Medical and prescription drug

The Extended Health Care plan generally covers:

• Hospital Care: A semi-private room is covered 100%.
• Convalescent Care: A semi-private room is covered at a maximum plan payment of $20 per day, up to 180 days.
• Paramedical services: Up to $1,000 for physical health and $1,000 for mental health per person per benefit year. Covered mental health practitioners include clincial counselors, psychotherapists, marriage and family therapists, licensed psychologists and social workers. X-rays are limited to a combined maximum of $20 per benefit year.
• Prescription drugs: Prescriptions written by a physician or dentist and dispensed by a licensed pharmacist or physician legally authorized to dispense medications. Prescribed smoking cessation aids are covered up to a lifetime maximum benefit of $500 per person.
• Vision: Eye exams every two benefit years; glasses, contacts and laser eye correction surgery every 24 months.
• Equipment and supplies: Ileostomy, colostomy, incontinence supplies, oxygen, medicated dressings, burn garments and more.
• Ambulance transport: Medically necessary transport to the nearest hospital.

The plan covers most prescription and medical expenses at 80%. See the chart below for vision coverage.

Medical and paramedical services

You’ll pay upfront and submit a claim to Sun Life for reimbursement:

• Health Claim Form (English)
• Health Claim Form (French)

Prescriptions

You'll pay your portion of the covered cost of the medication out of pocket. Present your Pay Direct Drug card at the pharmacy. The maximum dispensing fee covered by the plan is $10 per prescription. If your share of prescription expenses reaches the maximum of $2,000, the plan will pay 100% of your remaining eligible prescription costs for the remainder of the year. The out-of-pocket maximum applies to each covered plan member.

Brand vs. generic

Generic drugs have the same active ingredient as their brand name counterpart, but generally cost less. The plan covers prescription drugs up to the lowest priced equivalent, which are usually generic drugs.

If you’re prescribed a brand name drug that has a lower cost equivalent, you’ll only be reimbursed up to cost of the lowest-priced drug — even if your doctor writes “no substitution” on the prescription.

If there is a valid medical reason for not substituting your brand name drug with a lowest priced equivalent, you and your doctor will need to complete the Drug Exception Application Form. If your application is accepted by Sun Life, the plan will cover the cost of the brand name drug.

Specialty drugs

If you take specialty drugs, the Sun Life Preferred Pharmacy Network (PPN) provides reduced pricing for eligible medications with more than 2,500 specialty pharmacies across Canada (excluding Quebec).

Find a PPN pharmacy near you. If you need help or have questions, view the Preferred Pharmacy FAQs or contact Sun Life.

Prior authorization

Some medications need to be pre-approved to be covered by the plan. This is called prior authorization and helps keep your coverage affordable. Biologics and certain drugs used to treat conditions like asthma, multiple sclerosis, cancer and hepatitis require prior authorization.

Visit Sun Life with group contract number 150328 to view which medications require prior authorization and download the necessary forms for your doctor to complete.

For more information, view the Prior Authorization FAQs.

After you meet the deductible, the plan pays for either glasses, contacts or laser eye correction surgery per person.

The plan covers 100% of costs for medical emergency services during the first 60 days of temporary travel outside of your province of residence or outside of Canada. These services are subject to a lifetime maximum of $3,000,000 per person.

Learn more about your emergency medical coverage in English or French.

If you get non-emergency care while traveling out of your province of residence or outside of Canada, the plan will cover 80% of eligible expenses.