RSB Coverage

 

The Retirement & Survivor Benefits (RSB) Program includes three benefit plans:

You can choose to enrol in one or more of these plans. Each plan is described below.

Extended Health

The RSB Extended Health Plan provides coverage for some medical services and supplies that are not covered under provincial medical plans, such as BC’s Medical Services Plan (MSP).

To enroll in the RSB Extended Health Care Plan, you must be enrolled in a provincial health-care plan.

What is the annual deductible?

You pay an annual deductible of $1,000.

What is the lifetime coverage limit?

The maximum lifetime amount that you will be reimbursed is $200,000 per person enrolled in your benefit plan.

Reimbursement level for eligible expenses

After you have paid your deductible for the benefit year, you will be reimbursed at the following levels up to your lifetime maximum:

* After you have paid your annual deductible, you will be reimbursed for 80% of the cost of the eligible expenses of each person enrolled in your plan until that person has reached $1,000 in reimbursable expenses for prescription drugs, paramedical services, medical services and equipment, and in-province hospital costs combined. After this, you will then be reimbursed for 100% of that person’s eligible expenses for the remainder of the benefit year.

Please review your specific coverage in the Sun Life Benefits Handbook.

Prescription drugs

To ensure your prescription drug costs are covered, please confirm that you are registered with Fair PharmaCare. Learn more about Fair PharmaCare.

What the plan covers

You will be reimbursed for 80% of the costs of eligible prescription drugs that are prescribed by a physician or dentist and are obtained from a pharmacist. You can fill a three-month supply of eligible drugs at a time.

Sun Life will cover the cost of prescription drugs up to the cost of the lowest-priced generic equivalent; unless your doctor specifies in writing that no substitution for the prescribed drug may be made.

What the plan does not cover

The plan does not cover all drugs or medicines, even when they are prescribed. Some examples of what is not covered include over-the-counter drugs, preventive drugs and vaccinations, the cost of giving injections, vitamins, natural health products, treatments for weight loss if not medically necessary, hair growth stimulants, oral contraceptives, products to help you quit smoking or erectile dysfunction or fertility drugs.

You can review your specific coverage in the Sun Life Benefits Handbook.

Prior Authorization Program

Effective April 1, 2017, Sun Life is adding the prior authorization program to Extended Health benefits plans 2 and 3

What is it?

Prior authorization requires that coverage for certain drug therapies be pre-approved based on certain criteria. Sun Life is committed to continued group drug plan sustainability and plan member drug choice. The prior authorization program’s aim is to focus on monitoring claims for speciality drugs or treatments and ensure that plan members are getting reimbursement for the right drugs when needed.

How does it work?

If the drug your doctor prescribes for you needs prior authorization, send Sun Life a completed prior authorization form before filling your prescription. Sun Life will review your request, usually within five business days, and let you know in writing if you are approved and the duration of your approval period. You can also visit mysunlife.ca/priorauthorization and enter your group Contract Number: 020605 for a list of included drugs and forms.

Adding prior authorization to your group benefits plan will help keep drug plan costs down, making extended health care more affordable for plan members into the future.

Any questions? Contact Sun Life directly at 1-800-361-6212.

Download the Sun Life pamphlet

Paramedical services

What the plan covers

You will be reimbursed for 80% of the costs of services of some paramedical practitioners. There is a maximum annual cost specified for each discipline.

The practitioners covered under the plan are:

  • licensed psychologist, when ordered by a doctor ($100 for each person per benefit year);
  • licensed speech therapist, acupuncturist, podiatrist or chiropodist ($100 for each person per benefit year);
  • licensed physiotherapist (no doctor’s referral required) or massage therapist (doctor’s referral required), up to a maximum of $250 for each person per benefit year;
  • licensed naturopath or chiropractor ($200 for each person per benefit year).

If you are receiving services from a licensed psychologist or massage therapist, you must obtain a doctor’s referral for these services every 12 months.

