Benefits Booklet

Contract Number: 102350 and 151350
Effective: December 1, 2023

Issued: December 14, 2023
Koch-Glitsch Canada LP
Class C1 - Hourly members of Koch-Glitsch Canada LP
Table of Contents
How to Connect with Sun Life Financial 3
Benefit Summary 5
Making Claims 9
General Information 12
Extended Health Care 17
Emergency Travel Assistance 26
Dental Care 30
Long-Term Disability 38
Life Coverage 42
Accidental Death and Dismemberment 43
Your Group Benefits (C1) 2

How to Connect with Sun Life Financial
Questions?
We’re here to help. Talk to a Sun Life Financial Customer Care representative for assistance with your coverage by
calling toll-free at 1-866-881-0583.
For faster service, have your group contract number and member ID ready to enter into our automated telephone
system.
Plan Member Services

Download the my Sun Life Mobile App!
• Free from the Apple App Store or Google Play, anytime
• Fast and easy access, wherever you go, to your benefit information
• View and/or submit mobile claims instantly, depending on your plan
Don’t have a smartphone? Visit www.mysunlife.ca to obtain the following services:
• benefit information about coverage, claim status, and easy access to claim forms and/or e-claims, depending on
your plan
• chat live with an agent
• send a secure email message to the Sun Life Financial Customer Care Centre
• contact information
Access to mysunlife website

The first time you access your group benefits online, you will need to register to get your personal access ID and
password. To register you will need your group contract number and member ID.
Prior Authorization Program

For the form:
• visit our website at www.mysunlife.ca/priorauthorization
• call a Sun Life Financial Customer Care representative toll-free at 1-866-881-0583
For the list of drugs:
• visit our website at www.mysunlife.ca/priorauthorization
Your Drug Card

Provided by Sun Life or online at www.mysunlife.ca.
Note: If you have refused Extended Health Care coverage under this plan, this drug card does not apply to you.
Your Travel Card

Provided online at www.mysunlife.ca.
Note: If you have refused Extended Health Care coverage under this plan, this travel card does not apply to you.

Need to contact Sun Life’s Emergency Travel Assistance provider?
In the USA and Canada, call: 1-800-511-4610.
All other inquiries

Call 1-866-881-0583.

Benefit Summary
This is a summary of the coverage your plan provides. You should read it together with the information in the rest of
this booklet. Please see the related sections of this booklet for more information, including exclusions, limitations and
other conditions that apply to your plan.
General Information
We, our and us Throughout this booklet, we, our and us mean Sun Life Assurance Company of Canada
Waiting period 3 months of continuous employment
Any period during which you do not meet the eligibility requirements cannot be counted
as part of the waiting period
Termination Termination of coverage may vary from benefit to benefit as indicated in this Benefit
Summary. Coverage may also end on an earlier date, as specified in the General
Information section of this booklet.
Extended Health Care - Contract Number 151350

Benefit year January 1 to December 31
Deductible None
Reimbursement level
Drug card plan Included
Prescription drugs 80%
Drugs covered under this plan must have a Drug Identification Number (DIN) and be
approved under Drug evaluation
We will cover the following drugs and supplies that are prescribed by a doctor or dentist
and are obtained from a pharmacist:
• drugs that legally require a prescription
• life-sustaining drugs that may not legally require a prescription
• injectable drugs and vitamins
• compounded preparations, provided that the principal active ingredient is an eligible
expense and has a DIN
• diabetic supplies
• products to help a person quit smoking that legally require a prescription, up to a
lifetime maximum of $500 per person
• vaccines
• intrauterine devices (IUDs) and diaphragms
• colostomy supplies
• varicose vein injections

There are drugs and treatments that are not covered, even when prescribed. Please
refer to the Extended Health Care section of this booklet for details.
Other health professionals We reimburse certain drugs prescribed by other qualified health professionals the same
allowed to prescribe way as if the drugs were prescribed by a doctor or a dentist if the applicable provincial
drugs legislation permits them to prescribe those drugs.
Drug substitution limit We will not cover charges above the lowest priced equivalent drug unless we
specifically approve them. To assess the medical necessity of a higher priced drug, we
will require the covered person and the attending doctor to complete and submit an
exception form.
In-province hospital 100% of the difference between the cost of a ward and a semi-private room
Convalescent hospital 100% of the difference between the cost of a ward and a semi-private room, up to $20
per day for a maximum of 180 days for treatment of an illness due to the same or
related causes
Out-of-province 100%
emergency services Emergency Travel Assistance included
Time limit – 60 days after the date the person leaves the province where the person
lives
Lifetime maximum of $1,000,000 per person for out-of-province services
Out-of-province referred 80%

services
Medical services and 100%

equipment
Paramedical services 100% up to a maximum of $500 per person per benefit year per specialty for the
qualified paramedical practitioners listed below:
• psychologists
• massage therapists
• speech therapists
• physiotherapists
• naturopaths
• acupuncturists
• osteopaths or osteopathic practitioners, including a maximum of one x-ray
examination each benefit year
• chiropractors, including a maximum of one x-ray examination each benefit year
• podiatrists or chiropodists, including a maximum of one x-ray examination each
benefit year
Vision care 100% up to a maximum of $200 per person in any 24 month period
Termination When you retire
Dental Care - Contract Number 151350

Benefit year January 1 to December 31
Deductible Individual – $25 per benefit year

Family – $50 per benefit year

Fee guide The current fee guide for general practitioners in the province where the employee lives,
regardless of where the treatment is received
Reimbursement level
Preventive procedures 80% after the deductible
Basic procedures Periodontics and TMJ procedures – 50% after the deductible
Other procedures – 80% after the deductible
Major procedures 50% after the deductible
Orthodontic procedures 50%, without the deductible, only for children under age 19
Maximum benefit
Benefit year maximum $2,500 per person
If your coverage starts in the second half of a benefit year, the maximum amount for
that benefit year will be reduced by 50%
A separate lifetime maximum (below) applies to Orthodontic expenses
Lifetime maximum Orthodontic procedures – $1,500 per person
Termination When you retire
Long-Term Disability - Contract Number 102350

Maximum amount 66.7% of the first $2,500 of your monthly basic earnings, plus 40% of the balance of
your monthly earnings, up to a maximum benefit of $4,000
The maximum amount may be reduced by benefits and payments provided from other
sources as described in the Long-Term Disability section of this booklet
Elimination period 26 weeks
Maximum benefit The period ending on the last day of the month in which you reach age 65
period Benefits may also end on an earlier date as specified in the Long-Term Disability
section of this booklet
Termination The day you reach age 65 less the elimination period or the day you retire, whichever is
earlier
Tax status Your employer has indicated that this disability plan is an employee-pay-all plan which
means all required premium is paid by the employees covered under the plan.
Therefore, the benefit payments are not taxable income.

Life - Contract Number 102350
Employee Basic Life
Amount 1 times your annual basic earnings rounded to the next higher $1,000
Maximum – $250,000
Reduction Coverage is reduced to $5,000 when you reach age 65
If you continue, or begin, to work after having reached age 65, we calculate the amount
for which you would have been eligible if you had not already reached age 65, then, we
apply the above reduction clause to calculate the amount for which you are eligible.
Termination When you retire or reach age 70, whichever is earlier
Employee Optional Life
Amount You can choose coverage in units of $10,000

Maximum – $500,000
Proof of good health Approval required on the initial optional amount of coverage, except for the first $30,000
if enrolment is made within 31 days of the eligibility date, and any increase in that
coverage requested by the employee
Spouse Optional Life
Amount You can choose coverage in units of $10,000

Maximum – $500,000
Proof of good health Approval required on the initial optional amount of coverage and any increase in that
coverage requested by the employee
Termination When you retire or reach age 65, or when your spouse reaches age 65, whichever is
earlier
Accidental Death and Dismemberment - Contract Number 102350
Employee Accidental Death and Dismemberment
Amount Equal to Employee Basic Life coverage

Making Claims
There are time limits for making claims. You can find more on these time limits in the following chart. If you fail to
meet these time limits, you may not be entitled to some or all benefit payments.
To assess a claim, we may ask you to send us the following documents:
• medical records or reports
• proof of payment
• itemized bills
• prescriptions
• other information we need.
Proof of claim is at your expense.
Instructions and Time Limits for Sending Us Your Claims
Use this handy reminder to help you meet the time limits for sending in your claim.
Type of claim Starting the claims process Limits and special instructions
Extended Health Care Ask Sun Life for the form to Up to the earlier of the following
complete, or get the form on our dates:
website. • 90 days after the end of the
benefit year during which the
You can also submit claims for expense is incurred, or
some expenses electronically. For • 90 days after the end of your
more information, ask Sun Life. Extended Health Care
coverage.
Emergency Travel Assistance Contact Sun Life’s Emergency Having expenses reimbursed: To
Travel Assistance provider to notify have services or supplies
them that a medical emergency reimbursed that either you or
exists. another covered person have paid
for, proof of the expenses must be
provided to us within 30 days of the
person’s return to the province
where the person lives.
Refer to Reimbursement of
expenses under the Emergency
Travel Assistance section for further
details.

Dental Care Ask Sun Life for the form to Up to the earlier of the following
complete, or get the form on our dates:
website. • 90 days after the end of the
benefit year during which the
The dentist will have to complete a expense is incurred, or
section of the form. • 90 days after the end of your
Dental Care coverage.
You can also submit claims for
some expenses electronically. For If we consider it needed, we can
more information, ask Sun Life. require that you give us the
dentist’s statement of the treatment
received, pre-treatment x-rays and
any other related information.
For orthodontic procedures, a

treatment plan will need to be
submitted to us.
Long-Term Disability Ask your employer for the claim You should submit your proof of
forms and ensure that the following claim at least 8 weeks prior to the
people complete them: completion of your elimination
• you, period, but in no event later than 90
• your attending doctor, and days after the end of your
• your employer. elimination period.
The submission of these forms is If your Long-Term Disability

your proof of claim. coverage terminates, you must
advise us of the claim within 30
days of the date the coverage
terminates.
We will assess the claim and send

you or your employer a letter
outlining our decision.
From time to time, we can require

that you provide us with proof of
your continued total disability. We
must be provided with this
information within 90 days of the
request.

