Frequently asked questions (FAQs)
Health Plans
Who can I call if I have a Health and/or Dental coverage or claim inquiry?
Employees can contact Mary Galway directly at 709.738.8518 or 855.738.8518 or mgalway@triobenefits.ca.
What is Coordination of Benefits?
If you are covered for Extended Health or Dental benefits under this plan and another plan, benefits will be coordinated with the other plan following insurance industry standards. The maximum amount that you can receive from all plans is 100% of eligible expenses. Please refer to your benefits booklet under Coordination of Benefits for guidelines.
How do I report a change of name?
Complete Section F of the “Notice of Change” form and submit to your plan administrator for forwarding to Mary Galway.
I recently got married; will my spouse automatically become the beneficiary for my group life insurance?
No. Whether you marry or divorce, your designated beneficiary will not change unless you change it. In order to change your beneficiary, please complete Section C of the “Notice of Change” form and submit to your plan administrator for forwarding to Mary Galway.
My child is a student and no longer lives at home. Is he still covered under my plan?
Dependent children are covered up to age 21. A child who is a full-time student attending an educational institution recognized under the Income Tax Act is considered an eligible dependent until the age of 25 as long as he/she is entirely dependent on you for financial support. Please advise your plan administrator and provide proof of registration.
The drug my Doctor prescribed was not covered - why?
Not all prescribed drugs are automatically covered by your benefit list or formulary. You can apply for special authorization of the drug on an exception basis. Exceptions will only be made for drugs which legally require a prescription (over-the-counter drugs are not eligible). Please complete the “Exception/Special Authorization Application Form” and submit to Sun Life. Your physician must also complete a section of the form.
When does Sun Life require my Health and/or Dental Claims be submitted?
Sun Life must receive your claim no later than 90 days after the earlier of:
- the end of the benefit year during which you incur the expenses, or
- the end of your Health or Dental coverage.
I’m planning a trip out of the country, am I covered for health benefits?
Emergency services obtained within 60 days of the date you leave the province are covered. Hospital accommodation is limited to a maximum of $75 per day. All other eligible services or supplies are subject to the reimbursement level and conditions applicable to those expenses. The Emergency Travel Assistance benefit, called Medi-Passport, supplements the emergency portion of your Extended Health Care Coverage. Please refer to your benefits booklet under Extended Health Care: Expenses out of your province, and Emergency Travel Assistance. Due to the maximum on hospital accommodation, it is recommended that you purchase additional health coverage when travelling outside Canada.
Does my plan cover non-emergency transportation expenses?
If you are required to travel at least 200 kilometers round-trip to see a medical specialist or obtain treatment or services in a hospital, your travel expenses may be covered. Please refer to the Extended Health Care: Non-emergency transportation expenses section of your benefits booklet.
Does my dental plan cover orthodontics?
No, there is no orthodontic coverage under the plan.
Does my dental plan cover dentures?
Dentures may be covered if your dental plan covers Major Restorative Services (Option 2). It is recommended that a treatment plan be submitted to Sun Life, before the work is done, for any Major Restorative procedure.
Rebase or reline of an existing partial or complete denture may be covered under Basic Services (Option 1).
If I become disabled and unable to work, how/when should I file a claim for disability benefits?
If you are a full-time, permanent employee you may be eligible to receive disability benefits. Please obtain the applicable form from your plan administrator. Sections of the form are to be completed by you, your employer and your doctor.
Sun Life requires that forms for short term disability benefits be received no later than 30 days after the date your total disability begins.
Long term disability (LTD) claims must be received by Sun Life no later than 90 days after the 119 day elimination period. To avoid delays in processing your claim for LTD benefits, it is suggested you submit your claim 4-6 weeks before the date you are eligible to receive benefits.
If you need more information, please contact us.