Dental Benefits

Claims Requiring Pre-approvals

Prior Authorization Program (Extended health plan)

For medical services and equipment in excess of $5,000, a pre-authorization is required. Please refer to page 18 of the Policy Booklet (2017 edition).

Prior authorization requires that coverage for certain drug therapies be pre-approved based on certain criteria. For full details, refer to page 14-15 of the Policy Booklet (2017 edition).

You can also read about prior authorization on our website:

  1. Go to hr.ubc.ca/rsb.
  2. Scroll to find the header, “About RSB”.
  3. Click on “Extended Health”.
  4. Scroll to find “Reimbursement level for eligible expenses”.
  5. Click on “Prior Authorization Program”.

Predetermination (Dental)

Before you receive treatment for any dental procedure(s) that costs more than $500, we recommend that you receive a predetermination from Sun Life. For full details, refer to page 32 of the Policy Booklet (2017 edition).

You can also access this information on our website:

  1. Go to hr.ubc.ca/rsb.
  2. Scroll to find the header “About RSB”.
  3. Click on “Dental”.
  4. Scroll to find “Dental care predetermination (over $500)”.

In our winter 2019 edition of Viewpoints, we will expand on these two topics. Look for the article in December.

Frequently Asked RSB Questions

Frequently Asked RSB Questions

In this issue, we address two frequently asked questions that we receive from RSB plan members: how to request a copy of your medical and dental history online, and how to update your plan information.

FAQ: How do I request a copy of my medical and dental claims history?

Your first instinct may be to call Sun Life (1-800-361-6212), but did you know that you can easily and conveniently access your information online 24/7?

Here’s how you can access your claims history:

  1. Login to mysunlife.ca.
  2. Scroll down until you see “Completed claims”.
  3. Click on “All claims”.

 

  1. Select the relevant dates, and then click “Continue”.


FAQ: I need to update my RSB plan information. How do I do this?

Contact the RSB Administrator (julia.carandang@ubc.ca) to do the following:

Update your contact details:

  • Provide your new address, phone number and email

Change the bank account where your RSB premiums are withdrawn from:

  • Send a void cheque, as well as a note indicating the effective date, to the address below:

Attn: RSB Administrator
600 – 6190 Agronomy Road
Vancouver, BC Canada V6T 1Z3

2019 Sun Life Rates

2019 Sun Life Rates

Each year, the Sun Life Extended Health and Dental Care plans are reviewed with UBC’s Benefits Consultants to determine the appropriate premium rates to support claim costs expected for the upcoming year.

The following tables outline the required adjustments to the Extended Health and Dental Care plan premium rates, effective Jan. 1, 2019. The renewal rates are based on analyzing 12 months of past claims experience (Jul. 1, 2017 – Jun. 30, 2018) while incorporating ongoing inflation.

Dental Plan Current 2018 Monthly Rates New 2019 Monthly Rates
Effective Jan. 1, 2019
Adjustment
Single $45.81 $49.08 + 7.14%
Couple $91.91 $98.16 + 6.80%
Family $136.26 $145.80 + 7.00%
Extended Health Plan Current 2018 Monthly Rates New 2019 Monthly Rates
Effective Jan. 1, 2019
Adjustment
Plan 1 (LTM* $15,000)
Single $60.19 $51.16 – 15.00%
Couple $120.40 $102.32 – 15.02%
Family $120.40 $102.32 – 15.02%
Plan 2 (LTM* $50,000)
Single  $92.48 $103.94 + 12.39%
Couple $186.81 $207.88 + 11.28%
Family $186.81 $207.88 + 11.28%
Plan 3 (LTM* $200,000)
Single $63.75 $65.66 + 3.00%
Couple $127.53 $131.32 + 2.97%
Family $127.53 $131.32 + 2.97%

* LTM – Lifetime Maximum

2018 Reminders

Submit Your Extended Health Claims

Any extended health medical claims incurred in 2017 must be received by Sun Life by Dec. 31, 2018.

To submit your claim online:

To mail a paper claim form:

  1. Fill out a paper claim form by:
  1. Attach the relevant original receipts. Keep copies for your records.
  2. Mail your completed claim forms and original receipts to:

Sun Life
PO Box 2010 Stn Waterloo
Waterloo, ON N2J 0A6

Allianz Out-of-Country Claim Form

If you are enrolled in the Extended Health Plan and require emergency medical care while travelling outside BC, you or someone with you must call Allianz Global Assistance before receiving medical care. As Sun Life’s travel benefits provider, Allianz will guarantee or advance payment for eligible medical care. You can contact Allianz in the following ways:

  • In Canada & the US: 1-800-511-4610
  • All Other Countries: 1-519-514-0351
  • Documents Fax Line: 1-519-514-0374

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

Submitting claims for emergency medical expenses:

If you are submitting an emergency medi­cal claim (i.e. for services and supplies while in hospital, or for outpatient and physician’s services incurred outside of BC or Canada), Allianz will coordinate payment of your claim with the Medical Services Plan, the UBC plan and any other plans you have coverage with.