Life and Accidental Death and Ask Sun Life to provide the claim If the claim is a result of a death:
Dismemberment coverage forms. We must receive the claim form as
soon as possible after the death
occurred.
For any loss other than death:

We must receive the claim form
within 12 months after the loss.
For coverage during total

disability: We must receive the
proof of total disability within 12
months of the date the disability
begins. After that, we can require
that you provide us with ongoing
proof that you are still totally
disabled.

General Information
The information in this employee benefits booklet is important to you. It provides the information you need
about the group benefits available through your employer’s group contract with Sun Life Assurance Company of
Canada (Sun Life), a member of the Sun Life Financial group of companies.
This booklet is only a summary of your employer’s group contract. If there are any discrepancies between the group
contract and the information in this booklet, the group contract will take priority, to the extent permitted by law.
Your group benefits may be modified after the effective date of this booklet. We will notify you in writing of any
changes to your group plan. Any such notices will become part of this group benefits booklet and you should keep
them in a safe place together with this booklet.
Have questions? Need more information about your group benefits? Talk to Sun Life.
Your group benefits The contract holder, INVISTA Canada Company, self-insures the following benefits:
• Extended Health Care
• Emergency Travel Assistance
• Dental Care
This means INVISTA Canada Company has the sole legal and financial liability for the
benefits listed above and funds the claims. Sun Life provides administrative services
only (ASO) such as claims adjudication and claims processing. All other benefits are
insured by Sun Life.
Who is eligible to To be eligible for group benefits, you must reside in Canada and meet all the following
receive benefits? conditions:
• you are a permanent employee working in Canada.
• you are actively working for your employer at least 30 hours a week.
• you have completed the waiting period indicated in the Benefit Summary.
Your dependents become eligible for coverage on the later of the following dates:
• on the date you become eligible for coverage, or
• on the date they become your dependent.
You must apply for coverage for yourself in order for your dependents to be eligible.
Who qualifies as your Your dependent must be:

dependent • your spouse or your child, and
• residing in Canada or the United States.
Your spouse qualifies as your dependent if they are your spouse in one of the following
ways:
• by marriage.
• under any other formal union recognized by law.
• as your partner of the opposite sex or of the same sex who is living with you and
has been living with you in a conjugal relationship for at least 12 months.
You can only cover one spouse at a time.
Your children and your spouse's children (other than foster children) are eligible
dependents if they are under age 21 and do not have a spouse.

A child who is a full-time student under age 25 is also considered an eligible dependent
as long as the child is dependent on you for financial support and does not have a
spouse.
If a child becomes disabled before the maximum age and remains continuously
disabled, we will continue coverage if they are not able to support themselves financially
because of a disability and must rely on you financially. The exception is if they have a
spouse.
In these cases, you must inform Sun Life within 6 months of the date the child attains
the maximum age for this plan. Ask Sun Life for more on this.
How to enrol For you – You must provide the proper enrolment information to Sun Life.
For a dependent – You must ask for dependent coverage.
If you or your dependents already have similar Extended Health Care or Dental Care
coverage under this or another plan – You may refuse this coverage under this plan. If
the other coverage ends at a later date, you can enrol for coverage under this plan then.
You will need to provide proof of good health for the benefits listed below, as outlined in
the Benefit Summary section at the beginning of this booklet. This coverage will not
start before Sun Life has approved this proof of good health.
• Employee Optional Life
• Spouse Optional Life
When coverage Your coverage begins on the date you become eligible for coverage.
begins
If you are not actively working on the date coverage would normally begin, your
coverage will not begin until you return to active work.
A dependent’s coverage begins on the later of the following dates:

• the date your coverage begins.
• the date you first have a dependent.
If you are not actively working on the date your spouse's Optional Life coverage would
normally begin, then that coverage will not begin until you return to active work with your
employer.
Changes affecting If proof of good health is required, the change cannot take effect before Sun Life
your coverage approves the proof of good health.
If you are not actively working when an increase in coverage occurs or when Sun Life
approves proof of good health, the change cannot take effect before you return to active
work.
Updating your To ensure that coverage is kept up-to-date, it is important that you report any of the
records following changes to Sun Life:
• change of dependents.
• change of name.
• change of beneficiary.

Accessing your You may request copies of your records, including:
records • your enrolment form or application for insurance.
• any written statements or other record about your health that you provided to
Sun Life in applying for coverage.
• one copy of the insured contract.
We will not charge you for the first copy but we may charge a fee for further copies.
Need a copy of a document? Contact one of the following:

• our website at www.mysunlife.ca.
• our Customer Care centre, toll-free at 1-866-881-0583.
When coverage ends As an employee, your coverage will end on the earlier of the following dates:
• the date your employment ends or you retire.
• the date you are no longer actively working.
• the end of the period for which premiums have been paid to Sun Life for your
coverage.
• the date the group contract or the benefit provision ends.
A dependent’s coverage terminates on the earlier of the following dates:

• the date your coverage ends.
• the date the dependent is no longer an eligible dependent.
• the end of the period for which premiums have been paid for dependent coverage.
The end of coverage may vary from benefit to benefit. For information about a specific
benefit, please refer to the Benefit Summary section at the beginning of this booklet.
If you die while covered by this plan

Coverage for your dependents will continue until the earlier of the following dates:
• 24 months after the date of your death.
• the date the person would no longer be considered your dependent under this plan if you were still alive.
• the date your coverage would have terminated if you were still alive.
• the date the benefit provision under which the dependent is covered ends.
When dependent coverage continues, it is subject to all other terms of the plan.
The continuation of coverage does not apply to the spouse’s Optional Life.
Legal actions for insured benefits

Limitation period for Ontario:
Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is
absolutely barred unless commenced within the time set out in the Limitations Act, 2002.
Limitation period for any other province:
Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is
absolutely barred unless commenced within the time set out in the Insurance Act or other applicable legislation of
your province or territory.
Legal actions for self-insured benefits

Where the applicable legislation of your province or territory permits the use of a different limitation period, every
action or proceeding for the recovery of money payable under the plan is absolutely barred unless it is commenced
within one year of the date that we must receive your claim forms. Otherwise, every action or proceeding for the
recovery of money payable under the plan must be commenced within the time set out in the applicable legislation of

your province or territory.
Proof of disability
From time to time, Sun Life can require that you provide us with proof of your continued total disability. If you do not
provide this information within 90 days of the request, you may not be entitled to some or all benefit payments.
Coordinating your benefits with another plan

If you or your dependents are covered for Extended Health Care or Dental Care under this plan and another plan,
the maximum amount that you can receive from all plans is 100% of the total eligible expenses.
When you have more than one plan, insurance industry standards determine which plan you should claim expenses
from first.
Please send in claims for you and your spouse in the following order:
• First, send in the claim to the plan where the person is covered as an employee. If the person is an employee
under two plans, send the claim to the different plans in the following order:
• to the plan where the person is covered as an active full-time employee.
• then, to the plan where they are covered as an active part-time employee.
• then, to the plan where they are covered as a retiree.
• Next, send the claim to the plan where the person is covered as a dependent.
Please send in claims for a child in the following order:
• First send in the claim to the plan where the child is covered as an employee.
• Then, to the plan where they are covered under a student health or dental plan through their educational
institution.
• Then, to the plan of whichever parent has the earlier birth date (month and day) in the calendar year. For
example, if your birthday is May 1 and your spouse's birthday is June 5, you must claim under your plan first.
When you send us a claim, you must tell us about all other equivalent coverage that you or your dependents have.
Medical examination
We may require that you or your dependent have a medical examination if you make a claim. We will pay for the
examination. If the person fails or refuses to have an examination, we will not pay any benefits.
Recovering overpayments
If we have overpaid any amount of benefit, we have the right to recover this money. We will:
• ask you to reimburse us,
• deduct that amount from other benefit payments, or
• recover that amount by any other legal means available.
Assignments
For Life benefits – You may not assign any rights or interests to anyone.
For all other benefits – We reserve the right to deny your request for an assignment.
Definitions
Here are the definitions of some terms that appear in this employee booklet. Other definitions that describe specific
benefits appear in the benefit sections.
Accident An accident is a bodily injury that occurs solely as a direct result of a violent, sudden
and unexpected action from an outside source.

Appropriate treatment Appropriate treatment is defined as any treatment that is performed and prescribed by a
doctor or, when Sun Life believes it is necessary, by a medical specialist. It must be the
usual and reasonable treatment for the condition and must be provided as frequently as
is usually required by the condition. It must not be limited solely to examinations or
testing.
Basic earnings Basic earnings are the salary you receive from your employer excluding any bonus,
overtime or incentive pay.
Doctor A doctor is a physician or surgeon who is licensed to practice medicine where that
practice is located.
Illness An illness is a bodily injury, disease, mental infirmity or sickness. Any surgery needed to
donate a body part to another person which causes total disability is an illness.
Retirement date If you are totally disabled, your retirement date is your 65th birthday, unless you have
actually retired before then.

