IA Admin Guide E SunAdvantage

SunAdvantage
Administration Guide
for Sun Life administered group plans
Published May 2020
Use this guide if Sun Life administers your

plan members’ Benefits plan and prepares
your billing statements.
Find our guides on our SunAdvantage

Forms page.
Life’s brighter under the sun

Contents
Introduction 1
Protecting members’ privacy 1
Types of plans and effective dates 2

Determining effective dates 2
Participation level of 100% (mandatory benefit plan) 2
Participation level of anything other than 100% 2
(non-mandatory benefit plan)
About RAMQ 2
Combined mandatory and non-mandatory plans 3
For coverage that requires proof of good health 3
(see Enrolling in the plan section)
When a plan member refuses coverage 3
Reinstating a former plan member 3
If your plan has optional benefits 3
Enrolling in the plan 4

The Enrolment Guide 4
More on the Enrolment form 4
When proof of good health (Health Statement) is required 5
Submitting a Health Statement form 5
Naming a beneficiary 6
Revocable and irrevocable beneficiaries 6
Changing a beneficiary designation 6
More about beneficiary designations 7
Beneficiaries in Québec 8
Maintaining plan member records 10

Recording plan member changes . 10
Change from single to family status 11
Adding or removing dependents, newborns, change in spouse, etc. 11
Updating student information 11
Adding coverage that was initially refused due to comparable coverage 12
Terminating coverage 13
Changes due to age or retirement 13
Changing a beneficiary designation 13
Plan members who are approved for disability 13
Statutory leave 14
If a plan member dies 15
Adding or changing Optional Life benefits 15
i SunAdvantage Administration Guide – for Sun Life administered group plans

Purchasing individual insurance when benefits end or reduce 16
Who to call 16
Tax status of employer-paid premiums 17
Premiums 18
Pre-Authorized Chequing (PAC) 18
How we calculate premiums 18
Submitting claims 19
Electronically at mysunlife.ca 19
Mail service 19
Coordinating benefits with other plans 20
Extended Health Care 21
Out-of-province medical expenses 21
Pay-direct drug plans 22
When the drug card does not work at the pharmacy 22
Dental 24
Health Spending Account Guide 25
Personal Spending Account Guide 25
Disability 25
Life 26
Living Benefits 29
Other claims 30
Plan Sponsor Services – Group Benefits Administration Option 31
Administration and claim forms 32
Contact information 33
ii SunAdvantage Administration Guide – for Sun Life administered group plans

Introduction
As a plan administrator, you have an important role to play. We’ve designed this guide to
help you with your role. This guide describes the procedures to follow for the day-to-day
administration of your plan. These practices help to ensure that we provide coverage and
pay benefits, according to your plan’s terms.
We also created two companion guides:
• Health Spending Account Administration Guide

• Personal Spending Account Administration Guide
Please refer to the guide related to your plan.
A key part of your role is to provide us with all the plan member information. We use this
information to pay claims and calculate benefit premiums in a timely manner.
We store all plan member data, including beneficiary designations, on our administration
and claims systems. You must let us know about any changes to your plan member records,
as soon as possible. That includes changes in earnings, coverage and dependent status. You
need to keep a copy of all the information you send to us.
We’ve designed this guide based on a standard Sun Life benefit plan. Please disregard
information about benefits or terms that don’t apply to your plan.
Note: This guide does not replace the terms and conditions of your group benefits plan. It’s
your role to administer your plan according to the terms within your contract (abbreviated)
and benefit booklet.
Be sure to give us your company name and contract number when you contact us. If you
are writing us about a plan member, make sure you include:
• the plan member’s full name and

• Member ID.
Protecting plan members’ privacy

We’re committed to protecting your plan members’ personal information. Our global privacy
commitment specifies a common and consistent set of principles that all Sun Life companies
follow.
All of our representatives and employees need to sign and follow our annual Code of
Business Conduct. That includes our privacy rules.
Our privacy policy and Privacy Code for Canada includes obligations related to the collection,
use and disclosure of personal information. As administrator of your benefits plan, you
may need to handle documents that contain personal information about your employees
and their dependents. We rely on you to keep the same level of respect of privacy of
information, in your day-to-day administration activities.
You can find our privacy policy and Code for our Canadian operations on our website at
mysunlife.ca.
1 SunAdvantage Administration Guide – for Sun Life administered group plans

Types of plans and effective
dates
What type of benefit plan do you have? It’s important to know, since some administrative
details – such as effective dates – are based on the type of plan you have.
To enroll all eligible plan members according to your contract terms, please refer to the
participation level specified in your contract.
Determining effective dates

If your contract includes a waiting period, plan members must satisfy that waiting period
before their coverage takes effect.
Plan members must be actively at work on the date coverage would normally begin for
coverage to become effective.
Participation level of 100% (mandatory benefit plan)

Benefits take effect on the day after plan members satisfy the waiting period and other
eligibility requirements.
Participation level of anything other than 100%

(non-mandatory benefit plan)
Ensure you process plan member enrolments in a timely manner. The effective date of their
coverage is determined by the following:
If you receive the enrolment form ... Then the effective date is ...
• On or before the date the plan member • The date the plan member qualifies
qualifies for coverage
• Within 31 days of the date the plan • The date the plan member signs the
member becomes eligible Enrolment form
• More than 31 days after the date the • The date we approve the Health
plan member becomes eligible: The Statement (there may be a restricted
plan member is considered a late maximum for Dental). We’ll let you
applicant. The plan member and eligible know, in writing, if/when we approve the
dependents must complete a Health application
Statement form to verify proof of good
health.
About RAMQ
If your contract contains Health, Accident or Disability benefits, and your business is in
Québec, your contract must follow Québec Drug Insurance Plan requirements. This means
the drug portion of the Extended Health Care benefit must, at least, match the basic drug
plan provided by the Québec government. Plan members’ participation is compulsory for
both plan member and dependent coverage (unless the plan members and dependents
have coverage elsewhere (e.g., a spouse’s plan).

Combined mandatory and non-mandatory plans
We’ll base the benefits effective date on the rules specified above, for each type of plan.
For coverage that requires proof of good health (see Enrolling

in the plan section)
Benefits are effective on the later of:
• the date the plan member qualifies, or the date we approve the Health Statement
When a plan member refuses coverage
As a result of comparable coverage: Other than for comparable coverage:

• Plan members refuse Extended Health • Mandatory plan: Members cannot refuse
Care and/or Dental Care benefits because coverage if the plan is mandatory.
they have comparable coverage under • Non-mandatory plan: A member may
another group plan*. Members may refuse all coverage or all dependent
refuse coverage for themselves and their coverage, but members can’t pick and
dependents, or their dependents only. choose benefits.
*The most common type of comparable coverage is a spouse’s plan. But, a member could
also be covered under another group plan, as an active employee or a retiree.
Non-mandatory plan: Plan members must provide you with all refusals in writing, for
future reference. Make sure the member completes and signs a Refusal for Group
Coverage form. This will prove that you offered them coverage, and they refused it.
Reinstating a former plan member

• If your contract contains re-employment conditions (e.g. six months), the waiting period is
not required for rehires. This happens if a plan member is re-employed within the number
of months indicated in the contract.
• Coverage should be reinstated on the date of re-employment.
• If re-employment is outside the number of months specified in your contract, the member
will need to satisfy the waiting period from the date of re-employment. The waiting period
is set out in your contract.
• The reinstated plan member will have the same level of benefits as prior to termination.
The reinstatement rules follow the mandatory or non-mandatory plan rules outlined earlier.
If your plan has optional benefits

Your plan may include optional benefits such as Optional Life and Optional Accidental Death
& Dismemberment. We usually require the member to complete a Health Statement for
optional benefits.
Statement must be completed. Coverage becomes effective:
• on the later of the date the member or dependents are eligible or

• the date the Health Statement is approved. (see your group contract for details).

