hour operations centre (in Canada and USA, call 1-800-511-4610, elsewhere call collect 202-296-7493) before receiving medical care, and if necessary, Europ Assistance will guarantee or advance payment for the medical care.

All invasive or investigative procedures (such as surgery, angiogram, MRIs) must be pre-approved by Worldwide Assistance, except in extreme circumstances.

If pre-approved payment was not advanced to the medical service provider on your behalf and you incurred the cost of your care, submit a paper claim using an Extended Health Claim form to Sun Life; Sun Life will coordinate your claim with MSP and any other insurers. Please note that it is strongly suggested that you submit your claim within 30 days of your return home. For full information on emergency out-of-province care, please visit our Travel benefits section.

Heath Care Spending Account (Management & Professional and IUOE 882 staff only)

The UBC Health Spending Account (HSA) is a benefit for staff in the UBC Management & Professional and IUOE 882 employee groups that enhances extended health and dental care coverage presently offered through the UBC Benefits plan.  The HSA provides an annual credit that can be used to pay for a variety of expenses. For full more information about the HSA, what is eligible and how to make claims, visit the HSA information page.

Clinical Psychologist, Social Worker and Massage Therapist

To be reimbursed for these services, you must have a doctor’s referral (renewed every 12 months if necessary). Attach your doctor’s referral to your Extended Health Claim form. A clinical psychologist must also be licensed AND registered to practice in the province where psychological services are being obtained.

Custom-Made Orthopaedic Shoes and Custom-Made Orthotics

A detailed lab invoice issued to the provider of the service (i.e. the person dispensing the shoes or orthotics to you) by the manufacturer of the custom-made shoes and/or orthotics must be submitted with the claim.   This invoice should include an itemized breakdown of the raw materials used, their cost and any other associated costs incurred to manufacture the custom-made shoes or orthotics. If the costs relate to shoe modifications, the details and cost of each modification must be present.

Medical Services and Equipment (over $5,000)

Before purchasing any medical services and equipment over $5,000, send an Extended Health Claim form to Sun Life, detailing the service or equipment you plan to purchase. Sun Life will then send you a Claim Statement that will lay explain what part of the cost will be covered by the Sun Life plan, how much of the cost is your responsibility.

 

Details on Dental Claims

Generally, Dental Claims are submitted directly to Sun Life by your dentist, who will then charge you only the costs not covered by the plan.

However, your dentist may request that you submit your own claims. In this case, pay your dentist first and then make a claim, either by mailing a Dental Claim form to Sun Life, or by making an e-claim through the Sun Life members website.

Dental Claims for Dependents

Each time your dependents receive dental care, you (as the plan member) will have to authorize the claims. Print a copy of the Dental Claim form, sign Section 6 and give it to the dentist. If you forget your form, your dentist can mail you a Standard Dental Form for your signature, but this may result in delaying your dental claim.

Dental Care Preauthorizations or Orthodontic Treatment Plans (over $500)

Dental care procedure(s) in excess of $500, and all orthodontic work, require a preauthorization to Sun Life before you have the treatment done.

Your dentist should send a preauthorization to Sun Life on your behalf using a Dental Claim form, detailing the dental procedure(s) or orthodontic treatment plan.

Preauthorizations should include supporting information to illustrate the services that are being recommended. This information may take the form of x-rays, models, molds, etc. If your dentist does not provide the information with your preauthorization, it will be declined until the information has been received and reviewed by Sun Life. Sun Life may also request further information from your dentist as part of their review process.

Once the review process is complete, Sun Life will send you a Claims Statement that will lay out what part of the cost is covered by the plan, and what is your responsibility.

Failure to submit a preauthorization will result in delays in receiving reimbursement. If a preauthorization is not sent to Sun Life prior to commencement of treatment, you are responsible for what the plan does not cover.

Heath Care Spending Account (Management & Professional and IUOE 882 staff only)

The UBC Health Spending Account (HSA) is a benefit for staff in the UBC Management & Professional and IUOE 882 employee groups that enhances extended health and dental care coverage presently offered through the UBC Benefits plan.  The HSA provides an annual credit that can be used to pay for a variety of expenses. For full more information about the HSA, what is eligible and how to make claims, visit the HSA information page.

Need Help?

If you have questions about filing your claim, call Sun Life at 1-800-361-6212 or submit a secure message via the Sun Life Members website. For faster service, have your Access ID and password handy.

If you have general questions about your benefits, contact UBC Benefits.