Extended Health Care
General description of the coverage
The contract holder has the sole legal and financial liability for this benefit. Sun Life only acts as administrator on
behalf of the contract holder.
In this section, you means the employee and all dependents covered for Extended Health Care benefits.
Extended Health Care coverage pays for eligible expenses that you incur while covered under this plan.
Eligible expenses mean expenses incurred for the services and supplies described below that are medically
necessary for the treatment of an illness and do not exceed the reasonable and customary charges for the service or
supply being claimed. However, there are additional eligibility requirements that apply to drugs (see Prior
authorization program for details).
Medically necessary means generally recognized by the Canadian medical profession as effective, appropriate and
required for treating an illness according to Canadian medical standards.
Reasonable and customary charges mean:

• fees and prices normally charged in the regional area where the services or supplies are provided, and
• charges for services and supplies that represent reasonable treatment, considering the duration of services and
how frequently services and supplies are provided.
To qualify for this coverage you must be entitled to benefits under a provincial medicare plan or federal government
plan that provides similar benefits.
Reference to Doctor may also include a nurse practitioner – If the applicable provincial legislation permits nurse
practitioners to prescribe or order certain supplies or services, Sun Life will reimburse those eligible services or
supplies prescribed or ordered by a nurse practitioner the same way as if they were prescribed or ordered by a
doctor. For drugs, refer to Other health professionals allowed to prescribe drugs outlined in the Benefit Summary.
Claiming when the You must claim an expense for the benefit year in which you incur the expense. You
expense is incurred incur an expense on the date you receive the service or purchase or rent supplies.
The benefit year is indicated in the Benefit Summary.
See the table Instructions and Time Limits for Sending Us Your Claims at the
beginning of this booklet for information about when and how to make a claim.
Reimbursement level Claims will be paid up to the reimbursement level under this plan.
For each type of service listed below, the reimbursement level is indicated in the
Benefit Summary.
Prescription drugs
Prescription drugs We will cover the cost of the drugs and supplies that are listed in the Benefit Summary.
Quantity limit Payments for any single purchase are limited to quantities that can reasonably be used
in a 34 day period or, in the case of certain maintenance drugs, in a 100 day period as
ordered by a doctor.

What is not covered We will not pay for the following, even when prescribed:
• infant formulas (milk and milk substitutes), minerals, proteins, vitamins and collagen
treatments.
• the cost of giving injections, serums and vaccines.
• treatments for weight loss, including drugs, proteins and food or dietary
supplements.
• hair growth stimulants.
• drugs for the treatment of infertility.
• drugs for the treatment of sexual dysfunction.
• drugs that are used for cosmetic purposes.
• natural health products, whether or not they have a Natural Product Number (NPN).
• drugs and treatments, and any services and supplies relating to the administration of
the drug and treatment, administered in a hospital, on an in-patient or out-patient
basis, or in a government-funded clinic or treatment facility.
Drug evaluation The following drugs will be evaluated and must be approved by us to be eligible for
coverage:
• drugs that receive Health Canada Notice of Compliance for an initial or a new
indication on or after November 1, 2017.
• drugs covered under this plan and subject to a significant increase in cost.
Drug expenses are eligible for reimbursement only if incurred on or after the date of our
approval.
We will assess the eligibility of the drug based on factors such as:
• comparative analysis of the drug cost and its clinical effectiveness.
• recommendations by health technology assessment organizations and provinces.
• availability of other drugs treating the same or similar condition(s).
• plan sustainability.
Prior authorization The prior authorization (PA) program applies to a limited number of drugs, where you
program must get approval in advance for coverage under the program.
In order for drugs in the PA program to be covered, you need to provide medical
information. Please use our PA form to submit this information. Both you and your doctor
need to complete parts of the form. You will be eligible for coverage for these drugs if the
information you and your doctor provide meets our clinical criteria based on factors such
as:
• Health Canada Product Monograph.
• recognized clinical guidelines.
• comparative analysis of the drug cost and its clinical effectiveness.
• recommendations by health technology assessment organizations and provinces.
• your response to preferred drug therapy.
If not, your claim will be declined.
See How to Connect with Sun Life Financial at the beginning of this booklet for
information on how to obtain our prior authorization forms.
Reference Drug The Reference Drug Program (RDP) applies to select drugs determined by Sun Life.
Program Under RDP, Sun Life will:
• group together a set of drugs that are used to treat the same condition(s) in the
same or similar way (a therapeutic category).
• determine the most cost-effective drug within a therapeutic category (the Reference
Drug), considering such factors as cost to the plan, provincial programs, safety and
clinical effectiveness.
• limit the eligible cost of drugs in a particular therapeutic category to the eligible cost
of the Reference Drug (the Reference Drug Limit).
• apply the Reference Drug Limit to select province(s), excluding Québec. The
selected province(s) may vary with each therapeutic category.
For all therapeutic categories, the Reference Drug Limit applies to covered persons in
the selected provinces having no previous claims for a non-Reference Drug. The
Reference Drug Limit may also apply to covered persons with previous claims for a
non-Reference Drug depending upon the therapeutic category and such factors as:
• clinical support for switching to the Reference Drug.
• expected duration of treatment.
• provincial programs.
Any claim submitted under this plan within 120 days before the date that Sun Life applies
the Reference Drug to the plan is a previous claim. Any drug other than the Reference
Drug in a therapeutic category is a non-Reference Drug.
When the Reference Drug Limit applies, charges in excess of this limit are not covered,
unless there is a medical reason for the covered person to take the non-Reference Drug.
To assess medical necessity, Sun Life will require the covered person and the attending
doctor to complete and submit an exception form.
Hospital expenses in your province

Hospital We will cover the cost of room and board in a hospital in the province where you live, as
indicated in the Benefit Summary.
A hospital is a facility licensed to provide care and treatment for sick or injured patients,
primarily while they are acutely ill. It must have facilities for diagnostic treatment and
major surgery. Nursing care must be available 24 hours a day.
It does not include a nursing home, rest home, home for the aged or chronically ill,
sanatorium, convalescent hospital or a facility for treating alcohol or drug abuse or beds
set aside for any of these purposes in a hospital.
Convalescent hospital We will cover the cost of room and board in a convalescent hospital, as indicated in the
Benefit Summary, if this care has been ordered by a doctor and as long as it is primarily
for rehabilitation, and not for custodial care.
A convalescent hospital is a facility licensed to provide convalescent care and treatment

for sick or injured patients on an in-patient basis. Nursing and medical care must be
available 24 hours a day.
It does not include a nursing home, rest home, home for the aged or chronically ill,
sanatorium or a facility for treating alcohol or drug abuse.
Expenses out of your province

Expenses out of your We will cover emergency services while you are outside the province where you live. We
province will also cover referred services. For both emergency services and referred services,
the reimbursement level is indicated in the Benefit Summary.

For both emergency services and referred services, we will cover the cost of:
• a semi-private hospital room
• other hospital services provided outside of Canada
• out-patient services in a hospital
• the services of a doctor
Emergency services We will only cover emergency services obtained within the time limit indicated in the
Benefit Summary. If hospitalization occurs within this period, in-patient services are
covered until the date you are discharged.
Emergency services mean any reasonable medical services or supplies, including

advice, treatment, medical procedures or surgery, required as a result of an emergency.
When a person has a chronic condition, emergency services do not include treatment
provided as part of an established treatment program that existed before they left their
home province.
Emergency means an acute illness or accidental injury that requires immediate,

medically necessary treatment prescribed by a doctor.
Contact us right away in an emergency!

You or someone with you must contact Sun Life’s Emergency Travel Assistance (ETA)
provider, right away. Sun Life’s ETA provider must approve all invasive and investigative
procedures (including any surgery, angiogram, MRI, PET scan, CAT scan) before you
have them.
If Sun Life’s ETA provider does not hear from you first, before you receive
emergency services, and we determine that someone could have reasonably made
contact on your behalf, Sun Life has the right to deny or limit payments for all expenses
related to that emergency.
In extreme circumstances where contact with Sun Life’s ETA provider cannot be made
before services are provided, you must contact Sun Life’s ETA provider as soon as
possible afterwards.
An emergency ends when Sun Life’s ETA provider, based on available medical
evidence, deems you medically stable to return to the province where you live.
Emergency services Any expenses related to the following emergency services are not covered:
excluded from • services that are not immediately required or which could reasonably be delayed
coverage until you return to the province where you live, unless your medical condition
reasonably prevents you from returning to that province prior to receiving the medical
services.
• services relating to an illness or injury which caused the emergency, after such
emergency ends.
• continuing services, arising directly or indirectly out of the original emergency or any
recurrence of it, after the date that Sun Life or Sun Life’s ETA provider, based on
available medical evidence, determines that you can be returned to the province
where you live, and you refuse to return.
• services which are required for the same illness or injury for which you received
emergency services, including any complications arising out of that illness or injury, if
you had unreasonably refused or neglected to receive the recommended medical
services.
• where the trip was taken to obtain medical services for an illness or injury, services
related to that illness or injury, including any complications or any emergency arising
directly or indirectly out of that illness or injury.

