Overiew

Reimbursement: 100% 
Maximum: $2,000 per person per calendar year, generic drugs, includes pay-direct drug card

* Individuals whose drug costs are high relative to family income are encouraged to apply for coverage under the Special Support Program through the Government of Saskatchewan Drug Plan. You are encouraged to contact Saskatchewan Health Care Officials at 1-800-667-7581 for any assistance of the application process.

Covered Formulary Drugs

Sun Life will cover the cost of the following generic drugs and supplies that are prescribed by a doctor or dentist and are obtained from a pharmacist. Drugs covered under this plan must have a Drug Identification Number (DIN) in order to be eligible.

• Selected drugs and supplies that are therapeutically useful and cost effective, and listed on the Saskatchewan Drug Benefit Plan.
• Life-sustaining drugs that may not legally require a prescription.
• Intrauterine devices (IUDs) and diaphragms.
• Prescribed anti-smoking drugs, which legally require a prescription and are listed on the Saskatchewan Drug Benefit Plan, are limited to a lifetime maximum of $1,000

As mandatory generic substitution is a feature of your drug plan, the plan will only reimburse your prescription drugs up to the lowest priced (usually generic) equivalent, if one exists. Reimbursement for prescribed drugs will be made at the lowest priced interchangeable brand as listed in the Saskatchewan Drug Benefit List, even if “no substitution” is prescribed by the attending physician.

There may be valid medical reasons for not substituting your brand name drug with a lowest priced equivalent. If so, you and your doctor will need to complete a Drug Exception Application form. If the reasons are accepted by Sun Life, the plan will cover the cost of the brand name drug.

Sun Life will not pay for the following, even when prescribed:

• Infant formulas (milk and milk substitutes), minerals, proteins, vitamins and collagen treatments. 
• The cost of giving injections, serums and vaccines.
• Treatments for weight loss, including drugs, proteins and food or dietary supplements. 
• Hair growth stimulants.
• Drugs for the treatment of infertility.
• Drugs for the treatment of sexual dysfunction.
• Drugs that are used for cosmetic purposes.
• Natural health products, whether or not they have a Natural Product Number (NPN).
• Drugs and treatments, and services and supplies relating to the administration of the drug and treatment, administered in a hospital, on an in-patient or out-patient basis, or in a government-funded clinic or treatment facility

General Exclusions and Limitations

Sun Life will not pay for the cost of:

• Services or supplies payable or available (regardless of any waiting list) under any government sponsored plan or program unless explicitly listed as covered under this benefit.
• Services or supplies to the extent that their costs exceed the reasonable and usual rates in the locality where the services or supplies are provided.
• Equipment that Sun Life considers ineligible (examples of this equipment are orthopaedic mattresses, exercise equipment, air-conditioning or air-purifying equipment, whirlpools and humidifiers).
• Any services or supplies that are not usually provided to treat an illness, including experimental or investigational treatments. Experimental or investigational treatments mean treatments that are not approved by Health Canada or other government regulatory body for the general public.
• Services or supplies that do not qualify as medical expenses under the Income Tax Act (Canada).
• Services or supplies for which no charge would have been made in the absence of this coverage.

Sun Life will not pay benefits when the claim is for an illness resulting from:

• The hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
• Any work for which you were compensated that was not done for the employer who is providing this plan.
• Participation in a criminal offence

Reimbursement: 100% 
Maximum: $2,000 per calendar year (member only)

For each dental procedure, only reasonable expenses will be covered, up to the usual charge for the most economical alternate procedure, service or treatment consistent with accepted dental practice. See exclusions and limitations below.

Pre-Treatment Plan

If your dentist recommends any dental procedure that is expected to cost over $500, you should have your dentist complete a pre-treatment plan. Submit this plan to the insurer, and you will be advised of the benefits payable for the course of treatment.

Submitting a pre-treatment plan ensures that there are no misunderstandings about what reimbursement you will receive for expensive courses of treatment.

Fee Guide: The current fee guide for general practitioners approved by the Dental Association in the employee's province of residence.