Paramedical practitioner qualifications

The cost of paramedical services will only be covered if the paramedical practitioner meets specific qualifications/designations for their profession and they are licensed/registered with an appropriate regulatory body or society where the service is received (in Canada or the United States only). For example, in British Columbia, you will only be reimbursed for the cost of the services provided by a Naturopath with an N.D. (Doctor of Naturopathic Medicine) designation and who is licensed/registered with the College of Naturopathic Physicians of British Columbia.

Click here for a complete list of the acceptable qualifications/designations and regulatory bodies and societies for all paramedical practitioners in British Columbia.

Reasonable and customary charges

Medical services providers and suppliers charge a range of fees for certain services, including paramedical services.

Sun Life will determine “reasonable and customary” charges as the basis for reimbursing your paramedical claims, which are also subject to the reimbursement level and maximum amounts specified under the Extended Health Plan. Sun Life outlines the reasonable and customary charges by paramedical practitioners in each province in the Reasonable & Customary Charges for Paramedical Services document. If your practitioner charges more than this, you are responsible for this additional cost.

What the plan does not cover

The plan does not cover the services of religious or spiritual healers; occupational therapists; psychologist testing; or services of a kinotherapist, reflexologist, sexologist, sex therapist or shiatsu specialist.

You can review your specific coverage in the Sun Life Benefits Handbook.

Medical services and equipment

What the plan covers

You will be reimbursed for 80% of the costs of a wide variety of medical services and equipment when ordered by a doctor or dentist.

The plan covers services that include:

  • private duty nursing care in hospital if medically necessary,
  • transportation in a licensed ambulance or air ambulance,
  • accidental dental services,
  • equipment recommended for therapeutic use, such as wheelchairs, insulin pumps, blood transfusions and dialysis machines.

If the cost of these services is more than $5,000, you must receive pre-authorization from Sun Life. Other services and equipment also require pre-authorization from Sun Life, no matter the cost. Please see your Sun Life Benefits Handbook for details.

What the plan does not cover

The cost of some services and equipment is not covered under the plan, even when a doctor prescribes them. These include experimental treatments, personal comfort items, services and supplies for cosmetic purposes, or the services of a licensed practical nurse.

In-province hospital

What the plan covers

You will be reimbursed for 80% of the cost difference between a room on a general hospital ward (covered by MSP) and a semi-private or private hospital room.

What the plan does not cover

The plan does not cover:

  • hospital outpatient fees for out-of-province emergency claims,
  • care in a nursing home, hospice or rest home,
  • care in an alcohol or drug abuse treatment centre, even if it is located in a hospital,
  • user fees, and
  • costs associated with public ward accommodation or rest cures.

Emergency out-of-province and out-of-country medical care

What the plan covers

You will be reimbursed for 100% of the costs of out-of-province emergency doctor and hospital services obtained within 90 days of the date you leave your home province. An emergency is an acute, unexpected condition, illness, disease or injury that requires immediate assistance.

If you or a dependent are hospitalized during this period, the cost of in-patient hospital services is covered for 90 days. This 90-day limit will be extended if transporting the patient back home would be a risk to their life.

Some of the emergency expenses covered in this category include:

  • a semi-private hospital room,
  • other hospital services provided outside of Canada,
  • out-patient services in a hospital, and
  • the services of a doctor.

If you or a dependent are hospitalized while travelling outside of BC, the cost of in-patient hospital services is covered for 90 days. This 90-day limit will be extended if transporting the patient back home would be a risk to their life.

In addition to emergency doctor and hospital services, emergency expenses for all other services or supplies eligible under this plan are also covered outside of BC as if you had incurred the expense in BC. For example, emergency prescription drug expenses will be reimbursed as if you had made the drug purchase in BC.

You are also covered for other emergency travel assistance services through Medi-Passport, which is provided by Sun Life’s travel benefit provider, Allianz Global Assistance. These services include:

  • referrals to physicians, pharmacists and medical facilities,
  • transportation home or to a different medical facility,
  • travel expenses if stranded by a medical emergency,
  • repatriation, and
  • assistance with lost luggage or documents.

What the plan does not cover

The plan does not cover the cost of emergency medical services:

  • obtained after 90 days have passed since you left BC,
  • for pre-existing conditions that require continuous or routine medical care while outside your home province, or
  • required for injury or illness resulting from hostile action of any armed forces or from participating in a riot.

