Your Medical Coverage

Plan Options:

Standard

Enhanced

Eligible expense limits

 

 

Lifetime maximum

$100,000

$250,000 for all benefits other than Emergency Medical Care OOP/OOC (out of province/out of country) + Travel Assistance, which is covered up to $1 million.

Drugs

 

 

Maximum for prescription drugs*

$1,000

$2,000

Dispensing fees*

Full, up to a reasonable and customary limit

Full, up to a reasonable and customary limit

Drugs co-insurance*

80%

80%

Drugs covered

Costs of drugs or supplies that are prescribed in writing by a dentist or physician and are obtained from a pharmacist are covered

Costs of drugs or supplies that are prescribed in writing by a dentist or physician and are obtained from a pharmacist are covered

Vision care

 

 

Vision

80% co-insurance, maximum $150 every two years.
Includes: contacts lenses, eye glasses or laser eye surgery.

80% co-insurance, maximum $200 every two years.
Includes: contacts lenses, eye glasses or laser eye surgery.

Eye examination

Not covered

Up to $30 for optometrist fees every 2 plan years

Paramedical services

 

 

Paramedical services

$300 per practitioner, up to a maximum of $500 for all services combined.
Includes: physiotherapist, chiropractor+, osteopath+, podiatrist+, naturopath, chiropodist+, registered massage therapist, & speech therapist.
+ 1 x-ray per visit

$300 per practitioner, up to a maximum of $650 for all services combined.
Includes: physiotherapist, chiropractor+, osteopath+, podiatrist+, naturopath, chiropodist+, registered massage therapist, & speech therapist.
+ 1 x-ray per visit

Psychologist

$60 per visit, maximum seven visits per plan year

$60 per visit, maximum ten visits per plan year

Semi-private hospital (in Canada)

 

 

Semi-private hospital

80% during the first 30 days, 50% of the balance to a maximum of $5,000

80% during the first 30 days, 50% of the balance to a maximum of $10,000

Convalescent hospital

$20 per day, for a maximum of 180 days. Not custodial.

$20 per day, for a maximum of 180 days. Not custodial.

Medical services and equipment

 

 

Ambulance (in Canada)

Unlimited ground ambulance

Unlimited ground ambulance.
Air ambulance to a maximum of $5,000 per instance

Private duty nursing

$5,000 ($25,000 lifetime maximum)

$5,000 ($25,000 lifetime maximum)

Accidental dental

$5,000 lifetime maximum

$5,000 lifetime maximum

Hearing aids

$350 every five plan years

$500 every five plan years

Orthopedic shoes & supplies

Orthopedic shoes & orthopedic alterations & orthotics maximum $200 (prescription required)

Orthopedic shoes & orthopedic alterations & orthotics maximum $200 (prescription required)

Medical services & equipment (maximum per plan year)

$2,500 per insured person per plan year for all expenses listed in this category:

  • Diagnostic services: Reasonable and customary
  • Casts, splints, trusses, braces or crutches: $300
  • Wigs following chemotherapy: $350 lifetime maximum
  • Breast prosthesis: $200
  • Other: Reasonable and customary and up to plan maximums for artificial limbs and eyes; stockings; surgical brassieres; intraocular lenses following cataract surgery; stump socks; radiotherapy or coagulotherapy; oxygen, plasma and blood transfusion.

$5,000 per insured person per plan year for all expenses listed in this category:

  • Diagnostic services: Reasonable and customary
  • Casts, splints, trusses, braces or crutches: $500
  • Wigs following chemotherapy: $500 lifetime maximum
  • Breast prosthesis: $200
  • Other: Reasonable and customary and up to plan maximums for artificial limbs and eyes; stockings; surgical brassieres; intraocular lenses following cataract surgery; stump socks; radiotherapy or coagulotherapy; oxygen, plasma and blood transfusion.

Durable equipment

$2,500 per insured per plan year
Wheelchair: $4,000 lifetime maximum
(with some restrictions) Hospital beds: $1,500 per lifetime

$2,500 per insured per plan year
Wheelchair: $4,000 lifetime maximum 
(with some restrictions) Hospital beds: $1,500 per lifetime

Emergency out-of-province/country

 

 

Emergency out-of-province/ country

Not covered

Emergency medical expenses covered during the first 60 days of travel if the insured is under age 80, and subject to a six-month pre-existing medical** condition limitation.
If you have a pre-existing medical condition that existed during the six months prior to your trip, expenses related to this condition may not be covered.

Dental care

 

 

Dental coverage

Not covered

80%, diagnostic and preventative dental procedures (oral examination, oral hygiene instructions, fluoride treatment, scaling and polishing) 50%, Basic dental procedures (filling, removal of teeth, oral surgery, minor restoration, endodontics and periodontics) Maximum of $750 in the first plan year of coverage, maximum of $1,000 per plan year in subsequent years.

 

 

 

* This plan is second payer to any government - sponsored drug plan. In Quebec, this plan will be second payor to comply with RAMQ legislation.

** A pre-existing medical condition is an injury, illness, disease or symptoms which appeared, worsened or required medical attention, hospitalization or changes in treatment (including changes in medication or dosage) within the 6 months before travelling outside of your province of residence. Sun Life Financial may require medical evidence, from the attending physician, indicating that the insured person's medical condition was stable during the 6-month period before the insured person travelled outside of the province where the insured person resides. "Stable" means that a recurrence or worsening of the existing medical condition or any problems related to that condition was not expected while the insured person travelled outside the province of residence. Stability will not be affected by dosage changes to the following drugs: statins, warfarin, coumadin, insulin, and thyroxine. If the insured person start or stop these medications, it would be considered a change in medication that would affect their stability. If blood pressure medication changes, a 3-month stability period is required. If the insured person start or stop these medications, it would be considered a change in medication that would affect their stability and revert back to the 6-month stability requirement.

Coverage is subject to certain exclusions and limitations which are described in the individual policy issued to plan members. To be eligible for this plan, insured members must be insured under their provincial health care plan.