Enrolling in the plan
It’s good practice to enrol plan members in your benefits plan as soon as they’re hired. This
applies even though they’ll need to go through a waiting period before they qualify for coverage.
The Enrolment Guide

Step 1 Fill out the first section of the Enrolment form for each plan member.
Step 2 Have the plan member fill out the remaining sections of the form and return it to you.
Step 3 Review the Enrolment form to ensure the plan member fully completed and signed it.
Step 4 Make a copy of the completed Enrolment form for your file. Then, send the original
copy to SunAdvantage Client Services (see Contact information on page 33).
Step 5 You’ll receive a Member Change Form. Use this to confirm that we have recorded the
plan member information on our systems. Review this form to ensure the information
is accurate. You will also receive a wallet ID card to give to the member.
Please note the Enrolment Guide provides the plan member with:
• a fillable drug and travel card (if applicable)

• important information on how to access their benefit coverage online
• a copy of the benefit summary of their coverage
Plan members can access their benefit booklet, drug, travel and Member ID cards at
mysunlife.ca. If a member needs more cards, the member can sign into our website to print
extra copies.
Certain sections of the Enrolment Guide will not apply if:
• a member or their dependents are currently covered under another group plan for Extended
Health Care and/or Dental
• a member has refused benefits under this plan
Note: When you upload plan member data to our administration system, it is added to our
claims system. Then, we transfer it to our pay-direct drug system the next night. Any claims we
process during this period will not reflect the new data.
More on the Enrolment form

Detailed dependent information is entered on our claims system for validating claims eligibility.
The spouse details and children’s details section of the Enrolment form must be fully completed.
Plan members who are refusing Extended Health and/or Dental Care because they have comparable
coverage (e.g. under their spouse’s plan) should complete the refusal section of the form.
Advise your plan member to complete the non-smoking declaration if:
• your plan has Optional Life with smoker/non-smoker rates

• Your plan member is a non-smoker, and
• your plan member chooses Employee Optional Life
The plan member’s spouse must also complete the non-smoking declaration, if the member
chooses the Spouse Optional Life benefit.

Note: Incorrect information about the non-smoking status of the member or spouse may
invalidate a claim for Optional Life.
The beneficiary nomination is a legal document. So, the plan member must sign it in ink
(see Naming a beneficiary section on page 6).
When proof of good health (Health Statement) is required

A Health Statement form is required when a plan member:
• is a late applicant (see Determining effective dates on page 2)

• originally refused benefits in a non-mandatory plan and is now applying for coverage
• is applying for Optional Life benefits or other voluntary benefits, or
• the Life or –Long-Term Disability amount exceeds the non-evidence maximum (NEM).
(Please refer to your plan about NEM coverage. Your plan will indicate if NEM coverage
applies and the amount of the NEM.)
If your plan has NEM coverage, your member must submit proof of good health when they
first apply for coverage that exceeds the NEM amount. Then, a plan member must submit
proof of good health if they:
• increase Life coverage by at least 25% of existing coverage or $25,000 – whichever is

greater
• increase Long Term Disability coverage by at least 25% of the existing coverage
• or $500 per month – whichever is greater
Submitting a Health Statement form

Step 1 Complete “Part 1 – Plan Administrator Information.” Then, give the form to the plan
member for completion.
Step 2 Advise the plan member to answer all questions on the form. This will ensure their
coverage is not delayed. The plan member must also complete the spouse and/or
dependent sections of the form if this applies.
Step 3 The information requested on the Health Statement is highly confidential. So, let
your plan member know they must send the completed form directly to us. We’ve
included mailing instructions on the form.
Step 4 We will let you and your plan member know what we decide.
Step 5 If we approve your plan member’s application, we’ll update the member’s record
on our system. We’ll send a letter to the plan member to let them know of our
decision. The coverage will be effective on the date of approval and premiums
charged accordingly.
If we decline the application, we’ll send a letter to the plan member to let them know.
We’ll also let them know why we declined their coverage.
If we need more information, we’ll send a letter to the plan member, to request the
information we need. If the member does not provide what we need, we’ll let the plan
member know that we’ll close their file.
We’ll let you know if we approve the application, in writing. Please do not make
payroll deductions for the coverage until you have our written approval.
Naming a beneficiary
If your group contract includes Life benefits, the member should designate a
beneficiary on their Enrolment form stating the beneficiary’s full name and
relationship to the member.
Note: When a member nominates their beneficiary(s), you should ensure they don’t replace
their previous nomination of an irrevocable beneficiary. Please see below for more details on
irrevocable beneficiaries.
The beneficiary nomination is a legal document. Therefore the beneficiary section must be
completed, signed and dated in ink by the member. The member must initial any changes or
alterations to the nomination, no matter how small. We cannot accept changes by correction
fluid.
Note: Plan members cannot name a bank or institute as their beneficiary, to provide collateral
for a debt.
Revocable and irrevocable beneficiaries

Revocable beneficiary means that the plan member is free to change the beneficiary
designation at any time. We assume a beneficiary is revocable, unless they’re specifically
designated as irrevocable. This applies in all provinces, except in Québec.
Irrevocable beneficiary means the plan member cannot change the designation unless they are:
• Irrevocable by provincial law: A legally married spouse or civil union spouse designated
as the beneficiary is presumed to be irrevocable in the province of Québec. To make the
beneficiary revocable, the plan member must check off the revocable box on the Enrolment
form or Beneficiary Nomination form.
• Irrevocable at the member’s request: A member can voluntarily choose to designate
a beneficiary as irrevocable. They can just write the word “irrevocable” on the beneficiary
nomination. For example, “John Doe, Spouse, Irrevocable.”
• Irrevocable by court ruling: A court ruling can make a beneficiary designation irrevocable.
For example, a term of a divorce decree may require that the former spouse remain as
the beneficiary. You should keep the document issued by the court with the beneficiary
nomination, for future reference.
Changing a beneficiary designation

If the beneficiary designation is revocable, the member must complete, date and sign a
Beneficiary Nomination form.
If the beneficiary designation is irrevocable, the member must complete, date and sign a
Beneficiary Nomination form. To change an irrevocable beneficiary or to change the current
beneficiary designation from irrevocable to revocable, the member must submit one of the
following documents:
• Consent by Beneficiary form, signed by the irrevocable beneficiary, to revoke their rights
• Final Decree of Divorce (see the table below Beneficiaries in Quebec)
• Proof of death of the irrevocable beneficiary
If you have changed the design of your plan and your new plan adversely affects the irrevocable
beneficiary, then consent is not needed. For example, if you lower the amount of basic life
insurance for your plan members from $50,000 to $25,000, consent of the Irrevocable
Beneficiary is not needed.