Referred services Referred services must be for the treatment of an illness and ordered in writing by a
doctor located in the province where you live. Your provincial medicare plan must agree
in writing to pay benefits for the referred services.
All referred services must be obtained in Canada, if available, regardless of any waiting
lists. However, if referred services are not available in Canada, they may be obtained
outside of Canada.
Your medical services at a glance

Covered expenses Details Payment limits
Medical services and equipment

Out-of-hospital private duty nurse Must be medically necessary $15,000 per person during any 3
consecutive benefit years
Must be for nursing care, and not
for custodial care, and must be
prescribed by a doctor
The private duty nurse must be a

nurse or nursing assistant who is
licensed, certified or registered in
the province where you live and
who does not normally live with you
The services of a registered nurse

are eligible only when someone with
lesser qualifications cannot perform
the duties
Ambulance Transportation in a licensed
ambulance that takes you to and
from the nearest hospital that is
able to provide the necessary
medical services
Must be medically necessary
Expenses incurred outside Canada

for emergency services will be paid
based on the conditions that appear
in the Benefit Summary for Out-of-
province emergency services

Air ambulance Transportation in a licensed air

ambulance that takes you to the
nearest hospital that is able to
provide the necessary medical
services
Must be medically necessary
Expenses incurred outside Canada

for emergency services will be paid
based on the conditions that appear
in the Benefit Summary for Out-of-
province emergency services
Diagnostic services The following diagnostic services
that you receive outside of a
hospital, except where your
provincial plan considers the
expense to be an insured service:
• laboratory tests when
prescribed by a doctor
• ultrasounds
Dental services following an Dental services, including braces We will only cover up to the fee
accident and splints, to repair damage to stated in the Dental Association Fee
natural teeth caused by an Guide for a general practitioner in
accidental blow to the mouth that the province where the employee
occurs while you are covered lives
You must receive these services

within 12 months of the accident
Ophthalmologist or licensed Services of an ophthalmologist or $50 per person in any 24 month
optometrist licensed optometrist period
Wigs After chemotherapy $300 per person per benefit year
Equipment Medically necessary equipment that For wheelchairs, we only cover the
meets your basic medical needs, cost of a manual wheelchair, except
that you rented (or purchased at our if your medical condition requires
request) that you use an electric wheelchair
For equipment to be eligible, we

may require a doctor’s prescription
If alternate equipment is available,

eligible expenses are limited to the
cost of the least expensive
equipment that meets your basic
medical needs
Casts, trusses or crutches
Splints or braces Must be prescribed by a doctor
Breast prostheses Required as a result of surgery $200 per person per benefit year
Surgical brassieres Required as a result of surgery 2 brassieres per person per benefit
year

Artificial limbs and eyes

Stump socks 5 pairs per person per benefit year
Elastic support stockings, including Must be prescribed by a doctor 2 pairs per person per benefit year
pressure gradient hose
Custom-made orthotics for shoes Must be prescribed by a doctor, $350 per person per benefit year
podiatrist or chiropodist
Custom-made orthopaedic shoes or Must be prescribed by a doctor, $500 per person per benefit year
modifications to orthopaedic shoes podiatrist or chiropodist
Hearing aids $500 per person over 5 benefit
years
Repairs are included in this
maximum
Oxygen
Blood glucose monitors $700 per person, per lifetime
Continuous Glucose Monitor Only for persons diagnosed with Combined maximum of $4,000 per
(CGM), including receivers, Type 1 or Type 2 diabetes requiring person per benefit year
transmitters, and sensors insulin use
You must provide us with a doctor's

note confirming both the diagnosis
and insulin use

Paramedical services
Paramedical practitioners listed in The paramedical practitioners must Up to the reimbursement level
the Benefit Summary be qualified indicated in the Benefit Summary
We will not pay for the cost of

services rendered by a podiatrist in
Ontario unless they are performed
after the provincial medicare plan
has paid its annual maximum
benefit
Qualified means a person who is a member of the appropriate governing body established by the provincial
government for their profession. In the absence of a governing body, the person must be an active member of an
association approved by us.
Qualified paramedical practitioners must:

• belong to a regulatory body or in the absence of a regulatory body, belong to an association approved by us,
• be licensed or registered, as required by the applicable provincial regulatory body,
• have undergone appropriate training and obtained necessary credentials in support of the services or supplies
rendered,
• maintain clinical records and files consistent with the reasonable practices and standards of others in their field
or as may be required by a regulatory body or association,
• produce clinical records and files to us upon request and generally act in a manner that is responsive to
inquiries from us, and
• not engage in administrative practices unacceptable to us.
This is not an exhaustive list of qualifications. We have the sole discretion to determine whether a paramedical
practitioner is qualified to render a service or provide a supply. To the extent that the qualifications listed above
apply to clinics, we have the sole discretion to determine whether a clinic is qualified such that claims for services or
supplies rendered at that clinic are eligible for reimbursement under this plan.
Vision care
Contact lenses, eyeglasses or laser An ophthalmologist or licensed Up to the reimbursement level
eye correction surgery optometrist must have prescribed indicated in the Benefit Summary
contact lenses or eyeglasses
We will not pay for sunglasses,
You must have received the above magnifying glasses, or safety
from an ophthalmologist, licensed glasses of any kind, unless they are
optometrist or optician prescription glasses needed for the
correction of vision
We will only cover laser eye
correction surgery that an
ophthalmologist has performed
When coverage ends

See the Benefit Summary at the beginning of this booklet to see when your coverage ends.
Payments after coverage ends

If you are totally disabled, as defined in the contract, when your coverage ends, benefits will continue for expenses
that result from the illness that caused the total disability if the expenses are incurred:
• during the uninterrupted period of total disability,
• within 90 days of the end of coverage, and
• while this provision is in force.

If the Extended Health Care benefit ends, coverage for dental services to repair natural teeth damaged by an
accidental blow will continue, if both of the following apply:
• the accident occurred while you were covered, and
• you have the procedure within 6 months after the date of the accident.
What is not covered

We will not pay for the costs of:
• services or supplies payable or available (regardless of any waiting list) under any government-sponsored plan or
program, except as described below under Integrating with government programs.
• implanted prosthetic or medical devices (examples of these devices are gastric lap bands, breast implants, spinal
implants and hip implants).
• equipment that we consider ineligible (examples of this equipment are orthopaedic mattresses, exercise
equipment, air-conditioning or air-purifying equipment, whirlpools and humidifiers).
• services or supplies that are not usually provided to treat an illness, including experimental or investigational
treatments as defined in the contract.
• services or supplies that do not qualify as medical expenses under the Income Tax Act (Canada).
• services or supplies for which no charge would have been made in the absence of this coverage.
We will not pay benefits when the claim is for an illness resulting from:
• the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
• any work for which you were compensated that was not done for the employer who is providing this plan.
• participation in a criminal offence.
Integrating this plan with government programs

This plan will integrate with benefits payable or available under the government-sponsored plan or program (the
government program).
The covered expense under this plan is the remaining portion of the expense that the government program does not
pay or make available, regardless of:
• whether you have made an application to the government program,
• whether your being covered under this plan affects your ability to be eligible for or entitled to any benefits under
the government program, or
• whether there are any waiting lists.

Emergency Travel Assistance
In this section, you means the employee and all dependents covered for Emergency Travel Assistance benefits.
Emergency means an acute illness or accidental injury that requires immediate, medically necessary treatment
prescribed by a doctor.
This benefit, called Medi-Passport, supplements the emergency portion of your Extended Health Care coverage. We
will only cover emergency services obtained within the time limit indicated in the Benefit Summary. If hospitalization
occurs within this period, in-patient services are covered until the date you are discharged.
The emergency services excluded from coverage, and all other conditions including maximums, limitations and
exclusions that apply to your Extended Health Care coverage also apply to Medi-Passport.
Bring your Travel card with you! There you will find telephone numbers and the information you’ll need to confirm
your coverage and get help.
Getting help Contact us right away in an emergency!

You or someone with you must contact Sun Life’s Emergency Travel Assistance (ETA)
provider right away.
If Sun Life’s ETA provider does not hear from you first, before you receive
emergency services, and we determine that someone could have reasonably made
contact on your behalf, Sun Life has the right to deny or limit payments for all expenses
related to that emergency.
In extreme circumstances where contact with Sun Life’s ETA provider cannot be made
before services are provided, you must contact Sun Life’s ETA provider as soon as
possible afterwards.
Access to a fully staffed coordination centre is available 24 hours a day. Please consult
the telephone numbers on the Travel card.
Sun Life’s ETA provider may arrange for:
On the spot medical Sun Life’s ETA provider will provide referrals to physicians, pharmacists and medical
assistance facilities.
As soon as Sun Life’s ETA provider is notified that you have a medical emergency, its
staff, or a physician designated by Sun Life’s ETA provider, will, when necessary,
attempt to establish communications with the attending medical personnel to obtain an
understanding of the situation and to monitor your condition. If necessary, Sun Life’s
ETA provider will also guarantee or advance payment of the expenses incurred to the
provider of the medical service.
Sun Life’s ETA provider will provide translation services in any major language that may
be needed to communicate with local medical personnel.

Sun Life’s ETA provider will transmit an urgent message from you to your home,
business or other location. Sun Life’s ETA provider will keep messages to be picked up
in its offices for up to 15 days.
Transportation home Sun Life’s ETA provider may determine, in consultation with an attending physician, that
or to a different it is necessary for you to be transported under medical supervision to a different hospital
medical facility or treatment facility or to be sent home.
In these cases, Sun Life’s ETA provider will arrange, guarantee, and if necessary,
advance the payment for your transportation.
Sun Life or Sun Life’s ETA provider, based on available medical evidence, will make the
final decision whether you should be moved, when, how and to where you should be
moved and what medical equipment, supplies and personnel are needed.
Meals and If your return trip is delayed or interrupted due to a medical emergency or the death of a
accommodations person you are travelling with who is also covered by this benefit, Sun Life’s ETA
expenses provider will arrange for your meals and accommodations at a commercial
establishment. We will pay a maximum of $150 a day for each person for up to 7 days.
Sun Life’s ETA provider will arrange for meals and accommodations at a commercial
establishment, if you have been hospitalized due to a medical emergency while away
from the province where you live and have been released, but, in the opinion of
Sun Life’s ETA provider, are not yet able to travel. We will pay a maximum of $150 a day
for up to 5 days.
Travel expenses Sun Life’s ETA provider will arrange and, if necessary, advance funds for transportation
home if stranded to the province where you live:
• for you if, due to a medical emergency, you have lost the use of a ticket home
because you or a dependent had to be hospitalized as an in-patient, transported to a
medical facility or repatriated (sent home); or
• for a child if, due to a medical emergency, you need to be admitted to hospital and
they are left unattended while travelling with you outside the province where you live.
We provide this benefit for children who are under 16 or mentally or physically
handicapped.
If necessary, in the case of such a child, Sun Life’s ETA provider will also make
arrangements and advance funds for a qualified person to go home with the child as
their attendant.
We will pay a maximum of the cost of the transportation minus any redeemable portion
of the original ticket.
Travel expenses of Sun Life’s ETA provider will arrange and, if necessary, advance funds for one round-trip
family members economy class ticket for a member of your immediate family to travel from their home to
the hospital where you are:
• if you are there for more than 7 days in a row, and
• if you are travelling alone or you are travelling only with a child who is under 16 or
mentally or physically handicapped.
We will pay up to $150 a day for the family member to eat and stay at a commercial
establishment up to 7 days.

