Sun Life Personal Health Plan

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This is not a contract. Actual terms and conditions are detailed in the policy issued upon application approval.

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If you have questions please call us at 1-800-474-4474 or email us at inquiries@healthquotes.ca

Table of Contents (you can click on any coloured text to go to that section)

- GENERAL INFORMATION

- Details you need to know

- Eligibility

- Applying as a couple/family

- Dependants

- Annual and lifetime maximums

- Pregnancy

- Emergency travel medical

- Medical history

- Is a medical required to qualify for insurance?

- When do benefits begin and when are customers eligible to claim?

- How are benefits paid?

- Are premiums tax deductible?

- Are premiums guaranteed?

- How do you receive your policy?

- HEALTH CARE PLANS

- Plan Descriptions Table

- OPTIONAL COVERAGE

- Semi-Private Hospital Room
- Dental

GENERAL INFORMATION

Details you need to know

Eligibility

• Anyone who is 69 years of age or less, is a resident of Canada, and is covered under the provincial
health plan in their province of residence.

Applying as a couple/family

• If you are applying as a couple or family then you must choose the same plan and options for everyone.

Dependants

• Dependants must be under the age of 21 or under the age of 25 if they are in school full-time.

Annual and lifetime maximums

• All annual or lifetime maximums are per person. Annual maximums are based on a calendar year and
any unused portion may not be carried forward for use in subsequent years.

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Pregnancy

        • If you make your application during your first 20 weeks of pregnancy, you're eligible to apply for
           semi-private hospital coverage. The covered length of hospital stay will be limited to 2 days.
           When the baby is born, simply contact Sun Life Financial within 30 days of the birth and the baby
           can be added to your plan for a small, additional premium.

Emergency travel medical

• Emergency travel medical coverage contains a 9-month pre-existing conditions clause. Your policy
provides details about this clause.

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Medical history

• Based on the medical history of you or your family, coverage may be declined, modified or given
a higher premium.

Is a medical required to qualify for insurance?

• Applicants are asked a number of health questions on the application form. The need for additional
medical evidence will depend on these answers.

When do benefits begin and when are customers eligible to claim?

• Benefits begin: once approved; once any waiting periods have been satisfied; when coverage is established.
Coverage effective date is not limited to the first day of the month with Sun Life.

How are benefits paid?

• With Sun Life's pay direct drug card, the portion covered by the plan is paid automatically when the
card is presented to the pharmacist.

• Pay direct drug cards are not available for Quebec residents under the age of 65. However all claims
can be filled easily using Sun Life Financial claim forms.

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Are premiums tax deductible?

• Yes, Sun Life's Personal Health Insurance offers both coverage and the possiblility of saving valuable tax
dollars.

• To confirm eligibility you should contact your tax advisor or accountant.

Are premiums guaranteed?

• Yes, premiums are guaranteed for one year from the policy's effective date.

How do you receive your policy?

• Sun Life will mail you a welcome kit directly. This kit includes your policy, pay direct drug card and other
valuable information.

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	Basic plan	Standard plan	Enhanced plan
HEALTH CARE PLANS	Most economical plan for basic coverage.	Coverage for the same health expenses as Basic but at higher levels. Also with vision and emergency travel medical coverage.	The broadest and most generous level of coverage, including orthodontic and restorative dental coverage.
Reimbursement Summaries	Basic plan	Standard plan	Enhanced plan
Prescription drugs	Pay direct drug card (except Quebec) 60% reimbursement No deductible $5 dispensing fee cap $750 max/yr Includes smoking cessation drugs ($250 lifetime max) Excludes fertility drug and contraceptives	Pay direct drug card (except Quebec) 70% reimbursement on the first $7,000 of eligible expenses, 100% on the next $93,000 No deductible $5 dispensing fee cap $100,000max/yr Includes smoking cessation drugs ($250 lifetime max) Excludes fertility drug and contraceptives	Pay direct drug card (except Quebec) 80% reimbursement on the first $5,000 of eligible expenses, 100% on the next $95,000 No deductible $5 dispensing fee cap $100,000 max/yr Includes smoking cessation drugs ($250 lifetime max) Includes oral contraceptives Excludes fertility drugs
Preventative dental	3-month waiting period 60% reimbursement $500/yr max	OPTIONAL 3-month waiting period 70% reimbursement $750/yr max	OPTIONAL 3-month waiting period 80% reimbursement $750/yr max
Restorative dental	Not available	Not available	One year waiting period 50% reimbursement $500/year max
Orthodontics	Not available	Not available	2-year waiting period 60% reimbursement $,1500/lifetime max
Supplemental health care	60% reimbursement No deductible Alternative treatments: $25 maximum per visit $250/yr per practitioner Hearing aids $400/5 yrs Accidental dental $2000/year Licensed ground ambulance Emergency air ambulance Medical equipment and in-home nursing $2500/yr combined max $20,000 combined lifetime max	75% reimbursement No deductible Alternative treatments: $25 maximum per visit $300/yr per practitioner Hearing aids $400/5 yrs Accidental dental $2000/year Licensed ground ambulance Emergency air ambulance Medical equipment and in-home nursing $2500/yr combined max $20,000 combined lifetime max	75% reimbursement No deductible Alternative treatments: $25 maximum per visit $400/yr per practitioner Hearing aids $400/5 yrs Accidental dental $2000/year Licensed ground ambulance Emergency air ambulance Medical equipment and in-home nursing $10,000/yr combined max $30,000 combined lifetime max
Vision - Prescription eyeglasses, contact lenses, prescription sunglasses, and laser eye surgery.	No coverage	100% reimbursement 1-year waiting period $150 maximum every 2 years Eye exams up to $50 included in benefit maximum	100% reimbursement 1-year waiting period $150 maximum every 2 years Eye exams up to $50 included in benefit maximum
Emergency travel	No coverage	100% reimbursement 1st 60 days of trip $1 million lifetime max 9-month pre-existing condition clause Out of Country / Out of Province coverage	100% reimbursement 1st 60 days of trip $1 million lifetime max 9-month pre-existing condition clause Out of Country / Out of Province coverage
Optional benefit Semi-private hospital room	75% reimbursement $175/day 120 days/year	75% reimbursement $175/day 120 days/year	75% reimbursement $175/day 120 days/year
Other services?	Best Doctor's services	Best Doctor's services	Best Doctor's services

Semi-Private Hospital
• optional benefit
• 75% reimbursement
• up to $175 daily
• up to 125 days per year

Dental
• dental coverage is now optional for Standard and Enhanced plans
• white fillings for all teeth now included

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