For more details, including payor information and the option to purchase additional travel coverage to protect your lifetime maximum, please visit the RSB website or refer to your Policy Booklet.

How to submit a claim:

  1. Within 30 days of your return home, complete the Allianz Emergency Medical Expense Claim Form.
  2. Attach original receipts and make a copy of the entire claim for your records.
  3. Mail your claim form to the appropriate address indicated on the form.

Submitting claims for non-emergency medical expenses:

How to submit a claim:

  1. To ensure you are properly reimbursed, keep all receipts and always obtain a fully itemized bill for any hospital treatment.
  2. Complete an Extended Health Claim Form within 30 days of your return home and submit it to Sun Life. In section 3, indicate your claim is for out-of-Canada expenses.
  3. Attach original receipts and make a copy of the entire claim for your records.
  4. Mail your claim form to the appropriate address indicated on the form.

Submitting claims for non-emergency dental expenses outside of BC/Canada:

To submit a non-emergency dental claim:

  1. Complete a Dental Claim Form and submit it to Sun Life when you return home.

To submit a dental claim as a result of an accident:

  1. Complete an Allianz Emergency Medical Expense Claim Form within 30 days of your return home.
  2. Attach original receipts and make a copy of the entire claim for your records.
  3. Send the documents to the address listed on the form.

Frequently Asked Questions

Where can I find detailed information regarding my Sun Life extended health and dental benefits?

Where can I find the Sun Life extended health claim forms?

I lost my Sun Life pay-direct card. How do I find my benefits information?

  • First, note your RSB policy number (020605) and Sun Life Member ID (your 7-digit UBC employee ID OR 9-digit Social Insurance Number.)
  • Next, use your policy and member ID details to sign in the Sun Life website, where you can access your benefits information and download your new card.
  • You can also check your RSB enrolment confirmation letter for benefits information.
  • Contact Julia Carandang to obtain a new card.

Why was my extended health/dental claim denied?

  • UBC does not have access to your personal medical/dental usage and claim history. You will need to contact Sun Life directly at 1-800-661-7334 or at 1-800-361-6212.

I tried to submit a claim using policy number 025205, which is what I used as an employee in UBC, but I have been informed that my benefits have been terminated. What do I do?

  • Check that your policy number is 020605. Your Sun Life Member ID will be the same as when you were an active employee.
  • Refer to your RSB confirmation letter for a details related to your benefits.
  • Inform your medical providers of the changes to your benefits information.

Sun Life Delisted Service Providers

Sun Life regularly updates their list of delisted service providers. This means that certain medical and dental providers/services are not allowed to process claims through Sun Life.

This also means that Sun Life will not reimburse any claims from the providers/services that are mentioned on this list. Sun Life deems this necessary to protect you and your plan, so that only eligible claims are processed.

You can view information regarding the delisted service providers when you sign into your Sun Life account. You may also contact Sun Life directly at 1-800-361-6212 if you have any questions.

Demystifying Dental Fees and Claims

Understanding dental charges and claims doesn’t have to be like learning a foreign language. In this article, we demystify dentist fees and dental claims – all to help you become more informed.

What is the Dental Fee Guide?

The British Columbia Dental Association (BCDA) produces an annual fee guide for BC dentists, outlining over 1,400 dental codes, code descriptors and suggested fees that relate to specific elements of dental treatment. The document serves as a guide only: dentists are not required to follow the guide or any fee schedule.

Many dental plan providers base their coverage on the fees and codes within this guide. Sun Life, the RSB Program’s Dental Plan provider, reimburses for dental services based on the current year’s BCDA fee guide for general practitioners.

How do dentists determine their fees?

The cost of delivering high-quality dental care is based on the complexity of treatment for each patient, as well as the cost of the following factors:

  • Specialized equipment
  • Approved materials
  • Sterilization and safety protocols
  • Trained and licensed professional staff
  • External laboratory fees
  • Location of dental practice

What about fees for dental specialists?

Dental specialists receive additional training in a particular field of dentistry. When a high level of expertise is required, general practice dentists will refer patients to a specialist.

Specialized treatment can involve the use of special equipment, specific materials for treatment, additional staffing and ongoing education. All these factors are considered by specialists when determining treatment costs.

How can I be more informed?