More about beneficiary designations
Event Additional information

If your plan has Optional • A member may designate separate beneficiaries for
Life benefits Basic Employee Life, Optional Employee Life and Spouse
Optional Life.
• The member must complete each of the applicable
sections of the Enrolment form or Beneficiary
Nomination form. This is true even if the member
wishes to designate the same beneficiary for both basic
and optional benefits.
Please ensure that the member does not designate their

spouse as beneficiary for Spouse Optional Benefits.
Designating one beneficiary • The plan member must specify the name and relationship
of the beneficiary.
• The member must write 100% in the percentage area of
the form.
Designating more than one • The member must complete the name, relationship, and
beneficiary percentage on the form for each beneficiary. The total of
the designated percentages must equal 100 per cent.
Appointing a contingent • The member should complete the Contingent Beneficiary
beneficiary section of the Enrolment form or Beneficiary
Nomination form. (A contingent beneficiary is the
person designated to receive the proceeds if the primary
beneficiary dies before the insured.)
Designating a minor child • The member must appoint a trustee in all provinces,
except Québec.
• A trustee is not legally required in Quebec. (If the member
does designate a trustee, they must establish a separate
trust agreement. Or, they can include that information in
a will.)
Designating an estate If a member designates their estate as beneficiary, they
should bear in mind that:
• the insurance proceeds may be subject to estate taxes

• insurance proceeds payable to the estate are subject to
claims from creditors. These proceeds may be protected
from creditors if they’re payable to a named beneficiary.
• probate costs vary from province to province. And they
are based on the total value of the estate. These costs are
not incurred if proceeds are payable to a named individual
beneficiary.)
When no beneficiary is • Proceeds would go to the member’s estate.
designated
Note: A properly constituted and current Will should be
submitted with any claim to avoid delays in processing.

Other things to consider when more than one beneficiary has been designated:
The beneficiary dies before • We would pay the deceased beneficiary’s share in equal
the member and equal percentage amounts to the surviving beneficiaries.
beneficiary percentages were
assigned
The beneficiary dies before • We would pay the deceased beneficiary’s share to the
the member and different member’s estate.
beneficiary percentages were • The member should add the following notation to the
assigned form, if the deceased beneficiary’s share should be
divided equally:
“In the event of the death of one or more of
the above named beneficiaries, their share is
to be divided equally between the surviving
beneficiaries.”
• Other things to consider when more than one
beneficiary has been designated:
• Beneficiary dies before the member, and there
is no disposition of the share for the deceased
beneficiary. The share is payable:
a ) to the surviving beneficiary, or
b ) if there is more than one beneficiary, to the
surviving beneficiaries in equal shares, or
c ) if there is no surviving beneficiary to the
member’s estate
We recommend that plan members consult with a lawyer before they request a complex
beneficiary arrangement. Their lawyer could also give them advice based on their personal
circumstances.
Beneficiaries in Québec
The following table was prepared by the Canadian Life and Health Insurance Association Inc.
(CLHIA). It will help you understand beneficiary designations for Québec members. It will
help you know when a beneficiary change is allowed.
Current beneficiary designation Can be changed to

Spouse designated on or after 20/10/76 – Any beneficiary
if indicated as revocable on the enrolment
form
Spouse designated on or after 20/10/76 – Cannot be changed unless:
stipulates that designation is irrevocable, OR • A waiver was signed
does not stipulate that it is revocable • Divorce was granted on or after
20/10/76 and before 1/12/82 –
terminating the spouse’s rights, or
• Divorce was granted on or after 1/12/82
Husband designated on or after 1/7/70 To designate more than one beneficiary,
but before 20/10/76 with or without the member must complete the name,
revocability stipulation relationship, and percentage on the form for
each beneficiary. The total of the designated
percentages must equal 100 per cent.

Husband designated on or after 1/7/70 Cannot be changed unless:
but before 20/10/76 with irrevocability • A waiver was signed
stipulation • Divorce granted on or after 20/10/76
and before 1/12/82 – terminating the
husband’s rights, or
• Divorce was granted on or after 1/12/82
Husband designated before 1/7/70 Any beneficiary
Wife designated before 20/10/76, and Any beneficiary
divorce granted before 20/10/76
Wife designated before 20/10/76, but Child until 20/10/77; otherwise wife’s
divorce granted on or after 20/10/76 and designation is irrevocable except if she waived
before 1/12/82 her right or if divorce terminated her rights

Maintaining plan member
records
It’s important that you keep plan member information up-to-date at all times. This ensures
that your monthly premiums are totalled based on the most recent changes. It also helps us
to process and pay claims accurately.
Recording plan member changes

The effective date must be recorded for all changes affecting a member’s coverage such as:
• salary changes (when coverage is based on earnings)

• class/location change
• change in family status (e.g. from single to family)
• adding dependents (newborns, change in spouse, etc.)
• change in spousal coverage
• student information, and
• termination of coverage
Here are the steps in the member change process:
Step 1 The plan member lets you know when they need a record change
(e.g., new spouse).
Step 2 You record the change on the Member Change Form. Then send the completed
form to us by mail, fax or email.
Step 3 We update our systems to show the change.
Step 4 We send you an updated Member Change Form. We’ll also send you a new
wallet ID card for the plan member, if their information has changed.
Step 5 You review the updated Member Change Form to verify that the information was
updated correctly.
Step 6 You file the Member Change Form and use it for the plan member’s next change
request.
Note: When we change a plan member record in our administration system, the new data
is transferred to our claims system. Then, we transfer it to our pay-direct drug system the
next night. If we process claims during this period, the new data will not show.

Change from single to family status
When a plan member wants to change coverage and requests a change from single to a
family status, consider your plan type:
• Mandatory benefit plan – The change effective date is the date of the plan member’s
status change, i.e. date of marriage, adoption, birth of a child, etc.
• Non-mandatory benefit plan
If member requests change from single Then the effective date is:
to family due to an event such as
birth, adoption, marriage:
On or before the date of the event The date of the event*
Within 31 days of the event The date of the event*
More than 31 days after the date of the The date the Health Statement is approved,
event, the plan member’s dependents are and we will notify you in writing of the
late applicants and must complete a Health approval. (There may be a restricted
Statement to verify proof of good health maximum for Dental)
* We’ll need a Health Statement for dependents who’re not already covered.
Adding or removing dependents, newborns, change in

spouse, etc.
New dependent information needs to be updated or claims will be rejected.
Updating student information

Coverage for a dependent child ends at the lower age limit specified in your contract.
Unless, the dependent child meets the criteria for coverage as an overage student. See the
Determining eligibility section on page 2 for the definition of an overage student.
To qualify as an overage student, their learning institute must consider them a full-time
student. We’ll also consider co-op and apprenticeship programs. But, the overage student
must not be receiving Employment Insurance (EI) while they’re in school.
An overage student does not have to be living with the plan member to qualify as a
dependent. They can be earning an income during their studies.
You must notify us if coverage for a dependent child is to continue past the lower age limit.
You can do this through:
• Group Benefits Enrollment (GBE) (if you use Sun Life’s online Plan Sponsor Services
website for your administration)
• your tape file feed to Sun Life
• by contacting our member administration team
We’ll update our system to show the dependent child is an overage student. You’ll have to
let us know if their status changes in the future.

Coverage for an overage dependent ends:
• on the first day of the next term – if the student doesn’t return to full-time studies
• on the date the student graduates
We’ll allow coverage to continue through the summer term, if the student completed their
year of studies. But, they must be returning to their studies in September.
Your members should keep you up-to-date on changes to their dependents’ status. They
must also declare that the dependent is an overage student each time they submit a claim.
At least once a year, confirm that your plan members’ dependents are still enrolled in a
learning program full- time. The dependent must be enrolled as a full-time student for the
upcoming year.
If your policy includes dependent life, we may ask for proof of enrolment if we receive a
death claim. We’ll use it to verify that a dependent qualifies for a claim payment. The plan
member must keep their dependent status up-to-date.
How to determine if a school or college is accredited?
Visit the website listed in the table below, to see a list of the accredited institutions:
In Canada Outside Canada

cicic.ca/868/search_the_directory_of_ cicic.ca/976/get_information_on_applying_
educational_institutions_in_canada.canada to_study_abroad.canada
Adding coverage that was initially refused due to comparable

coverage
Event Mandatory plan Non-mandatory plan

Other coverage ends Coverage start date • Coverage start date should be
(e.g., spouse’s plan) should be the day after the day after the other coverage
the other coverage (e.g., end date. The plan member must
spouse’s plan) end date request coverage within 31 days of
this date.
• If coverage is not requested
within 31 days after the other
coverage ends, the plan member
is considered a late applicant. The
member and the member’s eligible
dependents must complete a
Health Statement to provide proof
of good health. There may be a
maximum limit for Dental.
Other coverage Coverage start date The member is considered a late
doesn’t end, but should be the original applicant. The member and the
member requests effective date member’s eligible dependents must
coverage after initially complete a Health Statement to
refusing provide proof of good health. There
may be a maximum limit for Dental.

