Frequently Asked Questions

General Information:

What is the benefit year?

The benefit year runs from July 1st to June 30th.  In order to have your claims processed, Sun Life must receive your claim prior to the September 30th following the end of the benefit year in which the claims were incurred.

Where is my HR Area Office?

Who qualifies as my dependent?

Your dependent must be your spouse or your child and a resident of Canada or the United States and maintaining provincial health coverage.

A spouse includes someone who is legally married to you, or your partner of the same sex or opposite sex who has been publicly represented as your spouse for at least the last 12 months.  You can only cover one spouse at a time.

A child includes unmarried children, legally adopted children, and children for whom you are the legal guardian.  This would also include your spouse's children if your spouse has sole responsibility by decree of divorce for support and maintenance of this child.

Children will be considered dependents up to age 21, or up to age 25 in the case of a full time student wholly dependent on you for support.

If you have a child who becomes handicapped before turning 21, we will continue coverage for that child as long as they are incapable of financial self-support because of a physical or mental disability, and are unmarried and dependent on you for support.  In these cases you must notify Sun Life within 31 days of the date the child turns 21.  Please contact your HR area office for more information on this process.

Further information on eligible dependents can be found in your benefits booklet.

How do I add a dependent to my benefits?

You can do this by completing the Extended Health and Dental Positive Enrolment Form and submitting this form to your HR Area Office.  Be sure to include all eligible dependents on this as we only keep the most recent form submitted on file.

Human Solutions:

What is Human Solutions?

Human Solutions is McMaster's Employee & Family Assistance Program (EFAP) provider.  Human Solutions offers counselling, mediation and support to all McMaster employees on a wide number of issues inlcuding, but not limited to addiction, career, family, life changes, mental health, legal and financial issues.  This confidential service is available to you, your spouse/partner, and any dependents living in your home under the age of 21.

Human Solutions can be contacted toll free at 1.800.663.1142.  For more information on the services provided please visit http://www.wilsonbanwell.com/

Blue Cross:

What do I do if I require emergency medical assistance while travelling?

If you are travelling and require emergency medical assistance, you call CanAssistance within 24 hours of your emergency.  They will validate your coverage and open a claim for you.  It is important to contact them as soon as possible.  Contacting CanAssistance will expedite your claim and they will be able to instruct you on the steps you need to take.  CanAssistance can be reached at 1.800.281.1474 when calling from Canada or the U.S., or at 416.425.2076 from anywhere else in the world.  Please have your policy number (30066) and your McMaster employee ID number ready when calling.

If CanAssistance is not used at the time of the emergency reimbursement or payment of service providers may be delayed or denied.  Be sure to contact Medavie Blue Cross upon your return to Ontario for information on filing your claim.  They can be reached at 416.626.1688. 

Detailed information on your emergency travel coverage can be found at the back of your benefit booklet under "Worldwide Travel Benefits".

What is the duration of my coverage for travel out-of-province?

All employees enrolled in the extended health care plan are covered for 60 consecutive days out of province for emergency medical assistance.  Faculty, Clinical Faculty and Librarians are covered for 120 consecutive days.

Faculty members on extended leaves related to University business or research may submit an application for extended coverage accompanied by supporting documents confirming the approved leave and a $50 cheque for administration fees.

How do I get replacement Blue Cross cards?

If you need a replacement card, please contact your HR area office and one will be ordered for you.  These cards may take 6 to 8 weeks to arrive and will be sent directly to your campus address.

Sun Life:

How do I get set up with a password and user ID so that I can view my claims online?

You can call Sun Life directly at 1.800.361.6212 and one of their customer service representatives will set you up with a user ID and password.  Once this is set up, you can log into the MySun Life secure site at http://www.mysunlife.ca/ and view a history of your claims online.  You will need your McMaster ID# and our Policy # 25018 ready when you call.

How do I find out when I last claimed for glasses/orthotics through Sun Life?

You can phone Sun Life at 1.800.361.6212 or you can log into the My Sun Life secure site and see a history of your claims online at http://www.mysunlife.ca/ .

How do I get set up with Direct Deposit?

When you phone Sun Life simple tell the customer service representative that you're interested in having your claim payment directly deposited into your bank account and they will refer you to one of their web services agents who will walk you through the process of setting this up.  You will need your McMaster ID # and our Policy # 25018 ready when you call.  Alternatively, you can simply attach a void cheque to your next claim and Sun Life will automatically set this up for you.  All future claims would then be paid by direct deposit unless otherwise communicated to Sun Life, so please be sure to keep your banking information up to date.

What is coordination of benefits and how do I use it?