  1. Talk to your dentist. Discuss all of your treatment options and the associated costs before proceeding. (Read on to learn what you need to do for recommended dental care procedures in excess of $500.)
  2. Ask if your dental office follows the BCDA fee guide. A dental office may bill some, or all, codes based on the suggested fee guide. The RSB Program’s Dental Plan reimburses based on the current year’s BCDA fee guide for general practitioners. If your dental office charges more than the guide, you’ll be responsible for the additional cost.If you receive dental services from a dental specialist, Sun Life reimburses based on the BCDA fee guide for general practitioners, plus 10%. You’re responsible for any amounts not covered by the UBC Dental Plan.
  3. Get a preauthorization for recommended dental work prior to receiving treatment. For dental care procedure(s) in excess of $500, you must receive a preauthorization from Sun Life before you obtain treatment. To begin the process:
  • Ask your dentist to complete the Dental Claim form, detailing the dental procedure(s). Your dentist can send this form to Sun Life for you by email or regular mail.
  • Your dentist should include supporting information (e.g. x-rays or pictures of models or molds) to illustrate the services that are being recommended. If your dentist doesn’t provide this information, your preauthorization for services will be declined until this information has been received and reviewed by Sun Life. Sun Life may also request further information from your dentist as part of its review process.
  • Once the review process is complete, Sun Life will send you a Claims Statement outlining what part of the cost is covered by the plan and what you will have to pay.

How do I make a dental claim?

Many dental offices will submit claims for your dental procedure(s) directly to Sun Life. You’ll need to provide your dentist with your UBC Group Number (020605) and your Member ID (seven-digit UBC employee number).

If your dentist does not submit claims on your behalf, you can submit a claim yourself using the Dental Claim form.

Resources:

2018 Sun Life Rates

2018 Sun Life Rates

Each year, the Sun Life Extended Health and Dental Care plans are reviewed with UBC’s Benefits Consultants to determine the appropriate premium rates to support claim costs expected for the upcoming year. Based on the review, it has been determined that there will be no change to the Extended Health and Dental Care plan premium rates for the 2018 calendar year.

The following tables outline no change to the Extended Health and Dental Care plan premium rates, effective January 1, 2018. The renewal rates are based on analyzing 12 months of past claims experience (July 1, 2016 – June 30, 2017) while incorporating ongoing inflation.

Dental Plan Current 2017 Monthly Rates New 2018 Monthly Rates
Effective Jan. 1, 2018
Adjustment
Single $45.81 $45.81 + 0%
Couple $91.91 $91.91 + 0%
Family $136.26 $136.26 + 0%
Extended Health Plan Current 2017 Monthly Rates New 2018 Monthly Rates
Effective Jan. 1, 2018
Adjustment
Plan 1 (LTM* $15,000)
Single $60.19 $60.19 + 0%
Couple $120.40 $120.40 + 0%
Family $120.40 $120.40 + 0%
Plan 2 (LTM* $50,000)
Single  $92.48 $92.48 + 0%
Couple $186.81 $186.81 + 0%
Family $186.81 $186.81 + 0%
Plan 3 (LTM* $200,000)
Single $63.75 $63.75 + 0%
Couple $127.53 $127.53 + 0%
Family $127.53 $127.53 + 0%

* LTM – Lifetime Maximum

Sun Life Rate Changes

Sun Life Rate Changes

Each year, the Sun Life Extended Health and Dental Care plans are reviewed with UBC’s Benefits
Consultants to determine the appropriate premium rates to support claim costs expected for
the upcoming year.

The following tables outline the required rate adjustments to the Extended Health and Dental
Care plans, effective January 1, 2017. The renewal rates are based on analyzing 12 months of
past claims experience (July 1, 2015 – June 30, 2016) while incorporating ongoing inflation.

Dental Plan Current 2016 Monthly Rates New 2017 Monthly Rates
Effective Jan. 1, 2017
Adjustment
Single $42.42 $45.81 + 8.0%
Couple $85.10 $91.91 + 8.0%
Family $126.17 $136.26 + 8.0%
Extended Health Plan Current 2016 Monthly Rates New 2017 Monthly Rates
Effective Jan. 1, 2017
Adjustment
Plan 1 (LTM* $15,000)
Single $51.89 $60.19 + 16.0%
Couple $103.79 $120.40 + 16.0%
Family $103.79 $120.40 + 16.0%
Plan 2 (LTM* $50,000)
Single $100.93 $92.48 – 8.5%
Couple $203.87 $186.81 – 8.5%
Family $203.87 $186.81 – 8.5%
Plan 3 (LTM* $200,000)
Single $70.02 $63.75 – 9.1%
Couple $140.07 $127.53 – 9.1%
Family $140.07 $127.53 – 9.1%

* LTM – Lifetime Maximum