Terminating coverage
We end plan members’ coverage when their employment ends, or if the member is no
longer actively working. But there are exceptions to the actively working requirement,
such as statutory leaves, layoffs and disability leaves. Check the continuation of coverage
provision in your contract to learn if coverage can continue or if it must end. If coverage
does end, then you must notify eligible members of their right to apply to convert their
group life insurance to an individual insurance policy.
Please see the Purchasing individual insurance when benefits end or reduce section
on page 16.) If your benefit plan has Extended Health Care or Critical Illness coverage, then
when your plan member calls Sun Life, we will tell them about their other rights to transfer
such coverage.
Changes due to age or retirement

We may reduce or end a plan members’ coverage at a certain age, or when they retire.
Dates may vary from one benefit to another. You don’t have to let us know about age-
related changes, or changes due to retirement. We set our system to automatically process
the change on the appropriate date.
For plan members who remain on disability claim until age 65, they are deemed retired.
Check your contract for the definition of Retirement Date.
Your plan member and their spouse can apply to convert their life insurance coverage to
an individual policy. They can do so when we reduce or end their coverage. Be sure to refer
your plan member to Sun Life. They’ll need to call us to have their life insurance converted
within 31 days. As noted above, there may be other individual insurance options available to
them too. (See Purchasing individual insurance when benefits end or reduce section
on page 16.)
Changing a beneficiary designation

Your plan member needs to fill out, date, sign and send a Beneficiary Nomination form
to you. Then, as the plan sponsor, it’s up to you to send the completed form to us.
We’ll update our systems with the information the member provides. (See Naming a
beneficiary section on page 6.)
Plan members who are approved for disability

We’ll update our systems to reflect the premium waiver for the appropriate benefits when:
• a member is receiving Long Term Disability benefits or when

• a Waiver of Life Premium is approved

Statutory leave
Your contract allows you to continue coverage while a member is on statutory leave.
The continuation of coverage provision in your benefit plan helps you comply with your legal
obligations to continue coverage under minimum standards legislation. Check with your
legal advisor if you are uncertain about your obligations to continue coverage under such
legislation.
You’ll need to make arrangements to collect any premiums required from the members.
We also allow members to waive non-taxable Long Term Disability (LTD) coverage and/or
optional coverage (e.g. Optional Life), during a statutory leave. But, you should encourage
your plan members to keep all coverage in place.If they choose not to, then you’ll need to
have them sign Sun Life’s waiver and release form.
Continuing coverage during a leave
• You don’t need to notify us if all coverage is continuing for the province’s legislated
statutory leave period.
• Plan members cannot choose to continue some benefits and cancel others.
• However, plan members can choose to waive optional coverage (e.g. Optional Life or
Critical Illness) or non-taxable LTD coverage or both.
• You must notify us if plan members cancel all coverage or choose to cancel optional
and/or non-taxable LTD coverage only.
If a plan member terminates coverage during their leave and they return to work
within the province’s legislated statutory leave period:
• Previous benefits coverage should be immediately reinstated when they return to work.
We will not enforce the waiting period.
• Reinstatement of coverage follows the mandatory/non-mandatory plan rules outlined
earlier. (See Types of plans and effective dates section on page 2.)
If a plan member terminates optional coverage and/or non-taxable LD coverage
• If your plan member re-elects optional coverage when they return to work, they’ll need
to complete a Health Statement and send it to us. We’ll re-instate non-taxable LTD
coverage, and we’ll use the plan member’s coverage effective date (in place before the
leave began) for the pre-existing condition provision.
About RAMQ:
Your contract must comply with Québec Drug Insurance Plan requirements if:
• your contract contains health, accident or disability benefits

• you have a place of business in Québec
This means the drug portion of the Extended Health Care benefit must at least match the
basic drug plan provided by the Québec government. Members must participate in the
plan to get member and dependent coverage (unless the members and dependents have
coverage elsewhere: e.g. spouse’s plan).

If a plan member dies
If a plan member dies, provide us with the date of their death. We’ll continue benefits for
the survivors based on the terms of your contract, if provided under your plan. Let the
survivors know they can continue to submit claims under the member’s contract number
and ID. We’ll terminate the coverage automatically, at the end of the survivor period.
Plan members must follow the instructions found in the Submitting Claims section
on page 19.
Adding or changing Optional Life benefits

If your plan has optional benefits, members may decide to add them after they’ve enrolled.
Or they may choose to increase the amount of optional coverage they initially chose.
Below are steps your plan member must take to add or change optional benefits.
• The member must complete the optional benefits section of the Enrolment form.
They must also complete a Health Statement. (Please see Submitting a Health
Statement on page 19.)
• If electing optional benefits for the first time, make sure the member nominates a
beneficiary.
• The member must also complete and sign a non- smoking declaration form to confirm
they’re a non-smoker. This is required if your plan has smoker/non-smoker rates for
Employee Optional Life. The member’s spouse must do the same if they choose Spouse
Optional Life.
Notes
• A non-smoker is a person who has not used tobacco within the past 12 months.
• A member or spouse must reconfirm their smoking status if they apply for more optional
coverage.
• A member or spouse who first declared themselves as a smoker, then stops smoking, can
request non-smoker status. They can do so by completing a non-smoking declaration.
• If we receive incorrect information about a non-smoking status we could reverse a claim
for Optional Life.

Purchasing individual
insurance when benefits
end or reduce
A plan member and their spouse can apply to convert their group life insurance to a Sun Life
individual policy. They can do so when their coverage ends, without having to give proof
of good health. The member must send their written request for conversion to us within
31 days from the date their Life coverage ends, or is reduced. Your benefit plan will set out
information about a plan member’s conversion rights.
The plan member can also choose to buy our Choices products too. Group health and
dental coverage can be transferred to our My Health Choice. Group critical illness can
be transferred to our Choices Critical Illness Insurance (Choices CII) product. We also offer
My Life Choice, as a less expensive alternative to the conversion product. The member
will not have to give proof of good health if they apply within 60 days from the date their
coverage ends. However, they will have to answer simple questions about their health.
You’re responsible for letting eligible plan members know about their right to apply to
convert their benefits, including:
• the 31-day period to convert their life insurance, and

• the 60-day period to buy Health Coverage Choice, Choices CII or My Life Choice
You also need to complete the Insurance options for plan members on termination
of group benefits form, to confirm that the plan member qualifies.
Please let the plan member know about these privileges as soon as possible. Be sure to do
so after their benefits end or is reduced, so they don’t miss the deadline.
Who to call
Plan members wanting to convert to individual life insurance or purchase Sun Life’s
Health Coverage Choice individual health and dental coverage can call 1 800 SUN-LIFE
(1-800-786-5433). Our call centre representatives will answer their call and ask for some
personal and group plan information. The representative will then pass the information onto
a Sun Life advisor. The advisor will then contact the plan member to discuss their insurance
options.

