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Health and Health Plus

The plan year for Health and Health Plus is Jan. 1 to Dec. 31. Your plan will automatically renew each year. You have 180 days after the end of the benefit year (Dec. 31) to submit your claim expenses that were incurred during that benefit year.

Co-insurance for Health Insurance refers to the portion that is paid by the insurance company. For example, a 90 per cent co-insurance means the insurer pays 90 per cent and you pay 10 per cent.

Benefit

Health

Health Plus

Plan maximum (lifetime reimbursement)

Lifetime limits on expenses per insured person:

  • $2,000,000 emergency out of province/country travel medical

  • $1,000,000 prescription drugs. Thereafter, with annual reinstatement of $25,000 per person for drugs, if the lifetime maximum is reached

Co-insurance

  • For the first $1,000 you claim, your insurance will reimburse you 50 per cent of your eligible claims. Once you claim more than $1,000, you are reimbursed at 90 per cent, up to the limits stated in the policy

  • For the first $1,000 claimed by all of your eligible dependents combined, your insurance will reimburse 50 per cent of their eligible claims. Once they claim more than $1,000 combined, the coverage is 90 per cent, up to the limits stated in the policy

This applies to prescription drugs, in-province hospital and convalescent hospital expenses, ambulance, nursing, medical equipment and services, paramedical services and hearing aids.

  • Your insurance will reimburse you 90 per cent of your eligible claims, up to the limits and caps stated in the policy

  • Claims for your dependents will be reimbursed at 90 per cent, up to the limits and caps stated in the policy

This applies to prescription drugs, ambulance, nursing and paramedical services.

Accidental Dental

  • Expenses incurred within three years of accident

  • $10,000 for any one dental accident

Ambulance

  • Unlimited ground and air ambulance

Emergency out-of-province / country travel medical

  • 100 per cent of the cost of emergency services while outside your home province

  • Coverage for pre-existing medical conditions with no exclusions

  • Lifetime maximum of $2,000,000 per insured person

  • Coverage for the first 90 days of travel if under age 70

  • Coverage for the first 30 days of travel if age 70 or over

Learn more about Emergency Travel Assistance.

Need more coverage to protect your entire trip? You can use the Emergency Medical Top-Up Plan. Learn more about the Top-Up Plan.

Hearing aids

  • $500 every four plan years

  • $1,000 every four plan years

Hospital

  • Room and board charges between standard ward and semi-private rate

  • Room and board charges between standard ward and semi-private rate plus up to $100 per day for private room accommodation

Convalescent hospital

  • Room and board charges if admitted within 24 hours following a period as an in-patient in a hospital (180 day maximum)

Rehabilitative facility

  • Room and board charges between standard ward and semi-private or private rate up to $200 per day to a maximum of $14,000 per lifetime

Medical equipment

  • Wheelchairs: $5,000 lifetime maximum, and expenses are limited to the use of a manual wheelchair except if the insured’s medical condition warrants the use of an electric wheelchair

  • Hospital beds: $5,000 lifetime maximum

  • $5,000 maximum per plan year for purchase of braces, crutches, canes, and walkers as a result of illness or injury

  • Wheelchairs: $5,000 every five plan years, and expenses are limited to the use of a manual wheelchair except if the insured’s medical condition warrants the use of an electric wheelchair

  • Hospital beds: no lifetime maximum

  • $5,000 maximum per plan year for purchase of braces, crutches, canes, and walkers as a result of illness or injury

Paramedical services

$350 per plan year per practitioner, per insured person. 

  • Physician’s order not required for:

    • Licensed chiropractor

    • Osteopath

    • Acupuncturist

    • Podiatrist

    • Licensed naturopath

    • Chiropodist

    • Speech therapist

    • Kinesiologist

    • Registered massage therapist

    • Physiotherapist ($1,000 per plan year per insured person)

  • $10,000 maximum for mental health services provided by an approved provider, either in person or online

$500 per plan year per practitioner, per insured person.

  • Physician’s order not required for:

    • Licensed chiropractor

    • Osteopath

    • Acupuncturist

    • Podiatrist

    • Licensed naturopath

    • Chiropodist

    • Speech therapist

    • Kinesiologist

    • Audiologist

    • Occupational therapist

    • Dietitian

    • Registered massage therapist

    • Physiotherapist ($1,000 per plan year per insured person)

  • $10,000 maximum for mental health services provided by an approved provider, either in person or online

Pharmacogenomic testing

  • One test per lifetime to a maximum of $500 when prescribed by a medical doctor for a medical diagnosis that is supported by pharmacogenomics testing. The test must be performed by an accredited laboratory

Prescription drugs

  • Generic drugs (or brand name drugs when no generic equivalent is available) listed in federal or provincial drug schedules that have a Drug Identification Number (DIN) and require a prescription

