Making A Claim

This section describes how to submit a claim and be reimbursed for expenses associated with your UBC Extended Health and UBC Dental benefits plan.

These benefits are administered by Sun Life and your benefit numbers are in the orange box to your left. Be sure to inform your dental office of these details; you’ll also need this information when making claims and calling Sun Life.

You are generally required to pay for the health-care costs covered by these plans when you receive treatment or service. You will then submit a claim for these expenses and be reimbursed by Sun Life. However, in some cases, as described under Pay direct options, you do not need to pay all or the full cost of the prescription drug or service.

Learn more:

Pay direct options

There are some cases where your pharmacist or health-care provider will bill Sun Life directly. These include:

  • prescription drug claims (when you use your Sun Life pay-direct drug card);
  • most dental services, as your dentist can often submit the claim directly; and
  • claims for vision care and other health-care services if your provider is registered with the TELUS Health eClaims Network, in which case your health-care provider will submit the claim on your behalf.

Use your Sun Life pay-direct card for 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 your Extended Health plan. When you pay this way, you do not need to submit a claim to Sun Life for reimbursement.

The Sun Life pay-direct drug card is issued under the employee name only.  The name of your dependents will not appear on the card, however they can use your card if you have enrolled them as your dependent.

Please note that non-oral contraceptive devices cannot be purchased using the Sun Life pay-direct drug card. You will need to pay for these devices and then submit a claim to Sun Life.

If you do not have your Sun Life pay-direct card with you, have recently enrolled for benefits and have not yet received your card from Sun Life, or are making a claim for a non-oral contraceptive device, pay the full price for your prescription. You can then submit your claim to Sun Life.

Have your dentist or health-care provider to submit the claim on your behalf

In some cases, your health-care provider can submit the claim on your behalf. This includes claims for dental services, as well as for vision care and paramedical services if your provider is registered with the TELUS Health eClaims Network.

If your dentist or health-care provider submits the claim on your behalf directly to Sun Life, you will be reimbursed as follows, depending on your dentist or health-care provider:

  • You pay your dentist or health-care provider the full amount of the service and Sun Life will reimburse you for the amount covered by the Extended Health and/or Dental plan.
  • You pay your dentist/provider the amount not covered by the Extended Health and/or Dental plan and Sun Life will reimburse the dentist/provider for the balance.

Dental claims for dependents

Each time your dependents receive dental care, you (as the plan member) must authorize the claims by printing a copy of the Dental Claim form, signing Section 6 and giving the form 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 delays in getting reimbursed for your dental claim.

Pre-authorization for dental care services over $500 and all orthodontic treatment

If a dental procedure costs more than $500 or if you are planning any kind of orthodontic work, you must receive preauthorization from Sun Life before this work is done. Read more about what’s required in the Dental Benefits page.

To receive preauthorization for this work, ask your dentist to complete the Dental Claim form, detailing the dental procedure(s) or orthodontic treatment plan, and then have him or her to send this form to Sun Life for you.

Submitting a claim

If your pharmacy or health-care provider (pharmacist, dentist or other providers who are registered with the Telus Health eClaims Network) have not submitted the claim on your behalf, you can submit a claim by:

Submitting an Extended Health or Dental claim online

When you submit a claim online rather than by mail, you will be reimbursed faster. The table below shows the types of claims that can be submitted through mysunlife.ca or the Sun Life mobile app.

The Sun Life mobile app includes a photo submission feature for uploading receipts and doctor’s referrals, if required. This is why more claims can be submitted over the app compared to mysunlife.ca.

The following claims can be submitted online:

Expense mysunlife.ca Sun Life mobile app
Prescription drugs Y Y
Paramedical services:
Acupuncturist
Chiropodist
Chiropractor
Massage therapist*
Naturopath
Osteopath
Physiotherapist
Podiatrist
Psychologist
Audiologist
Clinical counsellor
Dietician
Homeopath
Occupational therapist
Social worker
Speech therapist
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Medical equipment/supplies and services:
Nurse
Ambulance
Diabetic Supplies
Medical Equipment and Supplies
Hearing Aid and Supplies
Hospitalization
Laboratory/Diagnostic Services
Custom-made Orthopaedic Shoes
Prosthesis
Y
Y
Y
Y
Y
Y
Y
Y
Y
Dental** Y Y

*Your first claim for massage cannot be submitted on mysunlife.ca because a doctor’s note must accompany the claim. Submit the first claim by using Sun Life’s mobile app (you can submit the note with their photo submission feature) or by paper. A doctor’s referral is required every 12 months.

** With the exception of claims for bridges, crowns, dentures, dental accidents and all dental work that requires preauthorization.

You do 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 online claims and audits all online claims over $700.

For some procedures, such as when original receipts are required, you will need to submit a paper claim.

To submit a claim online:

  • Sign in to mysunlife.ca 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.
  • Under “my health and well-being,” click “my claims.” If the header Submit a claim appears, you can submit a claim online.
  • Choose the appropriate claim type (e.g., paramedical, vision) and follow the steps to submit your claim.