Basic Services

Basic Services include the following Preventive dental procedures and Basic Procedures:

Preventive dental procedures

• complete exam once every 36 months
• recall exam once every five months, to a maximum of two exams per benefit year
• emergency or specific exams limited to two per benefit year per type of exam
• complete series of X-rays OR one panorex once every 36 months
• bitewing x-ray once every five months, to a maximum of two sets per benefit year
• radiograph to diagnose or examine progress
• required consultations with another dentist
• polishing/cleaning and topical fluoride treatment every five months, to a maximum of two per benefit year
• emergency or palliative services
• diagnostic tests and lab exams
• removal of impacted teeth and anaesthesia
• space maintainers for primary teeth
• pit and fissure sealants
• oral hygiene instruction once per benefit year

Basic procedures

• fillings:
  • amalgam (silver)
  • composite (white) on all teeth − acrylic (replaced by composite)
• removal of teeth (except impacted teeth)
• prefab metal restorations and repairs for existing crowns (not custom made)
• endodontics (root canal therapy/fillings, treat disease of pulp tissue)
• periodontics (treatment of bone and gum disease)
  • root planing and scaling (covered to a combined maximum of 2 units per year for children under age 13 or 10 units per year for adults and children over age 13)
  • occlusal adjustment
  • provisional splinting
  • supplies usually intended for sport use (eg. mouthguards)
  • transplants and repositioning of the jaw
• surgery and related anaesthesia (except removal of impacted teeth)
• repair of bridges or dentures
• rebase or reline denture

General Exclusions and Limitations

Sun Life will not pay for services or supplies payable or available (regardless of any waiting list) under any government-sponsored plan or program unless explicitly listed as covered under this benefit.

Sun Life will only pay for a procedure that has a reasonably favourable prognosis in the opinion of Sun Life.

Sun Life will not pay for:

• procedures performed primarily to improve appearance.
• the replacement of dental appliances that are lost, misplaced or stolen.
• charges for appointments that a person does not keep.
• charges for completing claim forms.
• services or supplies for which no charge would have been made in the absence of this
• coverage.
• procedures or supplies used in full mouth reconstruction (capping all of the teeth in the mouth), vertical dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping teeth and joining teeth together to provide additional support).
• charges related to the temporomandibular joint (TMJ) treatment, except otherwise indicated in the list of covered expenses.
• experimental treatments.

Sun Life will also not pay for dental work resulting from:

• the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
• dental services required due to congenital malformation.
• participation in a criminal offence.

The Basic Life Insurance Plan provides a lump sum benefit to your beneficiary in the event of your death.

Benefits

In the event of your death from any cause at any time or place while you are insured, your beneficiary or estate (if you have not designated a beneficiary) will receive a payment of $30,000.

Death benefits may be paid in one lump sum or, if elected, under settlement options offered by Sun Life.

Beneficiary

When you become eligible for the Basic Life Insurance plan, your beneficiary designation will automatically be your estate. You may change your beneficiary at any time by completing a Beneficiary Nomination form. Any nominations you make are revocable, unless prohibited by law or you stipulate otherwise. It is your responsibility to keep your beneficiary designation up-to-date.

• Changing Beneficiaries

Disability Provision

If you become totally disabled before your 65th birthday and are unable to work at your own or any other job, you may apply to have your Basic Life Insurance continue without payment of premium until you recover, retire or reach age 65. Application must be made before the end of your first year of disability. You will be required to submit medical proof of your disability. Any amount of insurance continued is subject to the terms of the group contract.

Claims

In the event of your death, Human Resources will assist your beneficiary or executor in submitting a claim. Claims should be submitted as soon as possible.

Government Plans

Canada Pension Plan

A lump sum death benefit may be payable to your spouse or estate. In addition, a survivor’s pension may be payable to your spouse and/or an orphan’s pension may be payable to your dependent children.

Workers’ Compensation

If your death is the result of a work-related accident, a lump sum death benefit may be payable to your spouse. In addition, a specified monthly amount may be paid to your spouse or dependent children.

Benefits

In the event of your accidental death while travelling on authorized university business, your estate will receive $100,000. This benefit is in addition to other life and accident insurance benefits which may be payable.

There is an overall maximum of $500,000 payable for all losses resulting from the same accident, regardless of the number of insured persons involved. In the event of a single accident resulting in the death of more than one employee, the benefit will be pro-rated among the estates within the $500,000 maximum.

Benefits are also provided for accidental loss of limb, sight or hearing while travelling on authorized university business. These benefits are detailed in the Specific Loss Accident Indemnity section of the Business Travel Accident Insurance Plan policy.

The Corporate Administration Office has the necessary claim forms and will provide assistance in completing them.

Business Travel does not include everyday travel to and from work.

If you and your eligible dependents are covered for similar benefits under two plans, you can maximize the amount of money you get back by coordinating your benefits.

• Coordination of Benefits

View claim procedures including coordination of benefits and submission deadlines.

• Submitting claims

Learn more about:

• Eligibility and effective date of coverage for you and your dependents.
• Termination of Coverage
• Converting your benefits to an individual plan
• Proof of Coverage for Health and Dental Benefits
• Premiums

• Coverage and Eligibility