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Benefits

Making a health or dental care claim

When should I submit my claims?

In most cases, you must submit claims within 18 months of incurring an expense.

For expenses incurred out-of-country, if you did not contact Alliance Global Assistance at the time of emergency, you must submit claims within 30 days of returning home

If your coverage ends, you have 90 days to submit any outstanding claims.

While it is recommended to submit most claims as quickly as possible, it is also helpful if you hold claims for medical expenses until they total $50 or more.

An eligible expense is deemed to be incurred on the date the service is received or on the date supplies are purchased or rented. For example, if you purchase and pay for new eyeglasses on December 15, but pick them up on January 7, the claim date is December 15.

Note: Some coverage has maximums per benefit year. The benefit year runs from January 1 to December 31 annually.  

What is considered “proof of a claim”?

Proof of claims includes:

  • itemized bills
  • prescription receipts
  • reports from doctors or hospitals
  • hospital records

For any claims that are not submitted in hard-copy or through your provider, be sure to keep your receipts. Sun Life will randomly audit claim submission online so please keep your original receipts and supporting documentation for 12 months. If your claim is chosen for audit, Sun Life will ask you to mail the original receipt before processing your claim.

Claims for multi-appointment procedures

Claims for multiple appointment procedures (other than orthodontic) are paid after the procedure is completed.

You may claim after any orthodontic procedure, whether or not it is part of a series, or after any non-orthodontic procedure that requires only a single appointment.

Registering for mysunlife.ca

By registering for mysunlife.ca you’ll be able to:

  • submit most claims for instant processing;
  • sign up for to have claim payments deposited into your bank account within 24-48 hours;
  • print an all-in-one coverage card for your wallet;
  • print your personalized Pay-Direct Drug card
  • send secure e-mail messages to Sun Life;
  • print personalized claim forms;
  • print your out-of-country medical emergency travel card;
  • and more.

Register online in three easy steps (PDF).

Be sure to keep your password private and secure to prevent fraudulent claim submissions.

If you experience any problems registering online or have any questions, please contact the Sun Life Customer Care Centre at 1-800-361-6212.

Five ways to submit claims

 

For claim submission, you'll need your Sun Life policy and certificate number. The policy number is 25180 and your certificate number is your Ryerson employee number.

Direct pay

Your paramedical service provider (e.g. physiotherapist, chiropractor) or dentist may submit your claim electronically to Sun Life for direct pay. If this is the case, you will not have to pay out-of-pocket, however it is important that you review the form for accuracy of the charges. 

Pay direct drug card

Accepted at pharmacies across Canada, your Sun Life Pay-Direct drug card is used for prescription drug claims for you and your eligible dependents. The card allows pharmacies to bill Sun Life directly, reducing unnecessary out-of-pocket expenses.

How do I receive my card?

Your drug card will be mailed to you upon your enrolment in the plan.

You can also print your card from mySunLife website:

  1. Sign in to mysunlife.ca
  2. Click “Take me to…” in the my health and wellbeing section of the website.
  3. Select “Print drug card”

You must use your drug card for every prescription drug purchase otherwise you may not be reimbursed the full amount you paid out-of-pocket.

If you do not receive your card within four weeks of enrolment, contact Pension and Benefits.

Note: The plan includes a mandatory generic substitution for all drugs. This means that if there is a generic drug available for your prescription, the pharmacy will automatically substitute the generic drug, unless the prescribing physician or health professional stipulates no substitution, in which case reimbursement will be based on the cost of the drugs prescribed.

If your physician requires no substitution, they must stipulate “no substitution” on the prescription. The pharmacist will dispense the brand name drug and you will not have to pay the difference between the brand name and the generic equivalent.

If there is no indication on your prescription from your physician stipulating “no substitution”, the pharmacist will substitute the generic version where available. In this case, if you choose to take the brand name and there is a generic equivalent, you will have to pay the difference between the two.