Coordination of benefits provides greater security and coverage for dependent family members through the combined coverage of two plans.  This is especially useful for benefit areas which enforce annual or lifetime maximums.

If you are covered for Extended Health and/or Dental benefits under this plan and another plan (i.e. your spouse's plan), our benefits will be coordinated with the other plan following insurance industry standards.

The following guidelines will help you to determine where you should send a claim first:

• If you are claiming expenses for your spouse and your spouse is covered for those expenses under another plan, you must send the claim to your spouse's plan first.
• If you are claiming expenses for your children, and both you and your spouse have coverage under different plans, you must claim under the plan of the parent with the earliest birthday (month and day) in the calendar year.
• If you are claiming for yourself, you must always claim through your McMaster plan first.

Where can I use my drug card and what do all the numbers mean?

Your drug card can only be used at the pharmacy when filling a prescription written by a medical doctor or dentist.  For prescription drugs we have a dispensing fee cap of $6.50 for each prescription or refill.  If your pharmacy charges over $6.50 you are responsible for the remaining balance.  Although your drug card has all the correct information related to your extended health and dental coverage, your card cannot be used at your dentist or doctor's office directly.

Here is a sample sequence of numbers as seen on your drug card:

16  025018   0001234567   01

Ther pertinent numbers are highlighted; 025018 is your policy number and 1234567 represents your member certificate number which is the same as your McMaster ID number.  The remaining numbers are related to coding required by Sun Life.  If your pharmacist is having difficulties using your card, please direct them to call the Pharmacist hotline available to all pharmacies directly through Sun Life.  If problems persist please contact your area human resources office.

What is a "predetermination of benefits"and when should I use it?

A predetermination of benefits is a process whereby your Doctor or Dentist prepares an estimate of costs associated with services to be provided to you.  We suggest you use this process when incurring a large expense.  Send Sun Life the predetermination and they will respond and tell you how much of the planned treatment is covered.  This will let you know how much of the cost you will be responsible for before the work is done.

The predetermination can be sent electronically by your Dentist/Doctor or by mail using a claim form.

How do I find out if a specific drug is covered by Sun Life?

All prescription drugs have a Drug Identification Number (DIN) associated with them.  If you need to find out if a particular drug is covered before you visit the pharmacy, contact Sun Life directly at 1.800.361.6212 and provide them with our Policy number 25018, your McMaster employee ID, and the appropriate DIN.  This is ideal in situations where the prescription drug is related to new treatments or for prescriptions that are unusually expensive. 

How do I know which paramedical practitioners are covered?

Your benefit booklet lists all of the paramedical practitioners covered by your Plan.  Below is a listing of the eligible practitioners:

• Speech Therapist
• Psychologist
• Physiotherapist
• Massage Therapist
• Osteopath
• Chiropractor
• Podiatrist
• Chiropodist
• Naturopath
• Christian Science Practitioner

Although all plans cover the same practitioners, coverage amounts may vary depending on employee group.  To check your coverage and referral requirements please review your benefit booklet.

Are eye exams covered by my Extended Health Plan?

With the changes adopted by the Ontario Ministry of Health and Long Term Care on November 1, 2004, routine eye exams for people 20 to 64 years of age provided by optometrists and physicians are no longer covered.  This change does not affect children under the age of 20 or adults over the age of 65.

Coverage for eye exams varie by employee group.  Please refer to your specific employee group benefit page for details.

For more information about OHIP, please visit the Ontario Ministry of Health and Long Term Care.

Will Sun Life pay my dentist directly?

Sun Life will only issue payment to you, the member; therefore you are responsible for payment to your dentist.  If your dentis is able to submit electronically, Sun Life will continue to send any payment directly to you.

Leaves of Absence:

How do I notify my department, Human Resources and Payroll of my upcoming pregnancy/parental leave?

In order to notify all of the appropriate parties of your leave dates you must complete a Request for Leave of Absence (LOA) form.  The form asks you to state the intended start date and end date of your leave.  Please note that your leave must start on a Monday and end on a Friday to coincide with Employment Insurance (EI) benefits.  Once you have completed the form in full it must be signed by your department head or designate and forwarded to your Human Resources Area office for processing.  Upon receipt of your LOA form, HR will send a confirmation letter and information package to your home address.  Your fully approved LOA form will them be sent to Payroll and a Record of Employment (ROE) will be generated for you to use in your EI application.  You should contact payroll a few days before the start of your leave to arrange pick-up of your ROE.

How do I notify the University of an upcoming sick leave?

If you are aware that you will be away from work due to illness for a duration of 10 consecutive working days or longer, please contact one of our Return to Work Specialists who will walk you through the requirements to approve your leave.  Please call extension 26965 or 23564 for more details.