Returning you home If you die while out of the province where you live, Sun Life’s ETA provider will pay up to
(repatriation) $5,000 to do the following:
• arrange for all necessary government authorizations.
• arrange for the return of your remains in an approved container.
Returning your Sun Life’s ETA provider will arrange and, if necessary, advance funds up to $500 to
vehicle return a private vehicle to the province where you live or a rental vehicle to the nearest
appropriate rental agency if death or a medical emergency prevents you from doing so.
Lost luggage or If your luggage or travel documents become lost or stolen while you are travelling
documents outside of the province where you live, Sun Life’s ETA provider will direct you in how to
arrange for replacement of travel documents or who to contact about your lost or stolen
luggage. This is a service only. There is no benefit amount payable in the event of lost or
stolen luggage or documents.
Limits on advances Advances will not be made for requests of less than $200. Requests in excess of $200
will be made in full up to a maximum of $10,000.
Reimbursement of If you obtain confirmation from Sun Life’s ETA provider that you are covered and a
expenses medical emergency exists, Sun Life will reimburse you for services and supplies that you
paid for and that are covered by this plan. In this situation, you should do the following:
• keep the receipts.
• always obtain a fully itemized bill for any hospital treatment.
• within 30 days of your return home, complete an Extended Health Care claim form,
include original receipts and any itemized bills, and send directly to Sun Life’s ETA
provider. Sun Life’s ETA provider's address can be obtained by visiting our Sun Life
Financial Plan Member Services website at www.mysunlife.ca or by calling our
Sun Life Financial Customer Care centre toll-free number 1-866-881-0583.
Sun Life’s ETA provider will ask you to sign a form authorizing them to act on your behalf
with your provincial medicare plan. You must sign and return this form to Sun Life’s ETA
provider before your claim can be processed.
Coordination of If you are covered under this group plan and certain other plans, we will coordinate
coverage payments with the other plans in accordance with guidelines adopted by the Canadian
Life and Health Insurance Association.
The plan from which you make the first claim will be responsible for managing and
assessing the claim. It has the right to recover from the other plans the expenses that
exceed its share.
Your responsibility for You will have to reimburse Sun Life for any of the following amounts advanced by
advances Sun Life’s ETA provider:
• any amounts which are or will be reimbursed to you by your provincial medicare
plan.
• that portion of any amount which exceeds the maximum amount of your coverage
under this plan.
• amounts paid for services or supplies not covered by this plan.
• amounts which are your responsibility, such as deductibles and the percentage of
expenses payable by you.
Sun Life will bill you for any outstanding amounts. Payment will be due when the bill is
received.

Limits on Emergency There are countries where Sun Life’s ETA provider is not currently available for various
Travel Assistance reasons. For the latest information, please call Sun Life’s ETA provider before you leave
coverage on your trip.
Sun Life’s ETA provider reserves the right to suspend, curtail or limit its services in any
area, without prior notice, because of:
• a rebellion, riot, military up-rising, war, labour disturbance, strike, nuclear accident,
terrorism or an act of God.
• the refusal of authorities in the country to permit Sun Life’s ETA provider to fully
provide service to the best of its ability during any such occurrence.
Liability of Sun Life or Neither Sun Life nor Sun Life’s ETA provider will be liable for the negligence or other
Sun Life’s ETA wrongful acts or omissions of any physician or other health care professional providing
provider direct services covered under this group plan.

Dental Care
In this section, you means the employee and all dependents covered for Dental Care benefits.
Dental Care coverage pays for eligible expenses that you incur for dental procedures provided by a licensed dentist,
denturist, dental hygienist and anaesthetist while you are covered by this group plan.
For each dental procedure, we will only cover reasonable expenses. We will not cover more than the fee stated in
the Dental Association Fee Guide specified in the Benefit Summary. When a fee guide is not published for a given
year, the term fee guide may also mean an adjusted fee guide established by Sun Life.
We will base payments on the fee guide at the time the person receives the treatment.
To decide what part of a procedure we will pay for:
• we will first find out if you could have had alternate, or other, dental procedures.
• we confirm that these alternate procedures are part of usual and accepted dental work and produced a similar
result to the procedure that the dentist performed.
We will only pay the reasonable cost of the least expensive alternate procedure.
If you receive any It will be included as part of the final dental procedure used to correct the problem, and
temporary dental not as a separate procedure, if the temporary service is performed within 3 months of the
service final dental procedure. The fee for the permanent service will be used to determine the
reasonable and customary charge for the final dental service.
Claiming when the You must claim an expense for the benefit year in which you incur the expense.
expense is incurred
The benefit year is indicated in the Benefit Summary.
You incur an expense on the date your dentist performs a single appointment procedure.
For procedures which take more than one appointment, you incur an expense once the
entire procedure is completed, except for orthodontic procedures where an expense is
incurred for each appointment.
See the table Instructions and Time Limits for Sending Us Your Claims at the
beginning of this booklet for information about when and how to make a claim.
Deductible and The deductible is the portion of claims that you are responsible for paying. After the
reimbursement level deductible has been paid, claims will be paid up to the reimbursement level under this
plan.
For each type of service listed below, the deductible and the reimbursement level
are indicated in the Benefit Summary.
Maximum benefit Maximums are indicated in the Benefit Summary.

Getting an estimate For any major treatment or any procedure that will cost more than $500, we suggest that
before you have you send us an estimate before the work is done. Here’s what to expect:
certain procedures • you will send us a completed dental claim form that shows the treatment that the
dentist is planning and the cost.
• both you and the dentist will have to complete parts of the claim form.
• we will tell you how much of the planned treatment is covered. This way you will
know how much of the cost you will be responsible for before the work is done.
Your dental services at a glance

Covered expenses Details / Payment limits
Preventive dental procedures – Your dental benefits include the following procedures used to help prevent dental
problems. They are procedures that a dentist performs routinely to help maintain good dental health.
Oral examinations You are covered for the following complete, recall or specific oral examinations.
• 1 complete examination every 24 months. A complete examination includes
complete examination and charting of the hard and soft structures, periodontal
charting, pulp vitality tests, recording history, treatment planning, case presentation
and consultation with the patient.
• 1 recall or specific examination every 5 months. Recall and specific examinations
include a complete examination of the hard and soft structures, checking occlusion,
pulp vitality tests and consultation with the patient.
You are also covered for 1 exam per specialty every 24 months and for emergency
examinations.
• specialty examinations include general or specific examinations for periodontics, oral
surgery, prosthodontics and endodontics.
• an emergency examination includes an evaluation for acute pain or infection, and
pulp vitality tests.
X-rays You are covered for all the following x-rays:
• 4 bitewing x-rays in any 5 month period. A bitewing x-ray is a routine check-up x-ray
used to detect decay in molar teeth.
• 1 complete series of x-rays or 1 panorex every 24 months. A complete series of
x-rays is 10-14 individual x-rays, including bitewings, showing all the teeth in the
mouth. A panorex is a large panoramic view of the entire mouth.
• x-rays of single teeth, called periapical x-rays.
• 2 occlusal x-rays in any 12 month period.
• 2 extra oral x-rays in any 12 month period.
Test and lab exams Test and lab examinations covered by this benefit include microbiological tests,
histological tests and cytological tests.
Polishing Cleaning of teeth. Limited to 1 unit of 15 minutes of cleaning every 5 months.
Scaling and root Tartar removal. Scaling means removing calcium deposits above and below the gum
planing line. Root planing is the final smoothing of rough tooth surfaces and removing any
remaining calcium deposits.
You are covered for up to 15 units of 15 minutes of tartar removal in any 12 month
period.