Online claim submission

Submit your paramedical (e.g. chiropractor, massage therapist), vision and dental claims online using the Sun Life password protected plan member services website. In most cases, your claim is processed immediately and you receive an online notice telling you whether the expense is covered and the details of your claim payment.

Step-by-step claim submission

  1. Login to the mysunlife.ca home page
  2. Select Submit a Claim under "Take me to..." or select the type of claim from "Claims" on the menu bar.
  3. You will be guided through the claim process in a few easy steps.

You can also access online e-tutorials that includes my Benefits Paid Fast, an e-claims module.

Sun Life mobile application

Submit paramedical, prescription drug and dental claims by downloading the free Sun Life app, my Sun life Mobile, on your smartphone. Sign in using your Sun Life access ID and password.

You'll need to pay providers upfront and Sun Life will reimburse eligible expenses to your bank account most often within 24-48 hours.

Hard copy claim submission

To access a pre-filled claim form that includes your contract number, member ID, date of birth, and address sign into mySunlife, select “my claims” and then “Print claim form".

You can download an empty Extended Health Care Claim Form (PDF) or Dental Claim (PDF).

To complete your claim form:

  1. Complete both sides of the claim form. The signature at the bottom of the claim form must be yours, whether the claim is for yourself or one of your dependents. The claim will not be paid if the claim form is not properly completed.
  2. Make a copy of your claim form and receipts for your records. Some medical expenses not reimbursed by the group insurance may be eligible for a tax credit when you file your income tax return.
  3. Mail the completed form with all receipts directly to Sun Life. The mailing address is on the back of the claim form.
  4. Sun Life will mail a reimbursement cheque, if appropriate, to your home address along with an explanation of how your eligibility for payment has been determined. You can also arrange direct deposit to your bank account by contacting Sun Life at 1-800-361-6212 or reviewing the information on updating coverage obtained through your employer on the Sun Life Banking information updates webpage.

If you have questions about your coverage or the status of submitted claims, or disagree with any claim settlement, please contact Sun Life at 1-800-361-6212 or visit the Sun Life customer support page for more support details.

Submitting drug claims for employees or dependents under 25

The program OHIP+ provides Ontario residents under the age of 25 with prescription drug coverage for all drugs currently covered under the Ontario Drug Benefit (ODB) program, which includes more than 4,400 drugs.

  • The complete list of drugs covered under OHIP+ can be found on the Ontario government's Formulary Search website.
  • In some cases, medications not covered under the ODB program can be can be covered under OHIP+ by applying to the Ontario government’s Exceptional Access Program.
  • Medications not covered under the OHIP+ program (including the Exceptional Access Program) are covered under the Ryerson drug plan in accordance with the current provisions.
Filling prescriptions for employees or dependents under 25
  1. When filling a prescription for yourself or a dependent under 25, present the individual’s health card to the pharmacist. If the prescription is covered under OHIP+, there will be no charge for the medication.
  2. If the prescription is not covered by OHIP+, present your Ryerson drug card. If the medication is covered under Ryerson’s plan, you can pay using your drug card.
  3. If the medication is one that may be covered under the Exceptional Access Program, Sun Life will then send you a letter with instructions to apply for the program. If the drug is approved for the Exceptional Access Program, future prescriptions for this medication will be covered by OHIP+. If declined, future prescriptions continue under Sun Life.

How do I submit claims if my spouse has coverage?

Ryerson's benefits have been designed so that benefits paid by all group plans combined will provide coverage up to the actual eligible expenses incurred. If you or any of your dependents have coverage under your spouse’s plan, review coordination of benefits for more information.

Questions

Contact Sun Life Customer Care Centre between 8 a.m. - 8 p.m., Monday to Friday (excluding holidays) at 1-800-361-6212. You will need to provide the Ryerson Health Plan number 25180 and your Sun Life certificate number which is the same as your Ryerson ID number.


Ryerson reserves the right, at any time, to amend, change or discontinue any benefit coverage. If there is a question about coverage referred to in any portion of this benefits communication, the master contract from the insurer is the governing document.