Introduction:
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.

New Address for Sunlife Claims

IMPORTANT BENEFITS UPDATE - RE ORTHOTICS: OCTOBER 1, 2010: New requirements when submitting claims for orthotics and orthopaedic shoes

News Release : September, 2006

Warning: Sunlife Benefits - Prescription Reimbursement

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 Jeff Arbus (Union Co-Chair), Paddy Musson, Donna Mese, and Debbie Rautins. 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 Shirley McVittie, a
Benefits Officer at OPSEU head office (416 443-8888, Ext. 8657). She can answer your questions and assist you in
applications and appeals.

WARNING --  Sunlife Benefits - Prescription Reimbursement -- WARNING

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.

I t 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.