Topical fluoride You are covered for 1 treatment every 5 months.
treatment
Oral hygiene You are covered for 1 unit of 15 minutes of instruction every 24 months on how to brush
instruction and floss.
Disking Filing or reshaping teeth. Only children under 19 are covered for this procedure.
Space maintainers You are covered for this procedure when a dentist has removed a primary tooth and an
and maintenance appliance is used to maintain the space for a permanent tooth.
This procedure includes the design, separation, fabrication, insertion, cementation,
removal and 6 month follow-up care.
Maintenance includes adjustments and recementation, addition of clasps or activating
wires, repairs and recementation, and 6 month follow-up care.
Pit and fissure This is a coating put on top of any pits or cracks in teeth to prevent cavities from forming.
sealants You are covered for 1 treatment per tooth.
Caries, trauma and You are covered for sedative fillings that are applied to very deep cavities to reduce pain.
pain control
This procedure includes local anaesthesia, removal of decay or removal of existing
restoration, occlusal adjustment, pulp cap and placement of a sedative filling.
Extraction of This procedure includes local anaesthesia, removal of excess gingival tissue, surgical
impacted tooth service, control of hemorrhage, suturing, and post-operative treatment and evaluation.
• soft tissue impaction. Limited if additional teeth extracted in the same quadrant.
Surgery requires removal of overlying soft tissue and extraction of impacted tooth.
• partial bone impaction. Limited if additional teeth extracted in the same quadrant.
Surgery requires removal of overlying soft tissue, evaluation of flap, and either
removal of bone and tooth or sectioning and removal of tooth.
• complete bone impaction. Limited if additional teeth extracted in the same quadrant.
Surgery requires removal of overlying soft tissue, evaluation of flap, and removal of
bone and sectioning and removal of tooth.
Miscellaneous • diagnostic casts – unmounted for prosthetic dentistry.
• required consultations between two dentists, limited to 2 units of 15 minutes per
consultation.
Basic dental procedures – Your dental benefits include the following procedures used to treat basic dental
problems.
Fillings You are covered for amalgam fillings (silver) and composite or acrylic fillings (white
fillings).
An amalgam filling procedure includes pulp cap, sedative base, local anaesthesia,
occlusal adjustment, removal of decay or existing restoration, placement of filling and
finishing the restoration. Multiple restorations on 1 surface will be considered a single
filling.
A composite or acrylic filling procedure includes pulp cap, sedative base, local
anaesthesia, occlusal adjustment, removal of decay or existing restoration, placement of
filling and finishing the restoration. Multiple restorations on 1 surface will be considered a
single filling. Mesial-lingual, distal-lingual, mesial-buccal, and distal-buccal restorations
on anterior teeth will be considered single surface restorations.
Retentive pins You are covered for retentive pins (for amalgam and composite fillings).
Pre-fabricated metal This coverage is only available when a permanent crown is not being installed. You are
or plastic restorations covered for pre-fabricated metal or plastic restorations, including stainless steel crowns.
This procedure includes pulp cap, sedative base, local anaesthesia, occlusal adjustment,
removal of decay or existing restoration, and cementation of crown.
Veneers Veneers are white facings put on the front of the tooth's surface. Veneers are only
covered for teeth that cannot be restored with a regular filling as long as they are not
used primarily to improve appearance.
Endodontics Endodontics is root canal therapy and root canal fillings, and treatment of disease of the
pulp tissue.
Root canal therapy. This procedure includes treatment plan, pulp vitality test, opening
and drainage, local anaesthesia, tooth isolation, clinical procedure with appropriate x-
rays, relieving occlusion, smoothing tooth, and follow-up care.
Apexification. This procedure includes treatment plan, local anaesthesia, tooth
isolation, clinical procedure with appropriate x-rays, placement of dentogenic media, and
follow-up care.
Apicoectomy. This procedure includes treatment plan, local anaesthesia, clinical
procedure with appropriate x-rays, root resection, apical curettage, and follow-up care.
Retrofilling. This procedure includes apicoectomy, curettage and root-end filling.
Root amputation. This procedure includes recontouring tooth and furca.
Hemisection. You are covered for this procedure.
Vital pulpotomy. This procedure includes treatment plan, local anaesthesia, clinical
procedure and appropriate x-rays, and follow-up care.
Periodontics Periodontics is the treatment of bone and gum disease.
Definitive periodontal surgery. If you have surgery, coverage depends on how many
teeth are involved. You are covered for each type of surgery once every 12 months on
the same surgical site.
Definitive periodontal surgery includes local anaesthesia, management of infection,
surgical procedure, surgical dressing (packing), sutures, and post surgical care. A
surgical site is considered a sextant. The mouth is divided in 6 sextants. The allowance
for fewer teeth may be prorated. Definitive periodontal surgery includes the following
procedures:
• gingival curettage – definitive surgical procedure performed by the dentist under
local anaesthesia. You are covered for 1 gingival curettage per site every 12 months.
• gingivoplasty. You are covered for 1 gingivoplasty per site every 12 months.
• gingivectomy. You are covered for 1 gingivectomy per site every 12 months.
• flap approach. You are covered for 1 flap approach surgery per site every 12
months.
• grafts – pedicle, free soft tissue, lateral sliding and rotated. This procedure includes
local anaesthesia, management of infection, surgical procedure, surgical dressing
(packing), sutures, and post surgical care. You are covered for 1 graft per site every
12 months.
You are also covered for additional periodontal surgery which includes the following
procedures:
• distal wedge procedure. This procedure includes local anaesthesia, management of
infection, surgical procedure, surgical dressing (packing), sutures, and post surgical
care. A surgical site is considered a sextant. You are covered for 1 distal wedge
procedure per site every 12 months.

• treatment of periodontal abscess or pericoronitis. This procedure includes lancing,
scaling, curettage, medication, or surgery. You are covered for 1 unit of 15 minutes
per treatment and 2 units of 15 minutes in any 12 month period.
You are also covered for related periodontal services which include the following
procedures:
• provisional splinting. This procedure includes tooth preparation, acid etch, wire
replacement, acrylic or composite filling, occlusal adjustment, and 3 month follow-up
care. You are covered for 1 unit of 15 minutes per joint. Replacements must be
separated by at least 24 months.
• occlusal adjustment. You are covered for treatments to adjust your bite.
• periodontal appliance. Includes impression, insertion and adjustments within 6
months of insertion. Replacements must be separated by at least 12 months. A
periodontal appliance is used to treat gum disease.
• periodontal appliance adjustment or reline. You are covered for 1 unit of 15 minutes
in any 12 month period.
TMJ treatment The hinge joint of the jaw is called the temporomandibular joint or TMJ. You are covered
for TMJ appliances, including a maximum of 2 TMJ x-rays in any 12 month period. You
are not covered for appliances for tooth movement or tooth guidance.
Oral surgery Oral surgery includes local anaesthesia, removal of excess gingival tissue, surgical
service, control of hemorrhage, suturing, and post-operative treatment and evaluation. A
surgical site will be considered a sextant unless specified as a quadrant.
• extraction of erupted tooth – uncomplicated. Limited if additional teeth extracted in
the same quadrant.
• extraction of erupted tooth – complicated. Limited if additional teeth extracted in the
same quadrant. Surgery requires surgical flap or sectioning of the tooth.
• extraction of residual root. Limited if additional teeth extracted in the same quadrant.
• surgical exposure of impacted tooth. Limited if additional teeth exposed in the same
quadrant.
• alveoloplasty. This procedure includes remodelling, excision, removal and reduction
of bone.
• other procedures: stomatoplasty, remodelling mouth floor, vestibuloplasty, ridge
reconstruction, and mucus fold extension; surgical excision of tumours; surgical
excision of cysts; surgical incision and drainage; surgical removal of foreign body;
repairs of lacerations; frenectomy; salivary gland treatment; and antral surgery.
Related surgical You are covered for the following services only when you have eligible complicated oral
services surgery:
• anaesthesia, including pre-anaesthetic evaluation and post-anaesthetic follow-up:
general anaesthesia, deep sedation and provision of dental and anaesthetic
facilities, equipment and supplies.
• conscious sedation: inhalation technique, intravenous sedation, intramuscular
injections of sedative drugs; and combined techniques of inhalation plus intravenous
or intramuscular injections.
• therapeutic injections: administration of intramuscular drug injections.
Repairing, relining or Repairing dentures means fixing broken or damaged dentures. This procedure includes
rebasing dentures 3 month follow-up care.

Relining dentures means adding material so that the dentures fit properly. Rebasing
dentures means fitting dentures with a new base. You are covered for 1 reline or rebase
in any 12 month period. These services include 3 month follow-up care.
Major dental procedures – Your dental benefits include the following procedures used to treat major dental
problems.
Inlays, onlays and Inlays and onlays are metal or porcelain fillings placed on the surface of the tooth. Inlays,
gold foil restorations onlays or gold foil restorations are only covered for teeth that cannot be restored with a
regular filling because of extensive incisal or cusp damage.
Inlays and onlays include treatment planning, occlusal records, local anaesthesia,
removal of decay or old restoration, tooth preparation, pulp protection, impressions,
temporary services, insertion, occlusal adjustments, and cementation. Inlays are only
covered when x-rays indicate a crown will be required. Onlays are limited to teeth with
extensive incisal or cusp damage.
Gold foil restorations include treatment planning, local anaesthesia, removal of decay or
old restoration, tooth preparation, pulp protection, insertion, occlusal adjustments, and
gold material.
Crowns This procedure includes treatment planning, occlusal records, local anaesthesia,
subgingival preparation of the tooth and supporting structures, removal of decay or old
restoration, tooth preparation, pulp protection, impressions, temporary services,
insertion, occlusal adjustments, and cementation. It does not include porcelain or
porcelain fused to metal for molar teeth. Crowns are only covered for teeth that cannot
be restored with a regular filling because of extensive incisal or cusp damage.
Dentures You must have been covered continuously under this plan for a period of 12 months
before being covered for dentures.
Full dentures. Replacements must be separated by at least 5 years.
• standard dentures. This procedure includes treatment plan, initial and final
impressions, jaw relations records, try-in insertion, occlusal equilibration, and follow-
up care and adjustments for 3 months following insertion.
• standard immediate dentures. This procedure includes treatment plan, impressions,
jaw relations records, tissue conditioner, insertion, occlusal equilibration, and follow-
up care and adjustments for 3 months following insertion.
Partial dentures. Replacements must be separated by at least 5 years. This procedure
includes treatment plan, mouth preparation, initial and final impressions, jaw relations
records, connectors, rests, clasps, and bases, framework try-in, try-in evaluation,
insertion, occlusal equilibration, and follow-up care and adjustments for 3 months
following insertion.
Remake, partial denture. You are only covered when a replacement partial denture
would be covered.
Denture adjustments This procedure includes 3 month follow-up care.
Tissue conditioning You are covered for this procedure.
Fixed bridges The alternate benefit clause, outlined under General description of the coverage, may be
applied. We will only pay for the least expensive alternate procedure when considering
the cost of a bridge.
You must have been covered continuously under this plan for a period of 12 months
before being covered for fixed bridges. Replacement bridges are covered provided the
existing bridges are at least 5 years old.