Submitting an Extended Health or Dental claim by mail

  • Download an Extended Health or Dental claims form by visiting the Forms page.
  • Complete the form online by typing directly into the highlighted fields and printing the forms, OR by printing a hard copy of the form and filling it out by hand.
  • Sign your claim form and attach your original receipts.
  • Mail your completed claim form and receipts to the address indicated on the form.

Guidelines for submitting claims for other services

Custom-made orthopedic shoes and custom-made orthotics

You must submit a detailed lab invoice from the manufacturer of the custom-made shoes and/or orthotics to the provider of the service (i.e. the person dispensing the shoes or orthotics to you).

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 explain what part of the cost will be covered by the Sun Life plan and how much of the cost you will have to pay.

Submitting claims for out-of-province/country medical and dental care

Seeking emergency care outside of BC

Learn more about seeking medical or emergency care while you are travelling outside of BC and Canada.

If you require emergency medical care while outside of BC, you, or someone with you, must call Sun Life’s travel benefits provider, Allianz Global Assistance, before receiving medical care. If necessary, Allianz Global Assistance will guarantee or advance payment for your medical care.

In Canada and the US, you can reach Allianz Global Assistance’s 24-hour operations centre toll-free at 1-800-511-4610. Elsewhere, make a collect call to 202-296-7493.

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

Submitting claims for emergency medical expenses

If you are submitting claims for services and supplies while in hospital or for outpatient and physician’s services incurred outside of BC or Canada AND as a result of a medical emergency, Allianz Global Assistance will coordinate payment of your claim with the BC Medical Services Plan (MSP) (who is the first payor), the UBC plan (the second payor) and any other benefit plans you are covered by with Sun Life.

To ensure you are properly reimbursed, keep all receipts and always obtain a fully itemized bill for any hospital treatment.

To submit a claim:

  • Complete the Allianz Emergency Medical Expense Claim form within 30 days of your return home.
  • Attach original receipts and make a copy of the entire claim for your records.
  • Mail in your claim form to the appropriate address indicated on the form.

Note that there are some situations where it will be necessary for you to reimburse Sun Life. This includes any amounts that:

  • are paid for services or supplies that are not covered by your plan,
  • exceed the maximum amount of your coverage under your plan and
  • you are responsible for, such as deductibles and the percentage of expenses you must pay under your plan.

Submitting claims for non-emergency medical expenses

To ensure you are properly reimbursed, keep all receipts and always obtain a fully itemized bill for any hospital treatment.

To submit a claim:

  • Complete an Extended Health Claim Form to Sun Life within 30 days of your return home.
  • In section 3, indicate your claim is for out-of-Canada expenses.
  • Attach original receipts and make a copy of the entire claim for your records.
  • Mail in your claim form to the appropriate address indicated on the form.

Submitting claims for dental expenses

If you are have incurred out-of-pocket emergency and non-emergency dental expenses while travelling outside of BC or Canada, submit a dental care claim form to Sun Life when you return home.

If your claim was a result of a dental accident, complete the Allianz Emergency Medical Expense Claim form within 30 days of your return home. Attach original receipts and make a copy of the entire claim for your records and mail it to the appropriate address indicated on the form.

Coordinating benefit claims

If you are covered under another Extended Health and Dental benefit plan in addition to your coverage through the UBC plan (for example, through your spouse’s plan), you can submit expenses under both plans in order to maximize your reimbursement.

This is called coordinating your benefits and there are rules about the order in which claims are paid. Learn more about coordinating your benefit claims.

Getting reimbursed for Extended Health or Dental claims

There are two ways to be reimbursed for your extended health or dental expenses:

  • direct bank deposit or
  • 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. If you have not signed up for direct deposit, you will be reimbursed by cheque.

To sign up for direct deposit:

  • Login to mysunlife.ca 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.
  • Click “my coverage.”
  • Under “Take me to …” click “Direct deposit.”
  • Under “Review your banking information,” click “Update” and enter your updated banking information.

How long will it take to be reimbursed?

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

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

Health Spending Account claims

The UBC Health Spending Account is a benefit for some employee groups that covers expenses not covered by UBC’s Extended Health and Dental plans. You are eligible for this benefit if you are a member of the CUPE 2950, IUOE 882 or Management & Professional employee groups.

The HSA is an annual credit that can be used to pay for a variety of expenses. Learn more about the Health Spending Account, what expenses are eligible and how to make claims.

Claim deadlines

Extended Health claims: Dec. 31st of the calendar year following the year in which you incur the expense

Dental claims:  One year after the date in which you incur the expense

Health Spending Account claims: 90 days from the end of the calendar year in which you incur the expense

If you are leaving or retiring from the University, different claim deadlines will apply.  Refer to our Leaving UBC page for more details.

Need help?

If you have questions about filing your Extended Health or Dental claim, call Sun Life at 1-800-361-6212 or send a secure message via mysunlife.ca. For faster service, have your Access ID and password handy.

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