Tax status of employer-paid
premiums
You must include premiums for some benefits paid by plan sponsors, to their employees, as
income. This depends on the province where they live or work. You must show the value of
these taxable benefits when you report members’ income during the year, and when you
issue their tax slips.
Below is a quick overview of which employer-paid premiums are considered taxable. We do

not intend for this information to be tax advice. We recommend that you consult a tax
advisor about calculating taxable group benefits.
Income Tax Act (Canada) Income Tax Act (Québec)

Employer-paid premiums/ • Group life insurance • Group life insurance
contributions and sales tax • Group Sickness or • Group Sickness or
that are a taxable benefits Accident insurance Accident insurance
for employees plans (e.g. Critical Illness, plans (e.g. Critical Illness,
Accidental Death & Accidental Death &
Dismemberment) Dismemberment)
• Personal Spending • Personal Spending
Account Account
• Private health services
plan benefits (e.g.
Medical, Dental and
Health Spending Account)
Employer-paid premiums/ • Disability benefits (short • Disability benefits (short
contributions and sales and long-term) - when and long-term) – when
tax that are not a taxable disability claim payments disability claim payments
benefit for employees are taxable income are taxable income
• Private health services • Private health services
plan, such as Medical plan benefits (e.g., Medical,
Dental and Health Dental and Health
Spending Account Spending Accounts) when
the benefits are for the
surviving spouse
Canada Revenue Agency (CRA) establishes what group benefits must be included as taxable
member income in the province in which the member works or resides. You can find a
comprehensive list of these benefits at cra-arc.gc.ca/menu-e.html.
More information for members who live or work in Québec, including taxable benefit
information and requirements, can be found at revenuquebec.ca/en/
The information regarding members who live or work in the province of Québec is to
be used by Sun Life customers who’ve entered into an insurance contract with us. Plan
sponsors with an administrative services only (ASO) arrangement with Sun Life, and have
members in Québec, should refer to the Revenu Québec website.

Premiums
We produce and mail premium billing statements to you each month. We’ll also ensure
any changes your plan members make after your bill is produced is shown on the following
month.
Your premiums are due on the first of the month. You must pay them within the grace period
specified in your contract. If you don’t pay your premiums within this grace period, your claim
payments could be suspended until we receive payment.
Pre-Authorized Chequing (PAC)

For your convenience, we also offer pre-authorized chequing (PAC) as an option. If you are
interested in this payment method, complete the pre-authorized chequing form. This is
posted on our website see Administration and claim forms section on page 32.
How we calculate premiums

We calculate premiums for complete months only.
Your premiums are not payable for the first month if the effective date is after the first of the
month. For example:
• If the member’s coverage is effective on January 1, premiums are payable as of January 1.

• If the member’s coverage is effective on January 2, premiums are payable as of February 1.
Premiums are payable for the last month if the termination effective date is after the first of
the month. For example:
• If the member’s coverage is terminated on January 1, premiums are payable up to and

including December.
• If the member’s coverage is terminated on January 2, premiums are payable for the month
of January.

Submitting claims
At Sun Life, we want claims submission to be easy. So we offer plan members and providers
a number of ways to submit claims.
Electronically at mysunlife.ca
• If you are set up for e-claims, plan members can submit certain claims on website at
mysunlife.ca
• Applicable to Extended Health Care, Dental, Health Spending Account, Personal
Spending Account and disability claims
my Sun Life Mobile app:
• Plan members who download the my Sun Life Mobile app can submit and track their
benefits claims there.
• Applicable to Extended Health Care, Dental, Health Spending Account, Personal
Spending Account and disability claims
Dental: Dentists submit claims electronically, on behalf of their patients, using Electronic
Data Interchange (EDI). This means plan members don’t have to fill out claim forms after
visiting the dentist. Claims are received and processed fast.
Drug: Pharmacies can submit prescription drug claims electronically for customers who
have pay-direct drug plans.
Instant claims processing means minimal work for the member. Pay-direct drug cardholders
only pay the amount your plan doesn’t cover. Things like the deductible, or amounts over
the plan limits. Claims are submitted immediately and processed fast.
Mail service
Plan members can mail completed Extended Health Care, Dental, Health Spending Account
and Personal Spending Account claim forms. They can send their original receipts, to the
claim office listed on the back of the claim form. Members can download a personalized
claim form from mysunlife.ca.
We assess claims based on the information you or your plan members send to us. So, it’s
important that you help us keep our records up-to-date. It’s important that you ensure
claim forms are fully completed. We must receive them within the time limits specified in
your contract.

Coordinating benefits with other plans
Your plan members can coordinate their medical and dental expenses with other plans, to
maximize their benefits. All insurers use insurance industry guidelines to determine which
plan their claim should be sent to first. Here are the guidelines:
Claims for Plan members and their spouses: The plan under which the person is
covered as an employee pays first.
If the person is covered as an employee under two plans, the following order applies:
• The plan where the person is covered as an active, full-time employee.

• The plan where the person is covered as an active part-time employee.
• The plan where the person is covered as a retiree.
• The plan where the person is covered as a dependent pays last.
Claims for dependent children should be submitted in the following order:
• The plan where the child is covered as an employee.

• The plan where the child is covered under a student health or dental plan provided
through an educational institution.
• The plan of the parent with the earlier birth date (month/day) in the calendar year pays
before the plan of the parent with the later birth date (month/day) in the calendar year
(e.g. the member’s birthday is in June and the spouse’s birthday is in March, the spouse’s
plan pays before the member’s plan).
• If both parents’ birthdays fall on the same month and day, the plan of the parent whose
first name begins with the earlier letter in the alphabet.
• The above order applies in all situations except when parents are separated or divorced
and there is no joint custody of the child, in which case the following order applies:
• Plan of the parent who has custody of the child (the member should note on the claim
form that they have custody of the child);
• Plan of the spouse of the parent with custody of the child (the member should note on
the claim form that they have custody of the child);
• Plan of the parent who does NOT have custody of the child (the member should note on
the claim form that they do not have custody of the child), and
• Plan of the spouse of the parent without custody (the member should note on the claim
form that they do not have custody of the child).
If a dental accident occurs, health plans with dental accident coverage will pay benefits before
the dental plan.
The amount of benefit payable under the second plan cannot exceed the total amount of
eligible expenses incurred LESS the amount paid by the first plan.
To claim the balance that was unpaid from the first plan, the member needs to send us the
original claim statement received from that plan along with copies of the receipts or the
initial Dental Claim Form. Receipts should include the name of the patient, the nature of the
treatment or medical product, the name of the prescribing doctor, the date and the amount
charged.

If both spouses’ benefit plans are administered by Sun Life:
• The member can direct us to pay from both benefit plans as part of the same claim
process.
The member completes the appropriate section of the Extended Health Care and/or Dental
claim form, showing both plans contract and ID numbers. The spouse must sign the claim
form to allow us to process the claim under their plan. If a dental accident occurs, health
plans with dental accident coverage will pay benefits before the dental plan.
Extended Health Care

Extended Health Care benefits cover necessary medical expenses that aren’t covered
by provincial hospital and medical plans (see your group contract for more details). Plan
members must submit a completed Extended Health Care Claim form for all medical
expenses, other than expenses that are payable under a drug card program. They must
submit this, with original receipts, to our group claims office address – shown on the claim
form. We don’t accept photocopies of receipts, except when the member is coordinating
benefits with another plan, as outlined earlier. We recommend that members keep copies of
all documents they send to us.
Hospitals normally submit claims for hospital expenses directly to us, and we pay the
hospital directly. We send the member a claim statement that shows what was claimed and
what we paid.
Note: Members should check their claim statement to ensure they actually received the
services that were claimed.
If your plan member claims expenses for a spouse or child, see the Coordinating benefits
with other plans section on page 20.
Out-of-province medical expenses

To make a claim for emergency medical expenses, while travelling out-of-province, your
plan member must:
• contact Allianz Global Assistance Service Canada Inc. (AZGA)* immediately

• follow the instructions in their Travel Benefit pamphlet (available at mysunlife.ca) to get
their travel card and more
Note: Members who travel should keep their card with them at all times. They must call
Allianz Global Assistance before they incur a medical emergency expense.
To claim non-emergency, out-of-province medical expenses, plan members must complete

and submit an Extended Health Care Claim form, with their original receipts.
*AZGA is our travel assistance service provider.