  • $1,000,000 lifetime maximum per insured. Once lifetime maximum is reached, annual $25,000 maximum reinstated

  • Injectable drugs, vitamins and allergy serums

  • Vaccines, whether or not they require a prescription

  • Fertility drugs up to $2,400 lifetime maximum

  • Diabetic supplies

Prescription drugs (dispensing fee)

  • Eligible expenses for the dispensing fee are limited to 50 per cent of up to $10 for each prescription or refill. The reimbursement level is increased to 90 per cent once the out-of-pocket maximum for prescription drug expenses has been reached

  • Eligible expenses for the dispensing fee are limited to 90 per cent of up to $11 for each prescription or refill

Private duty nursing

  • Licensed, certified or registered nurse or nursing assistant who is not a relative of the patient or a resident in the insured’s home

  • Prescribed by a physician and rendered outside the hospital

  • $25,000 every three consecutive plan years, if age 65 or under

  • $5,000 per plan year if over age 65

Medical services

  • Laboratory tests, ultrasounds and other medical imaging services, blood oxygen, colostomy and ileostomy supplies, artificial limbs and eyes, radiotherapy, diabetic supplies and cosmetic surgery necessary to repair disfigurement due to an accident sustained while insured, up to $5,000 per plan year (some restrictions apply)

  • Breast prosthesis, $500 maximum per two plan years, per insured person

  • Mastectomy brassieres, two per plan year, per insured person

  • Surgical stockings, two pairs per plan year, per insured person

  • Amputation socks, five pairs per plan year, per insured person

  • Wigs following chemotherapy, $500 lifetime maximum, per insured person

  • Continuous glucose monitors

  • Insulin pumps

  • Colostomy supplies

  • Orthopedic shoes and orthopedic modifications, and orthotics, maximum $400 per insured person in two plan years

  • Requires a doctor’s prescription

  • Laboratory tests, ultrasounds and other medical imaging services, blood oxygen, colostomy and ileostomy supplies, artificial limbs and eyes, radiotherapy, diabetic supplies and cosmetic surgery necessary to repair disfigurement due to an accident sustained while insured, up to $5,000 per plan year (some restrictions apply)

  • Breast prosthesis, $500 maximum per two plan years, per insured person

  • Mastectomy brassieres, two per plan year, per insured person

  • Surgical stockings, two pairs per plan year, per insured person

  • Amputation socks, five pairs per plan year, per insured person

  • Wigs following chemotherapy, $500 lifetime maximum, per insured person

  • Continuous glucose monitors

  • Insulin pumps

  • Colostomy supplies

  • Orthopedic shoes and orthopedic modifications, and orthotics, plus custom-made orthotic inserts for shoes or custom-made orthopedic shoes or modification to orthopedic shoes, up to a combined maximum of $300 per insured person per plan year

  • Requires a doctor’s prescription

  • Contact lenses or intraocular lenses following cataract surgery, limited to a lifetime maximum of one lens per eye

Vision care

Not included

For any insured person, in two plan years, this can include:

  • $50 maximum per insured person every two plan years for ophthalmologist or licensed optometrist services

  • $300 per insured person under age 18 in a 12-month period or for any other covered person in any 24-month period. This can include:

    • Contact lenses, eyeglasses or laser eye correction surgery (laser eye correction surgery must be performed by an ophthalmologist)

    • Requires prescription by an ophthalmologist or licensed optometrist

    • Prescription sunglasses, magnifying glasses or safety glasses for the correction of vision

    • For coverage following cataract surgery, refer to medical services above

Your coverage information is always close at hand

By visiting mysunlife.ca or using the Sun Life mobile app, you can:

  • Find out what your health plans cover

  • Submit claims for instant processing

  • Submit a copy of a receipt

  • Easily check the status of your claims

  • Get help faster by calling us from within the app — we’ll have your plan details ready to go

  • Have your coverage cards handy wherever you go, view them on the app or save them to Apple Wallet

  • Use the drug look-up tool to find out how much of your prescription drug costs are covered and more

If you don’t have the my Sun Life mobile app, you can still file a claim by visiting mysunlife.ca or completing an Extended Health Care Claim Form (for health claims only).

For details on changing between Health and Health Plus, see your benefits booklet or contact one of our OMA Insurance s​ervice representatives, who will be happy to help you.​


OMA Health and Health Plus is underwritten by Sun Life Assurance Company of Canada. Sun Life Assurance Company of Canada is the insurer of this product and is a member of the Sun Life group of companies. For inquiries, please call Sun Life’s Client Care Centre at 1-800-758-1641, Monday to Friday, 8 a.m. to 8 p.m. ET. or visit www.sunlife.ca.

For complete details regarding coverage, please see the terms and conditions of Policy 17884. If there is any conflict between this document and the wording of the policies (or the certificate), the wording of the policies will govern. A copy of the policy may be requested.

Exclusions and limitations may apply.