Sun Life Benefits
Sun Life is the carrier for our Benefit Plans (including the Extended Health, Dental, Vision, and Hearing Care). Should you be denied coverage for any of the claims you submit, you should appeal the decision through Sun Life’s appeal process and through the Joint Insurance Committee (JIC). However, before appealing, please consult with the union office for advice on other means to reverse the decision. Often, it is simply a matter of providing more thorough/exact feedback about your claim.
You can access detailed information on your claims records at the Plan Member Services page of the Sun Life web site.
Addresses for Submitting Sun Life Claims
Sun Life now prefers to receive all claims online. Log in to your member account at https://www.sunlife.ca/
Postal mail address:
Sun Life Assurance Company of Canada
PO Box 2010 STN Waterloo
Courier shipment address:
Sun Life Assurance Company of Canada
Digital Mail Services 300C21
227 King Street South
IMPORTANT BENEFITS UPDATE – RE ORTHOTICS: OCTOBER 1, 2010: New requirements when submitting claims for orthotics and orthopaedic shoes
NOTE Regarding Vaccinations
Your doctor may recommend that you or your children obtain certain vaccinations, for travel purposes, or against various illnesses such as meningitis and herpes. Not all vaccinations are reimbursed under the plan. Be sure to check with Sun Life FIRST before going ahead with an expensive vaccine that you may not receive reimbursement for. The pharmacist does not always have up to date information on what is covered under the plan either, so for any significant expense, check with Sun Life first.
Joint Insurance Committee (JIC)
The Joint Insurance Committee (JIC) facilitates communication between the College Council and OPSEU on the subject of group insurance for CAAT-A employees, including Basic Life Insurance, Supplementary Life Insurance, Dependent Life Insurance, Extended Health Insurance, Long-Term Disability Insurance (LTD), the Dental Plan, and any other negotiated benefits that may be included in the group insurance plan (Appendix IV).
The committee is composed of four management representatives appointed by the colleges and four from OPSEU, elected at the biennial OPSEU CAAT-A Divisional meeting.
One of the important functions of this committee is to review the unresolved claims of members. If you feel that your claim for medical reimbursement, LTD, or some other benefit has been unjustly refused, please forward it to this committee.
The four OPSEU CAAT-A members of the JIC are Frank Turco (Union Co-Chair), Heather Giardine-Tuck, Liz Seabrook, and Audrey Taves. They (and your Local 560 officers) can answer your questions about various aspects of our insurance plan and advise you on matters such as applying for LTD or appealing denials of your claims for medical, dental or other benefits.
If you have exhausted all other sources of information, another very helpful individual is Kim MacPherson, a Benefits Officer at OPSEU head office (416 443-8888, Ext. 5564). She can answer your questions and assist you in applications and appeals.
NOTE — Sun Life Benefits – Prescription Reimbursement
Unless your doctor specifies in your prescription that there shall be no substitution for a “brand name drug”, you will receive reimbursement only for 85% of the cost of the “generic” form of that drug. Should you elect to take home the brand name, without this specification, you will have to pay the difference in cost between the brand and generic prescription, in addition to paying the 15% cost not covered by the plan.
It is not that our drug plan per se requires the issuance of generics as a substitute for brand drugs; rather it is provincial law governing pharmaceuticals that requires that substitution. Our plan has a built-in compliance with the law.