Carry your card with you when you travel

We recommend that you carry your Medi-Passport card with you when you travel. It contains telephone numbers and the information needed to confirm your coverage and receive assistance.

To obtain your Medi-Passport card:

Learn more

To learn more about what to do if you need to seek medical assistance while travelling, how to submit claims and other information, please:

  • refer to Sun Life’s brochure, and
  • review the resources on this site under the Benefits While Travelling section, keeping in mind that the lifetime maximum coverage and length of travel time covered are different for active employees enrolled in the UBC Extended Health Plan and individuals enrolled in the RSB Program.

Dental

The RSB Dental Plan covers a wide range of dental services, from regular check-ups to major procedures such as root canals and crowns. These procedures may be provided by a licensed dentist, denturist, dental hygienist or anaesthetist.

For a complete description of your benefits coverage, please refer to your Sun Life Benefits Booklet.

  • Deductible: There is no deductible for this coverage.
  • Benefit year maximum: $1,500 per person per benefit year (January 1 to December 31) for all preventive, basic and major services combined.
  • Reimbursement level for eligible expenses: You will be reimbursed at the following levels up to your benefit year maximum:
  • Preventive procedures: 70%
  • Basic procedures: 70%
  • Major procedures: 50%

Your reimbursement will be based on these percentage levels, your benefit year maximum and the fee stated in the BC Dental Association Fee Guide that is current at the time of the treatment.

You need to obtain preauthorization from Sun Life for all dental procedures that cost more than $500.

If your Dental benefit ends, you will still be covered for procedures to repair natural teeth damaged in an accident if the accident occurred while you were covered, and the procedure is performed within six months after the date of the accident.

Preventive procedures

You will be reimbursed for 70% of the cost of preventive procedures performed by a dentist to help you maintain good dental health. These include:

  • complete oral examinations,
  • x-rays,
  • teeth polishing and fluoride treatments,
  • diagnostic models, and
  • removal of impacted teeth

Basic procedures

You will be reimbursed for 70% of the cost of procedures to treat basic dental problems. These include:

  • fillings,
  • tooth extractions,
  • basic restorations such as temporary stainless steel crowns (permanent crowns are covered under major procedures),
  • root canals, and
  • periodontics and oral surgery.

Major procedures

You will be reimbursed for 50% of the costs of major procedures. These include:

  • permanent crowns,
  • inlays or onlays, and
  • prosthodontics such as bridges or dentures

Dental care pre-authorizations (over $500)

You must receive preauthorization from Sun Life before you receive treatment for any dental procedure(s) that cost more than $500.

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

Your dentist should include supporting information, such as x-rays or pictures of models or molds, to illustrate the services that are being recommended. If your dentist does not provide this information with the form, 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.

When Sun Life is deciding to pay for a dental procedure, they will investigate if there is a viable alternate treatment. If the alternate procedure will result in an equivalent level of success, then Sun Life will pay the amount for the least expensive alternate procedure.

It’s your responsibility to request a preauthorization in advance of receiving dental treatment in order to know what the Dental plan will cover and how much you will be expected to pay out of pocket. If you obtain dental services without a preauthorization, you are responsible for what the plan does not cover and in the case of major dental work this could be a significant and unexpected amount.

What the Dental Plan does not cover

Your Dental Plan does not cover:

  • procedures primarily to improve appearance
  • replacing lost or stolen dental appliances
  • charges for completing forms
  • supplies intended for sport or home use
  • experimental treatments

Making a claim

Dental claims can be submitted electronically to Sun Life. It is up to you and your dentist as to whether you initially pay your portion of the dental bill or the entire amount. You will be reimbursed based on the percentage coverage levels, your benefit year maximum and the fee stated in the BC Dental Association Fee Guide that is current at the time of the treatment.

Employee and Family Assistance Program

The Employee and Family Assistance Program (EFAP) provides confidential, self-referred counselling or other assistance to you or your family members. RSB members have the same access to EFAP services as active UBC employees. Learn more about EFAP’s extensive counselling services and resources.