Pay-direct drug plans
A pay-direct drug card helps us to simplify the prescription drug claim process. It also helps us to
eliminate the use of claim forms. It reduces the plan member’s out-of-pocket expenses.
Plan members can use drug cards to purchase eligible prescription drugs, only. Drug cards are
accepted at most drug stores across Canada. Members can show their drug card to the pharmacist
and if the drug is eligible, will pay only the amount not covered by the plan
(e.g. the deductible or amounts over the plan limits).
A drug card is available for the member within the:
• Member site. Members can sign into mysunlife.ca to print or print extra copies for themselves.
• my Sun Life Mobile: Plan members who download the my Sun Life Mobile app can use their
smartphone as a drug card.
Note:
• Plan members can only use their drug cards within Canada. If a member needs to fill a
prescription while traveling, they can submit a paper Extended Health Care Claim Form
when they return to Canada. We will assess the claim and convert the eligible expense amount
to Canadian dollars.
When the drug card does not work at the pharmacy

Below are some of the most common reasons that drug cards are declined by a pharmacy.
Issue Solution
Incorrect birth • When submitting a prescription, the pharmacist will ask for the
date is entered patient’s date of birth. The pharmacist keys this information in
when sending the claim electronically. If the date of birth the
pharmacist submits does not match the date of birth on our
system, the claim is declined.
• Plan members should ask the pharmacist to check if they entered
the correct birth date. If it was and the claim is still rejected, the
member should check to see what birth date is recorded on our
system. Then, the member must process a change to correct it if
necessary.
• Since the pay-direct drug system uses the date of birth to identify
the patient, special handling may be required for multiple births:
e.g., twins.
Incorrect Relationship codes are different for the plan member, spouse,
relationship code dependent child, overage student and disabled dependent child. Plan
is entered members should ask the pharmacist to check that the code entered
is correct.
Benefits are being Drug claims can be coordinated electronically at the pharmacy ONLY
coordinated, if the member and spouse both have pay-direct drug plans through
and your plan is one of Canada’s recognized pay-direct drug card providers. If not, the
second payor spouse must submit a claim to their plan first, and the member can
then submit a paper claim to your plan for the unpaid balance.
The prescribed Not all prescription drugs are covered under your benefits plan,
drug is not depending on your plan design. The pharmacist can contact the
covered doctor to see if a therapeutically equivalent drug (that is covered) can
be prescribed.
If the plan member receives less than the amount they expected
A member may receive a benefit amount that is less than what is specified under your plan if:
• They have purchased a brand-name drug instead of a generic substitute. Your plan covers
only up to the cost of generic drugs.
• The pharmacy charges more than the “reasonable and customary” limit typically charged in
their regional area for dispensing fee or ingredient costs. “Reasonable and customary” limits
are applied on a number of expenses. These limits ensure you don’t incur unnecessary
costs when providers charge excessive fees.
Maximum drug supply covered at one time
Normally, a 100-day supply of a drug is the maximum quantity covered at one time. Your
plan may also limit the supply for acute drugs to a 34-day supply.
Items that cannot be purchased with the card
There may be some drug expenses covered under your plan that your plan members can’t
purchase with their drug card.
See your Benefit booklet available within the Contract & documents page for a list of these
items. The member will need to pay the pharmacy for these expenses and submit Extended
Health Care Claim.
Dependent records must be up to date
We may decline claims if a plan member’s dependent information isn’t set up on our system.
It’s your role to verify that overage dependents continue to meet your plan’s eligibility
requirements, plus let us know when their coverage ends.
Overage dependents must be a full-time student or disabled, and financially dependent on

your plan member.
Lost or stolen cards
If a plan member loses their drug card or had it stolen, they can get a new card from:
• my Sun Life mobile app

• mysunlife.ca
• your Group Client Services administration (notify your contact immediately)
Paper and mobile app drug cards are accepted by all participating pharmacies.
When a plan member leaves your company
When a plan member leaves your company, follow the normal process found on the
Terminate a member page. Drug cards will no longer be accepted by pharmacies once the
termination date is entered on the system. You should, therefore, have the plan member
destroy their drug card(s) immediately.

Where to call
If there’s a problem with a plan member’s drug card at the pharmacy, encourage them to
have the pharmacist call the Pharmacy Help Desk at Telus, for assistance. (Telus is our drug
card provider.)
If a plan member contacts you with a problem, please have them contact our Customer
Care Centre (CCC). They’ll need to give us the following information:
• Their name, member ID number and group contract number

• Details of the problem and the date of the transaction, and
• Name, address and phone number of the pharmacy (if applicable)
Dental
With Dental care benefits, your plan members are covered for procedures done by:
• a licensed dentist
• denturist
• dental hygienist, or
• anaesthetist
Benefits include preventive and restorative dental treatment, in accordance with specific plan
details, such as:
• deductibles
• co- insurance levels
• fee guides and maximums – as outlined in your group contract
We’ll cover reasonable expenses for each dental procedure, up to the usual charge for:
• the most economical alternate procedure, and

• service or treatment consistent with accepted dental practice.
Plan members’ eligible expenses must not be greater than the fee stated in the appropriate
dental association fee schedule.
Members can follow these steps to submit a claim for Dental benefits:
Step 1 The dentist may submit the claim directly to us electronically. Your member should
get a copy of the claim submitted.
Step 2 If the dentist hasn’t sent the form to us, your plan member and the member’s
dentist will need to complete their respective parts of the Dental Claim form.
Step 3 Your plan member should submit the claim to us at the address shown on the
form (if using a Sun Life claim form). They must also do so within the time limit
specified in your group contract.
Plan members can find steps to claim expenses for a spouse or child in the Coordinating
benefits with other plans section of this guide on page 20.

Getting an estimate
Plan members should ask their dentist to send us a fee estimate called a predetermination.
This is for treatments over the amount specified in your contract. With this predetermination,
we’ll let the plan member and their dentist know which expenses (if any) will be covered. And
we’ll do so before the expense is incurred. This precaution allows the plan member to discuss
treatment options with their dentist before the work starts. It also allows them to budget for
the expense, if it’s not covered by your plan.
Note: A predetermination is not a guarantee. In some situations, the amount of benefits paid
may be different than the amount that was approved. For example, if the claimant has other
work done in the meantime, that could bring them over the annual coverage maximum. The
amount paid may also be different if the work done is different from the work outlined in the
dentist’s estimate.
Orthodontic claims
We’ll repay members as expenses are incurred. We’ll pay about one-third of the full eligible
treatment cost, for the initial payment.
Health Spending Account Guide

Please refer to our Health Spending Account Administration Guide, if relevant to your plan. It’s
available on the SunAdvantage Forms page.
Personal Spending Account Guide

Please refer to our Health Spending Account Administration Guide, if relevant to your plan. It’s
available on the SunAdvantage Forms page.
Disability
Short Term Disability and Long Term Disability benefits provide your plan members with a
portion of their lost income, during periods of total disability. Members must complete the
elimination (qualifying) period specified in your contract. They must qualify for these benefits
based on the terms of your group contract.
Short Term Disability and Long Term Disability claim forms come in three parts:
• the plan member statement, which must be completed by the plan member
• the attending physician statement, which must be completed by the doctor supervising the
plan member’s treatment, and
• the plan sponsor statement, which must be completed by you, the plan administrator
Your plan member can submit each part of the claims forms separately, as they’re completed.
We must receive claim forms within the time limits indicated in your contract.
When a plan member returns to work, let us know immediately. If you or the plan member
get a benefit payment that includes benefits for any period that the plan member was able to
work (and doesn’t qualify for benefits), the member should return the payment to us for final
adjustment.

