The RSB Extended Health Plan provides coverage for some medical services and supplies that are not covered under provincial medical plans, such as BC’s Medical Services Plan (MSP).
To enroll in the RSB Extended Health Care Plan, you must be enrolled in a provincial health-care plan.
What is the annual deductible?
You pay an annual deductible of $1,000.
What is the lifetime coverage limit?
The maximum lifetime amount that you will be reimbursed is $200,000 per person enrolled in your benefit plan.
Reimbursement level for eligible expenses
After you have paid your deductible for the benefit year, you will be reimbursed at the following levels up to your lifetime maximum:
- Prescription drugs: 80%*
- Prior Authorization Program (effective April 1, 2017)
- Paramedical services: 80%*
- Medical services and equipment: 80% *
- In-province hospital: 80%*
- Emergency travel assistance (Medi-Passport): 100%
* After you have paid your annual deductible, you will be reimbursed for 80% of the cost of the eligible expenses of each person enrolled in your plan until that person has reached $1,000 in reimbursable expenses for prescription drugs, paramedical services, medical services and equipment, and in-province hospital costs combined. After this, you will then be reimbursed for 100% of that person’s eligible expenses for the remainder of the benefit year.
Please review your specific coverage in the Sun Life Benefits Handbook.
Prescription drugs
To ensure your prescription drug costs are covered, please confirm that you are registered with Fair PharmaCare. Learn more about Fair PharmaCare.
What the plan covers
You will be reimbursed for 80% of the costs of eligible prescription drugs that are prescribed by a physician or dentist and are obtained from a pharmacist. You can fill a three-month supply of eligible drugs at a time.
Sun Life will cover the cost of prescription drugs up to the cost of the lowest-priced generic equivalent; unless your doctor specifies in writing that no substitution for the prescribed drug may be made.
What the plan does not cover
The plan does not cover all drugs or medicines, even when they are prescribed. Some examples of what is not covered include over-the-counter drugs, preventive drugs and vaccinations, the cost of giving injections, vitamins, natural health products, treatments for weight loss if not medically necessary, hair growth stimulants, oral contraceptives, products to help you quit smoking or erectile dysfunction or fertility drugs.
You can review your specific coverage in the Sun Life Benefits Handbook.
Prior authorization program
Effective April 1, 2017, Sun Life is adding the prior authorization program to Extended Health benefits plans 2 and 3
What is it?
Prior authorization requires that coverage for certain drug therapies be pre-approved based on certain criteria. Sun Life is committed to continued group drug plan sustainability and plan member drug choice. The prior authorization program’s aim is to focus on monitoring claims for speciality drugs or treatments and ensure that plan members are getting reimbursement for the right drugs when needed.
How does it work?
If the drug your doctor prescribes for you needs prior authorization, send Sun Life a completed prior authorization form before filling your prescription. Sun Life will review your request, usually within five business days, and let you know in writing if you are approved and the duration of your approval period. You can also visit mysunlife.ca/priorauthorization and enter your group Contract Number: 020605 for a list of included drugs and forms.
Adding prior authorization to your group benefits plan will help keep drug plan costs down, making extended health care more affordable for plan members into the future.
Any questions? Contact Sun Life directly at 1-800-361-6212.
Paramedical services
What the plan covers
You will be reimbursed for 80% of the costs of services of some paramedical practitioners. There is a maximum annual cost specified for each discipline.
The practitioners covered under the plan are:
- licensed psychologist ($100 for each person per benefit year) when ordered by a doctor or nurse practitioner (if applicable provincial law permits nurse practitioners to prescribe this service);
- licensed speech therapist, acupuncturist, podiatrist or chiropodist ($100 for each person per benefit year);
- licensed physiotherapist (no doctor’s referral required) or massage therapist (doctor’s or nurse practitioner's referral required), up to a maximum of $250 for each person per benefit year;
- licensed naturopath or chiropractor ($200 for each person per benefit year).
If you are receiving services from a licensed psychologist or massage therapist, you must obtain a doctor’s or nurse practitioner's referral for these services every 12 months.
Paramedical practitioner qualifications
The cost of paramedical services will only be covered if the paramedical practitioner meets specific qualifications/designations for their profession and they are licensed/registered with an appropriate regulatory body or society where the service is received (in Canada or the United States only). For example, in British Columbia, you will only be reimbursed for the cost of the services provided by a Naturopath with an N.D. (Doctor of Naturopathic Medicine) designation and who is licensed/registered with the College of Naturopathic Physicians of British Columbia.