This procedure includes treatment planning, occlusal records, local anaesthesia,
subgingival preparation of the tooth and supporting structures, removal of decay or old
restoration, tooth preparation, pulp protection, impressions, temporary services, splinting
and intraoral indexing for soldering purposes, insertion, occlusal adjustments, and
cementation. Does not include porcelain or porcelain fused to metal abutments or
pontics for molar teeth.
You are also covered for the following procedures:
• repairing fixed bridges.
• recementing fixed bridges.
Miscellaneous • retentive pins with inlays, onlays or crowns. This procedure is for the retention and
preservation of the tooth.
• retentive pins with fixed bridges. This procedure is for the retention and preservation
of the tooth.
• cast metal post and core – custom made casting includes cast core. This procedure
is for teeth which have had root canal therapy. You are covered for 1 post and core
per tooth.
• prefabricated post, prefabricated post and core – manufactured metal post –
manufactured metal post and core. This procedure is for teeth which have had root
canal therapy. You are covered for 1 post and core per tooth.
• amalgam and pin crown build-up, composite and pin crown build-up. This procedure
is for the retention and preservation of the tooth.
• repair of inlays, onlays or crowns.
• recement inlays, onlays or crowns. You are covered for 1 unit of 15 minutes per
tooth every 6 months.
Orthodontic procedures – Your dental benefits include the following procedures used to treat misaligned or
crooked teeth.
Only persons under the maximum age indicated in the Benefit Summary are covered for these procedures.
Coverage includes The following orthodontic procedures are covered:
orthodontic • orthodontic examination. This procedure includes diagnostic casts, complete
examinations, radiograph series or panoramic film, cephalograms, facial and intraoral photographs,
including orthodontic consultations and case presentation.
diagnostic services • surgical exposure of impacted tooth. This procedure is covered for orthodontic
and fixed or purposes.
removable appliances • fixed or removable orthodontic appliances. This procedure includes tooth movement
such as braces or tooth guidance.
• orthodontic band splint.
When coverage ends

Payments after coverage ends

If the Dental Care benefit ends, coverage for dental services to repair natural teeth damaged by an accidental blow
will continue, if both of the following apply:
• the accident occurred while you were covered, and
• you have the procedure within 6 months after the date of the accident.

What is not covered
We will not pay for services or supplies payable or available (regardless of any waiting list) under any government-
sponsored plan or program unless explicitly listed as covered under this benefit.
We will not pay for services or supplies that are not usually provided to treat a dental problem.
We will not pay for:
• procedures performed primarily to improve appearance.
• the replacement of dental appliances that are lost, misplaced or stolen.
• charges for appointments that you do not keep.
• charges for completing claim forms.
• services or supplies for which no charge would have been made in the absence of this coverage.
• supplies usually intended for sport or home use, for example, mouthguards.
• procedures or supplies used in full mouth reconstructions (capping all of the teeth in the mouth), vertical
dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or
restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping
teeth and joining teeth together to provide additional support).
• transplants and repositioning of the jaw.
• charges related to the temporomandibular joint (TMJ) treatment, except otherwise indicated in the list of covered
expenses.
• charges related to implants, including surgery charges.
• experimental treatments.
We will also not pay for dental work resulting from:
• teeth malformed at birth or during development.

Long-Term Disability
Long-Term Disability coverage provides a benefit if you become totally disabled. You qualify for this benefit if you
provide proof of claim acceptable to Sun Life that confirms both of the following:
• you became totally disabled while covered, and
• you have been following appropriate treatment for the disability since it started.
For the purposes of your Long-Term Disability coverage:
• during the elimination period and the following 24 months (this period is known as the own occupation period),
we consider you to be totally disabled while you are continuously unable due to an illness to perform the essential
duties of your own occupation, in any workplace, including in a different department or location with your
employer or with another employer, and
• afterwards, we will consider you to be totally disabled while you are continuously unable due to an illness to
perform any occupation, for any employer, for which you are or may become reasonably qualified by education,
training or experience.
The availability of work with any employer does not affect the determination of total disability.
We pay these benefits at the end of each month. We base them on your coverage on the date you became totally
disabled.
See the table Instructions and Time Limits for Sending Us Your Claims at the beginning of this booklet for
information about when and how to make a claim.
When disability Your Long-Term Disability payments begin on the later of the following dates:
payments begin • after you have been totally disabled for the uninterrupted period indicated in the
Benefit Summary.
• after the last day benefits are payable under any short-term disability, loss of income
or other salary continuation plan.
This period, which must be completed before disability benefits become payable is called
the elimination period.
What we will pay Here is how we calculate your Long-Term Disability payments. All references to benefits
and payments in this disability provision are to the gross amounts before any deductions.
Step 1: We take the maximum amount indicated in the Benefit Summary.
Step 2: We subtract any benefits or payments provided under:

• any government-sponsored plan such as the Canada Pension Plan and the Québec
Pension Plan, excluding any benefits or payments on behalf of a dependent, for the
same or a subsequent disability.
• any Workers' Compensation Act or similar law for the same or a subsequent
disability.
• a motor vehicle insurance plan.
• a group plan, including any coverage you have because you are a member of an
association but excluding any benefits or payments provided under a Critical Illness
plan.
• a retirement or pension plan funded in whole or in part by your employer, due to your
disability or a medical condition.
• the Québec Parental Insurance Plan.

The result from Step 2 is the amount you will normally receive.
Take the result you got in Step 2, add the above sources of benefits and payments plus
the other sources of benefits and payments listed below and check the total you get. If
it’s more than 85% of your basic earnings when your disability began, we will reduce
your Long-Term Disability payment by the excess. If the benefit is non-taxable, your
income after income tax is the one we use.
Other sources of benefits and payments:

• any Workers' Compensation Act or similar law for another disability.
• any Criminal Injuries Compensation Act or similar law.
Important to remember:
• If you are eligible for any of the benefits or payments described above and do not
apply for them, we will still consider them. We can estimate those benefits and
payments and use them when we calculate your Long-Term Disability payments.
• If any of the benefits or payments described above are provided in a lump sum, we
will determine the equivalent compensation this represents on a monthly basis using
generally accepted accounting principles.
• We will not take into account any benefits or payments that began before your
disability began. However, increases in those benefits or payments as a result of
your disability will be taken into account.
• We have the right to adjust your Long-Term Disability benefit payments when
appropriate under the above provision.
Interrupted periods of disability after payments begin

If you had a total disability for which we paid Long-Term Disability benefits and total disability reoccurs due to the
same or related causes, we will consider it a continuation of your previous disability if it occurs within 6 months of the
end of your previous disability.
We will base these benefits on your coverage as it existed on the original date you become totally disabled.
Rehabilitation / Partial disability program

Sun Life may require you to participate in a partial disability or rehabilitation program that we have approved in
writing.
This may include one or more of the following:
• consulting our rehabilitation specialist,
• part-time work,
• working in another occupation or vocational training to help you become capable of full-time employment.
During your rehabilitation program, you may receive Long-Term Disability payments plus income, benefits and
payments from other sources.
However, if during any month the total of any income, benefits and payments provided is more than 100% of your
basic earnings when your disability began, indexed for inflation, your Long-Term Disability payment will be reduced
by the excess. If the benefit is non-taxable, your income after income tax is the one we use.
You should consider participating in a partial disability or rehabilitation program as soon as possible after becoming
disabled. If you enter a partial disability or rehabilitation program during the elimination period, it will not be
considered an interruption of the elimination period.
Your participation in a partial disability program will be limited to the own occupation period.

If you recover damages from another person
We have the right to part of any money you recover through legal action or settlement from another person,
organization or company who caused your disability.
If you decide to take legal action, you must comply with the applicable terms of the group contract concerning legal
action.
For disability benefits paid or payable prior to the date of judgment or settlement, if you recover money, you must pay
us 75% of your net recovery or the total disability benefits paid or payable to you under this plan, whichever is less.
For disability benefits payable after a judgment or settlement, where 75% of your net recovery exceeds the amount
that we recover for past disability benefits, we have the right to deduct that excess from ongoing disability benefits.
Refer to your group contract for more information.
What you are responsible to do

During your total disability, you must make reasonable efforts to do all of the following. If you do not, Sun Life may
hold back or discontinue benefits.
• recover from your disability, including participating in any reasonable treatment or rehabilitation program and
accepting any reasonable offer of modified duties from your employer.
• return to your own occupation during the first 24 months that benefits are payable.
• receive training to qualify for another occupation if it becomes apparent that you will not be able to return to your
own occupation within the first 24 months that benefits are payable.
• try to get work in another occupation after the first 24 months that benefits are payable.
• obtain benefits that may be available from other sources.
When payments end

Your Long-Term Disability payments end on the earlier of the following dates:
• the date you are no longer totally disabled.
• the end of the maximum benefit period indicated in the Benefit Summary.
• the last day of the month in which you retire with a pension or are eligible to retire with a full pension or a full
pension equivalent.
• the last day of the month in which you die.
When coverage ends

What is not covered

We will not pay benefits for any period where one or more of the following is true:
• you are not receiving appropriate treatment.
• you do any work for wage or profit except where Sun Life has approved it in advance.
• you are not participating in an approved partial disability or rehabilitation program, if required by Sun Life.
• you are on a leave of absence, strike or lay-off.
• you are absent from Canada longer than 4 months due to any reason.
• you are serving a prison sentence or are confined in a similar institution.
We do not pay benefits if you become totally disabled within 12 months after your coverage begins and your disability
results directly or indirectly from a condition which existed on or before the date your coverage began. However, this
limitation will not apply to you if you have been covered for Long-Term Disability with your employer for at least
13 weeks during which:
• you have been actively working continuously (up to 3 days of absence does not count), and
• you have not been treated for the condition by a doctor or any medical personnel under the direction of a doctor.
If your coverage ends but you are covered again under this plan, we will use the latest date your coverage began
when applying the above limitation.