To submit a claim for Long Term Disability benefits, or to have premiums waived under the
Life and Accidental Death & Dismemberment benefits, be sure to fill out the relevant claim
forms. Then, send them to us six to eight weeks before the start of the Long Term Disability
payments.
Notes:
• If a plan member is covered by Sun Life for both Long Term Disability and Life benefits,
we’ll assess the waiver of premium claim for the Life benefit. This is done at the same
time we assess the Long Term Disability claim.
• Notice of claim is not required for the Long Term Disability benefit if the plan member is
receiving group Short Term Disability benefits from Sun Life.
• Be sure to advise us if a plan member is receiving disability benefits under a government
plan, as the plan member might qualify for waiver of premiums.
Life
We’ve provided the following data for your information only. It is not meant to provide
you with legal advice. Plan administrators must be careful not to provide opinions on the
settlement of life insurance claims. Instead, we recommend that plan administrators direct
all questions about a specific claim to our Life Claims Department (see page 33 for
contact information).
Partial (advance) payment immediately upon death
Where the beneficiary is a family member (e.g., a spouse) and has an immediate need for
funds, a partial claim payment (of up to $10,000) can be made (within 24 hours), before
they submit death claim forms. This is intended to help the family deal with immediate
financial issues, such as funeral costs or outstanding debts.
As a plan sponsor, the decision to offer a partial (advance) payment is at your discretion.
We will not issue advance payments if there are any unusual events surrounding the
member’s death.
We need the following information to issue partial advance payments:
• Group contract number

• Member ID
• Name of deceased
• Date of birth of deceased
• Date of death of deceased
• Cause of death
• Amount of insurance in force at date of death
• Name of beneficiary
• Relationship of beneficiary to the deceased member
• Date last worked and reason
• Notification of Death form
• Member’s Enrolment form, and
• Change of beneficiary form(s), if any

We need the following information to issue a death claim payment:
• Notification of Death form (see below),

• Proof of death in the form of a Physician’s statement or an original or certified copy of a
provincial death certificate or a funeral director’s statement of death.
• Election of method of settlement and statement of claim form (see below), and
• The original Enrolment form and any subsequent Beneficiary Nomination forms.
• For an Optional Life insurance claim, in addition to the above, we require:
• The original approval notice issued by Sun Life issued confirming approval of the
member’s application for Optional Life insurance, and
• A completed Physician’s Statement if death occurs within two years of coverage being
approved or if the benefit is more than $250,000 and coverage has been in effect for less
than five years. This is in addition to an official death certificate.
Note: Depending on the events surrounding the member’s death, we may need more
information to process the claim.
Notification of Death form
After the death of a plan member or dependent, you’ll need to fill out the right section(s) of
the Notification of Death form. Be sure to include the:
• correct plan member ID number

• group contract number
• billing group number and class
Then, you must sign and date this form to confirm coverage, before you send it to us.
We should also be provided with all beneficiary forms.
Election of Method of Settlement and Statement of Claim form
If there is more than one beneficiary, send a complete Election of Method of Settlement
and Statement of Claim form for each beneficiary.
Estate claims
When the benefit is payable to the member’s estate, the following applies:
For life insurance amounts we require
Less than $50,000 No additional documentation

More than $50,000, Notarized copy of the will
but less than
$100,000 Note: If the deceased plan member was a Québec resident who
designated their estate as beneficiary and the proceeds exceed
$50,000, we require a notarized copy of the notarial will.
Exceeding $100,000 and the deceased plan member was a resident of
Ontario Notarized copy of the Certificate of Appointment of Estate Trustee

with a will
Québec Notarized copy of the notarial will
Any other province Notarized copy of the probated will

If there isn’t a will
For life insurance amounts we require
Ontario Notarized copy of the Certificate of Appointment of Estate Trustee

without a will
Québec Notarized copy of the Notarial Declaration of Heirs
Any other province Notarized copy of Letters of Administration
More about wills
In order to apply the terms of a will to the group Life benefit, the will must be dated later
than the Enrolment form (if the Enrolment form designates a different beneficiary than is
shown in the will).
If the beneficiary is the estate
If the proceeds are payable to the estate, the estate’s legal representative should complete
the Claimant Statement.
Note: A signed and dated Claimant Statement is considered a legal document. This
statement provides authorization to allow Sun Life to obtain necessary medical information,
police report, coroner’s report, etc.
Plan administrators should avoid giving an opinion on how the will is to be applied. Once we
review a copy of the will, we will provide that information.
If the beneficiary is a minor
• If a trustee has been appointed, the trustee should complete the claim form and include
documentation showing their appointment. We will pay the proceeds to the trustee on
behalf of the minor.
• In Québec, the surviving parent is the Sole Tutor for the minor and should complete the
claim on their behalf. If there is no surviving parent and an administrator has not been
designated, a court-appointed Tutor must make the claim.
• If there is no trustee in place and a Legal Guardian for Property has been
appointed for the minor, the legal guardian should complete the claim form and
provide documentation showing their appointment.
• If a legal guardian hasn’t been appointed, payment will be made into the courts
or the public trustee in trust for the minor.
• Notes: Each province has its own legislation concerning payments to a legal guardian on
behalf of a minor.
• If a beneficiary is interested in exploring other payment options, we’ll direct them
to their nearest Sun Life advisor who can explain the options available to them.
How proceeds are paid
While we offer beneficiaries a number of payment options, payment by cheque is by far the
most common. We will issue the cheque in the beneficiary’s name and send it to you. You
are then responsible for arranging the delivery of the cheque to the beneficiary.

Criminal offence
If the beneficiary is charged with a criminal offence related to the death claim, we cannot
settle the claim until the criminal charge has been cleared or otherwise resolved. Under
Canadian law, no one can benefit from a criminal offence.
Beneficiary pre-deceases member
If the beneficiary pre-deceases the member, we require proof of the beneficiary’s death
(i.e. funeral director’s statement). In this situation, we will pay out the proceeds to the
member’s estate. If there is more than one beneficiary, the proceeds may be shared among
the remaining surviving beneficiaries or the deceased beneficiary’s share may be paid to the
member’s estate. (See Naming a beneficiary section.)
Simultaneous death
If the beneficiary and the member die at the same time (e.g. in the same accident), we try
to determine the exact time of death, to determine who died first. If we can’t determine if
the member or beneficiary died first, the Insurance Act and Québec Civil Code require us
to presume that the beneficiary died first. In that case, the beneficiary’s share goes to the
member’s estate, or, if there was more than one beneficiary, the proceeds may be shared
among the remaining surviving beneficiaries, or the deceased beneficiary’s share may be
paid to the member’s estate. (See Naming a beneficiary section.)
If the beneficiary died after the member, the beneficiary’s share goes to the beneficiary’s
estate.
Living Benefits
Under our Living Benefits Loan Program, a terminally ill plan member with a life expectancy
of 24 months or less may apply for:
• a loan of up to 50% of the Basic Life insurance amount – up to a maximum of $100,000
If the member is within five years of a scheduled reduction of Basic Life insurance, the
maximum Living Benefit payable will be:
• Fifty per cent of the lowest reduced amount of the Basic Life insurance
The amount of the Living Benefits loan, plus interest, will be deducted from the proceeds
paid to the beneficiary(s), on the member’s death.
Notes:
• If a member is within five years of a scheduled termination they are not eligible for the
program.
• Before requesting a Living Benefits loan, you should contact your Sun Life group
representative to discuss the possible financial impact on your contract.