Click here for a complete list of the acceptable qualifications/designations and regulatory bodies and societies for all paramedical practitioners in British Columbia.
Reasonable and customary charges
Medical services providers and suppliers charge a range of fees for certain services, including paramedical services.
Sun Life will determine “reasonable and customary” charges as the basis for reimbursing your paramedical claims, which are also subject to the reimbursement level and maximum amounts specified under the Extended Health Plan. Sun Life outlines the reasonable and customary charges by paramedical practitioners in each province in the Reasonable & Customary Charges for Paramedical Services document. If your practitioner charges more than this, you are responsible for this additional cost.
What the plan does not cover
The plan does not cover the services of religious or spiritual healers; occupational therapists; psychologist testing; or services of a kinotherapist, reflexologist, sexologist, sex therapist or shiatsu specialist.
You can review your specific coverage in the Sun Life Benefits Handbook.
Medical services and equipment
What the plan covers
You will be reimbursed for 80% of the costs of a wide variety of medical services and equipment when ordered by a doctor, dentist or nurse practitioner (if applicable provincial law permits nurse practitioners to prescribe or order certain supplies or services.
The plan covers services that include:
- private duty nursing care in hospital if medically necessary,
- transportation in a licensed ambulance or air ambulance,
- accidental dental services,
- equipment recommended for therapeutic use, such as wheelchairs, insulin pumps, blood transfusions and dialysis machines.
If the cost of these services is more than $5,000, you must receive pre-authorization from Sun Life. Other services and equipment also require pre-authorization from Sun Life, no matter the cost. Please see your Sun Life Benefits Handbook for details.
What the plan does not cover
The cost of some services and equipment is not covered under the plan, even when a doctor prescribes them. These include experimental treatments, personal comfort items, services and supplies for cosmetic purposes, or the services of a licensed practical nurse.
In-province hospital
What the plan covers
You will be reimbursed for 80% of the cost difference between a room on a general hospital ward (covered by MSP) and a semi-private or private hospital room.
What the plan does not cover
The plan does not cover:
- hospital outpatient fees for out-of-province emergency claims,
- care in a nursing home, hospice or rest home,
- care in an alcohol or drug abuse treatment centre, even if it is located in a hospital,
- user fees, and
- costs associated with public ward accommodation or rest cures.
Emergency out-of-province and out-of-country medical care
What the plan covers
You will be reimbursed for 100% of the costs of out-of-province emergency doctor and hospital services obtained within 90 days of the date you leave your home province. An emergency is an acute, unexpected condition, illness, disease or injury that requires immediate assistance.
If you or a dependent are hospitalized during this period, the cost of in-patient hospital services is covered for 90 days. This 90-day limit will be extended if transporting the patient back home would be a risk to their life.
Some of the emergency expenses covered in this category include:
- a semi-private hospital room,
- other hospital services provided outside of Canada,
- out-patient services in a hospital, and
- the services of a doctor.
If you or a dependent are hospitalized while travelling outside of BC, the cost of in-patient hospital services is covered for 90 days. This 90-day limit will be extended if transporting the patient back home would be a risk to their life.
In addition to emergency doctor and hospital services, emergency expenses for all other services or supplies eligible under this plan are also covered outside of BC as if you had incurred the expense in BC. For example, emergency prescription drug expenses will be reimbursed as if you had made the drug purchase in BC.
You are also covered for other emergency travel assistance services through Medi-Passport, which is provided by Sun Life’s travel benefit provider, Global Excel Management. These services include:
- referrals to physicians, pharmacists and medical facilities,
- transportation home or to a different medical facility,
- travel expenses if stranded by a medical emergency,
- repatriation, and
- assistance with lost luggage or documents.
What the plan does not cover
The plan does not cover the cost of emergency medical services:
- obtained after 90 days have passed since you left BC,
- for pre-existing conditions that require continuous or routine medical care while outside your home province, or
- required for injury or illness resulting from hostile action of any armed forces or from participating in a riot.
Carry your card with you when you travel
We recommend that you carry your Medi-Passport card with you when you travel. It contains telephone numbers and the information needed to confirm your coverage and receive assistance.
To obtain your Medi-Passport card:
Learn more
To learn more about what to do if you need to seek medical assistance while travelling, how to submit claims and other information, please:
- refer to Sun Life’s brochure, and
- review the resources on this site under the Benefits While Travelling section, keeping in mind that the lifetime maximum coverage and length of travel time covered are different for active employees enrolled in the UBC Extended Health Plan and individuals enrolled in the RSB Program.