Claims

Extended Health Claims

To make a claim on your RSB Extended Health coverage, complete a Sun Life claim form. Forms are available:

• on the Sun Life members website. By downloading the form and using your access ID and password, your personal information and contract number is automatically filled out on the form.
• from Jennifer Mitchell at 604.822.4580
• for download here.

Extended Health claim forms have to be submitted by mail directly to the nearest Sun Life claims office (address on page 2 of the claim form), since they must include original receipts for your medical expenses. Remember to keep a copy of the completed claim form and receipts for your records.

How to submit an Extended Health or Dental claim online

1. Login to the Sun Life Members website using your Access ID. If you don’t have an Access ID, click on “Register now” at www.mysunlife.ca or 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.

Emergency Medical Claims: Out-of-Province/Country

You, or someone with you, must call Europ Assistance’s 24-hour operations centre (In Canada and USA, call 1.800.511.4610; in Mexico, call 001.800.368.7878 and elsewhere call collect 202.296.7493) before receiving medical care, and if necessary, they will guarantee or advance payment for the medical care.

All invasive or investigative procedures (like surgery, angiogram, MRIs, etc) must be pre-approved by Europ Assistance, except in extreme circumstances.

If the pre-approved payment was not advanced to the medical service provider on your behalf and you incurred the cost of your care, submit your claim on paper using an Extended Health Claim form to Sun Life; Sun Life will coordinate your claim with the Medical Services Plan and any other insurers. Please note that it is strongly suggested that you submit your claim within 30 days of your return home.

Clinical psychologist 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.

Medical services and equipment (over $3,000)

Before making your purchase, ask for a pre-determination from Sun Life by sending an Extended Health Claim form detailing the service or equipment you plan to purchase. Sun Life will then send you a Claim Statement which will lay out what part of the cost is covered by the plan, and what is your responsibility.

Dental claims

For Dental Claims, your dentist will generally use a Standard Dental Claim form that can be submitted on your behalf electronically to Sun Life. However, your dentist may give you the claim form and request that you submit your own claims. In this case, make the claim by either mailing the dental claim form to Sun Life, or by making an e-claim through the Sun Life members website. It is between you and your dentist as to whether you just pay your portion of the dental bill or the whole amount initially.

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 Claim form for your signature, but this may result in delaying your dental claim.

Dental care preauthorizations (over $500)

Dental care procedures in excess of $500 require a preauthorization to be sent to Sun Life by your dentist prior to you having the treatment done.

Your dentist should send a preauthorization to SunLife on your behalf using a dental claim form, detailing the dental procedure(s).

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 which will lay out what part of the cost is covered by the plan, and what is your responsibility. This way, you’ll know how much you will need to pay before the work is done, and you won’t be surprised by having to pay for an expensive treatment you thought was covered under the plan, but isn’t.

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

How long will it take?

The time it takes for you to receive payment for your extended health or dental expenses will depend partly on the postal system and partly on the method of payment you’ve chosen. Direct deposit will mean that you get your reimbursement in your hands sooner than waiting for a cheque to arrive at your home through the mail.

If you opt for direct deposit, Sun Life will not send you a Claims Statement/Explanation of Benefits, but this information is available to you by logging on to the Sun Life members site.

Once your claim reaches the Sun Life office, the turn-around times for claims are:

• Extended Health Care claims – 95% are processed within 7 calendar days.
• Dental Care paper claims – 95% are processed within 7 calendar days.
• Dental Care electronic claims – 100% are processed within 7 calendar days.
• Dental Care preauthorizations – 94% are processed within 7 calendar days.

If you have questions or concerns about your claims, contact Sun Life’s Customer Care Centre at 1-800-661-7334.