Other claims
Waiver of Life Premium
The waiver of premium feature under the Life benefit provides ongoing Life coverage for a
disabled plan member (and/or covered dependents) without payment of premium during
the disability period. This is subject to the terms of the contract that were in effect on the
date the member became disabled. It includes reductions and terminations.
Where Sun Life provides the Life benefit but not the Long-Term Disability benefit, we
require the following information to assess the Waiver of Life Premium claim:
• Employer’s statement
• Waiver of premium claim – Claimant’s statement
• Waiver of premium claim – Attending physician’s statement of disability
Accidental Death & Dismemberment (AD&D)
To make a claim for Accidental Death & Dismemberment, contact us, and we’ll send you the
required forms. Our claims forms are clear and thorough, and we will contact the member
and their physician as appropriate to ensure we have all the information needed to assess a
claim. We keep the member informed of the claim process and decisions.
Critical Illness Insurance
To make a claim for Critical Illness Insurance, the member should contact us, and we will
send them the required forms. Our claim forms are clear and thorough, and we will contact
the member directly throughout the claim process to keep them informed of the status of
their claim. We will correspond directly with the physician and /or the hospital, if necessary,
to obtain any additional medical information we need.

Plan Sponsor Services
– Group Benefits
Administration Option
Interested in a simpler, more convenient way to manage your group benefits program? Our
customer- driven GBA web-based tool lets you handle the fundamental aspects of your
group benefits program. GBA removes the paperwork that slows things down. It also makes
record-keeping quick and easy. What’s more, it puts information at your fingertips when you
need it.
With our GBA web-based tool, you can:
• enrol plan members, update their records, terminate and/or reinstate their coverage
• generate, print and/or save Coverage Summaries and drug cards( if applicable) for plan
members
• view the details of your benefit plan’s coverage and plan set-up
• download and print/save your Contract, Focus Updates, Benefit booklets and other plan
documents
• download and print a wide range of standard guides and forms for administration
• view and print a monthly premium statement at your convenience
Flexible Security
Security is critical when you’re using the Internet to administer your benefit plan. We keep
your data secure and confidential with:
• Strong encryption
• Firewalls
• A high level of physical security at our server site
You also have the flexibility to tailor security levels to suit your needs. For example, you can
choose to limit plan administrators’ access. That way, they can only see data or conduct
transactions for plan members in their location.
All you need
1. Windows 10 or higher
2. 128 bit encryption
3. Microsoft Adobe Acrobat Reader 8.0 or higher
4. The latest browser version with all the applicable security patches installed (We
recommend this for improved security, performance and support.)
5. Access to your browser provider’s website (to verify that you have the latest browser
version available):
• Microsoft Internet Explorer
• Google Chrome
• Mozilla Firefox
• Apple Safari
6. A plan sponsor Access ID and Password
If you are interested in this option of administering your Group Benefits plan, please contact
your Client Service Administrator for more information (see Contact information section
on page 33).

Administration and claim
forms
To help you with the administration of your plan, our standard forms have been posted to our
Plan Sponsor website, under the Guides & Information section, on the Guides & Forms page.
You can also access forms without an Access ID or password. Follow these steps to do so:
Step 1 Go to our website at smallbusiness.sunlife.ca
Step 2 Select “Forms”
Step 3 A list of forms in alphabetical order will be displayed and are available to download
and print

Contact information
As your group benefits partner, we understand your need for quick and easy access to
information on every aspect of your plan. Here’s how you can contact us, whenever you
have a question or concern:
Visit our website at mysunlife.ca to find useful contact information, and other information
you may need.
You can reach SunAdvantage Client Services at:

Phone number:
1-877-786-7227
Fax number:
1-877-823-6605 or (514) 399-1107
Mailing address:
Sun Life Assurance Company of Canada SunAdvantage Department
PO Box 11010 Stn CV
Montreal QC H3C 4T9
Courier:
Sun Life Assurance Company of Canada SunAdvantage Department
1155 Metcalfe St
Montreal QC H3B 2V9
Web site address:

smallbusiness.sunlife.ca
Hours of operation:
8:30 a.m. – 4:30 p.m. EST Eastern, Ottawa and Central Region
9:30 a.m. – 6:30 p.m. EST Western

Life’s brighter under the sun
Group Benefits | sunlife.ca

Group Benefits are provided by Sun Life Assurance Company of Canada,
a member of the Sun Life group of companies. GB10052-E 06-20 ds-mp

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SunAdvantage

Use this guide if Sun Life administers your

Find our guides on our SunAdvantage

Life’s brighter under the sun

Types of plans and effective dates 2

Enrolling in the plan 4

Maintaining plan member records 10

i SunAdvantage Administration Guide – for Sun Life administered group plans

Tax status of employer-paid premiums 17

Plan Sponsor Services – Group Benefits Administration Option 31

Administration and claim forms 32

ii SunAdvantage Administration Guide – for Sun Life administered group plans

We also created two companion guides:

• Health Spending Account Administration Guide

Please refer to the guide related to your plan.

• the plan member’s full name and

Protecting plan members’ privacy

1 SunAdvantage Administration Guide – for Sun Life administered group plans

Determining effective dates

Participation level of 100% (mandatory benefit plan)

Participation level of anything other than 100%

2 SunAdvantage Administration Guide – for Sun Life administered group plans

For coverage that requires proof of good health (see Enrolling

When a plan member refuses coverage

As a result of comparable coverage: Other than for comparable coverage:

Reinstating a former plan member

If your plan has optional benefits

Statement must be completed. Coverage becomes effective:

• on the later of the date the member or dependents are eligible or

3 SunAdvantage Administration Guide – for Sun Life administered group plans

The Enrolment Guide

• a fillable drug and travel card (if applicable)

Certain sections of the Enrolment Guide will not apply if:

More on the Enrolment form

Advise your plan member to complete the non-smoking declaration if:

• your plan has Optional Life with smoker/non-smoker rates

4 SunAdvantage Administration Guide – for Sun Life administered group plans

When proof of good health (Health Statement) is required

• is a late applicant (see Determining effective dates on page 2)

• increase Life coverage by at least 25% of existing coverage or $25,000 – whichever is

Submitting a Health Statement form

Revocable and irrevocable beneficiaries

Changing a beneficiary designation

6 SunAdvantage Administration Guide – for Sun Life administered group plans

Event Additional information

Please ensure that the member does not designate their

• the insurance proceeds may be subject to estate taxes

7 SunAdvantage Administration Guide – for Sun Life administered group plans

Current beneficiary designation Can be changed to

8 SunAdvantage Administration Guide – for Sun Life administered group plans

9 SunAdvantage Administration Guide – for Sun Life administered group plans

Recording plan member changes

• salary changes (when coverage is based on earnings)

Here are the steps in the member change process:

Step 3 We update our systems to show the change.

10 SunAdvantage Administration Guide – for Sun Life administered group plans

• Non-mandatory benefit plan

Adding or removing dependents, newborns, change in

Updating student information

Step 3 We update our systems to show the change.