We will not pay benefits for total disability resulting from:
• intentionally self-inflicted injuries.
Waiver of premium
Long-Term Disability premiums will be waived while you are receiving Long-Term Disability benefits.

Life Coverage
Your Life coverage provides a benefit for your beneficiary if you die while covered. Your spouse's Life coverage
provides a benefit if your spouse dies while covered.
See the Benefit Summary at the beginning of this booklet to see the amount of coverage and the date
coverage ends.
Who we will pay If you die while covered, we will pay the full amount of your benefit to your last named
beneficiary on file with us.
If you have not named a beneficiary, we will pay the benefit amount to your estate.
Anyone can be your beneficiary. You can change your beneficiary at any time, unless a
law prevents you from doing so or you indicate that the beneficiary is not to be changed.
For your spouse’s optional coverage, we will pay the full amount of the benefit to the last
named beneficiary on file with us. If you have not named a beneficiary, we will pay the
benefit amount to you.
Fact
If you designated a beneficiary under a previous group plan of the employer, we will
apply and carry it forward to your coverage under this plan until you change it.
There are different rules for designating a minor beneficiary, please refer to your contract
for specific information.
Suicide If you or your spouse have any optional coverage that has been in effect for less than 2
years, we will not pay benefits if death is by suicide, regardless of whether you or your
spouse have a mental illness or intend or understand the consequences of your actions.
Coverage during total Life coverage may continue without the payment of premiums if you become totally
disability disabled before you retire or reach age 65, whichever is earlier, as long as you are totally
disabled. This continued coverage must follow the terms of the contract which were in
effect on the date you became totally disabled, including reductions and terminations.
There are a number of rules and conditions in the group contract that apply to coverage
during total disability. Please contact Sun Life for details.
Converting Life coverage

If your Life coverage or your spouse’s Life coverage ends or reduces for any reason other than your request, you or
your spouse may apply to convert the group Life coverage to an individual Life policy with Sun Life without providing
proof of good health.
The request must be made within 31 days that the Life coverage reduces or ends.
Important
There are a number of rules and conditions in the group contract that apply to converting this coverage, including the
maximum amount that can be converted. Please contact Sun Life for details.
Accidental Death and Dismemberment
Accidental Death and Dismemberment coverage provides benefits if you die or suffer any of the losses listed in the
table under What we will pay, and it is due to an accident that occurs while covered. Any death benefit we will pay
under this coverage is in addition to any Life coverage.
See the Benefit Summary at the beginning of this booklet to see the amount of coverage and the date
coverage ends.
What we will pay

We will pay this benefit if you are in an accident or exposed to the elements and, as a direct result, you suffer one of
the losses listed below within one year of that accident or exposure.
The amount that we will pay is a percentage of the Accidental Death and Dismemberment coverage, as follows:
TABLE OF LOSSES
Loss of life 100%
Loss of both arms or both legs 100%
Loss of both hands or both feet 100%
Loss of one hand and one foot 100%
Loss of one hand or one foot, and entire sight of one eye 100%
Loss of one arm or one leg 75%
Loss of one hand or one foot 75%
Loss of four fingers on the same hand 33 1/3%
Loss of thumb and index finger on the same hand 33 1/3%
Loss of four toes on the same foot 25%
Loss of use of both arms or both legs 100%
Loss of use of both hands or both feet 100%
Loss of use of one arm or one leg 75%
Loss of use of one hand or one foot 75%
Loss of entire sight of both eyes 100%
Loss of speech and loss of hearing in both ears 100%
Loss of entire sight of one eye 75%
Loss of speech 75%
Loss of hearing in both ears 75%
Loss of hearing in one ear 25%
Quadriplegia 200%
Paraplegia 200%
Hemiplegia 200%

Remember…
• We only pay the largest percentage for injuries to the same limb resulting from the same accident.
• We will only pay up to 100% of the amount of coverage if an accident results in more than one loss. This does
not include quadriplegia, paraplegia or hemiplegia, where we will pay up to 200%.
• Loss of use must be total and must have continued for at least one year. Before we pay the benefit, you must
provide proof that the loss is permanent.
Limit on benefit If more than one person covered by the group contract is eligible for benefits resulting
amounts from the same accident, Sun Life will pay up to a maximum of $3,000,000 for all claims
related to the accident.
Additional benefits In addition to your Accidental Death and Dismemberment payment, we also offer
additional benefits if you die or suffer a loss as a result of an accident. There are
specific conditions that apply to each benefit and you can get more information
about when these benefits apply from Sun Life.
Repatriation benefit: Pays up to $10,000 for the return of your body if you die 100
kilometres or more away from your home.
Rehabilitation program: Pays up to $10,000 of your expenses in a rehabilitation program.
Spouse occupational training benefit: Pays up to $5,000 to your spouse for occupational
training if you die.
Child education benefit: Pays 5% of the amount of coverage up to $5,000, each year up
to a maximum of 4 years, to cover a dependent child’s tuition fees in a post-secondary
school if you die.
Family transportation benefit: Pays up to $5,000 for hotel accommodations and travel
costs of an immediate family member if you are hospitalized 150 kilometres or more
away from home.
Coverage during total disability

If you become totally disabled while covered and premiums are no longer payable for Life coverage, this coverage will
continue without the payment of premiums, but not past age 65.
Any amount of continued coverage follows the terms of this group plan when your total disability began.
What is not covered

We will not pay for losses that result from one or more of the following actions:
• self-inflicted injuries, by firearm or otherwise.
• a drug overdose.
• carbon monoxide inhalation.
• attempted suicide or suicide, regardless of whether the person has a mental illness or intends or understands the
consequences of their actions.
• flying in, descending from or being exposed to any hazard related to an aircraft while
• receiving flying lessons.
• performing any duties in connection with the aircraft.
• being flown for a parachute jump.
• a member of the armed forces if the aircraft is under the control of or chartered by the armed forces.
• full-time service in the armed forces of any country.

Converting coverage
If you apply to convert your group Life coverage to an individual Life policy with Sun Life, you may have an Accidental
Death benefit attached to the individual Life policy.
Important
There are a number of rules and conditions in the group contract that apply to converting this coverage, including the
maximum amount that can be converted. Please contact Sun Life for details.

Respecting your privacy
Our Purpose is to help our Clients achieve lifetime financial security and live healthier lives. We collect, use and
disclose your personal information to: develop and deliver the right products and services; enhance your experience
and manage our business operations; perform underwriting, administration and claims adjudication; protect against
fraud, errors or misrepresentations; tell you about other products and services; and meet legal and security
obligations. We collect it directly from you, when you use our products and services, and from other sources. We
keep your information confidential and only as long as needed. People who may access it include our employees,
distribution partners such as advisors, service providers, reinsurers, or anyone else you authorize. At times, unless
we’re prohibited, they may be outside your jurisdiction and your information may be subject to local laws. You can
always ask for your information and to correct it if needed. In most cases, you have a right to withdraw your consent,
but we may not be able to provide the requested product or service. Read our Global Privacy Statement and local
policy at www.sunlife.ca/privacy or call us for a copy.
You have a choice

We will occasionally inform you of other financial products and services that we believe meet your changing needs. If
you do not wish to receive these offers, let us know by calling 1-877-SUN-LIFE (1-877-786-5433).
Life’s brighter under the sun
Group Benefits are provided by Sun Life Assurance Company of Canada,
a member of the Sun Life Financial group of companies.
GB10171-E

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Contract Number: 102350 and 151350

Effective: December 1, 2023

Extended Health Care 17

Emergency Travel Assistance 26

Accidental Death and Dismemberment 43

Your Group Benefits (C1) 2

Plan Member Services

Access to mysunlife website

Prior Authorization Program

Your Drug Card

Your Travel Card

Your Group Benefits (C1) 3

All other inquiries

Your Group Benefits (C1) 4

Waiting period 3 months of continuous employment

Extended Health Care - Contract Number 151350

Drug card plan Included

Prescription drugs 80%

Your Group Benefits (C1) 5

Out-of-province referred 80%

Medical services and 100%

Termination When you retire

Dental Care - Contract Number 151350

Deductible Individual – $25 per benefit year

Your Group Benefits (C1) 6

Preventive procedures 80% after the deductible

Major procedures 50% after the deductible

Benefit year maximum $2,500 per person

A separate lifetime maximum (below) applies to Orthodontic expenses

Lifetime maximum Orthodontic procedures – $1,500 per person

Termination When you retire

Long-Term Disability - Contract Number 102350

Elimination period 26 weeks

Your Group Benefits (C1) 7

Employee Basic Life

Reduction Coverage is reduced to $5,000 when you reach age 65

Termination When you retire or reach age 70, whichever is earlier

Employee Optional Life

Amount You can choose coverage in units of $10,000

Termination When you retire or reach age 65, whichever is earlier

Spouse Optional Life

Amount You can choose coverage in units of $10,000

Accidental Death and Dismemberment - Contract Number 102350

Employee Accidental Death and Dismemberment

Amount Equal to Employee Basic Life coverage

Termination When you retire or reach age 70, whichever is earlier

Your Group Benefits (C1) 8

Instructions and Time Limits for Sending Us Your Claims

Your Group Benefits (C1) 9

For orthodontic procedures, a

The submission of these forms is If your Long-Term Disability

We will assess the claim and send

From time to time, we can require

Your Group Benefits (C1) 10

For any loss other than death:

For coverage during total

Your Group Benefits (C1) 11

Who qualifies as your Your dependent must be:

Your Group Benefits (C1) 12

A dependent’s coverage begins on the later of the following dates: