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Eligible Expenses

Personal Travel

Eligible expenses include:
  • public-ward accommodation and auxiliary hospital services in a general hospital,
  • the services of a physician,
  • out-patient services in a hospital,
  • one-way economy airfare for the patient and professional attendant, back to the province of residence, when medically necessary,
  • medical evacuation by ambulance, when Sun Life determines that suitable care is not available where the emergency occurs,
  • family assistance, for example, reimbursement of expenses to return dependent children, under age 16, to Canada, subject to certain limits (combined maximum payable - $2,500 for any one travel emergency),
  • transportation arrangements to the nearest hospital that provides the appropriate care, or back to Canada,
  • medical referrals, consultation and monitoring,
  • legal referrals,
  • a telephone interpretation service,
  • a message service (messages held up to 15 days for family and business associates),
  • advance hospital and medical expense payment, and
  • return of the deceased, in the event of death, to the province of residence, to a maximum of $3,000.
If a treatment or service is not offered in the patient’s province of residence and the person is referred to a hospital in another province, in writing, by the attending physician in his/her province of residence, the plan pays 100% for reasonable and customary charges for the same services, up to a maximum of $25,000 per illness.

Business Travel

Eligible expenses include:
  • drugs and medicines available only by prescription and listed in the current Compendium of Pharmaceuticals and Specialties,
  • private-duty nursing, prescribed by a physician as medically necessary, where the service is provided by a registered nurse not a member of your family or ordinarily resident in your home, to a maximum of $1,000 per person,
  • transportation by local licensed ambulance,
  • diagnostic laboratory and X-ray examinations,
  • administration of anaesthesia, oxygen, blood, and blood transfusions,
  • semi-private hospital room and board charges and related services and supplies, including drugs administered while confined to hospital for up to 30 days, and
  • physician charges for medical or surgical services.
The plan also covers reasonable and customary charges for transportation, medical services, and medical supplies for an emergency evacuation, to a maximum of $50,000 for each employee, as long as:
  • the attending physician certifies that:
    • your medical condition warrants immediate transportation to the nearest hospital where appropriate medical treatment can be obtained, or
    • after being treated at a local hospital, your medical condition warrants transportation to your Canadian residence for further medical treatment or to recover, or both,
  • travel is by the most direct and economical route, and
  • expenses for special transportation (that is, any land, water, or air conveyance required to transport you during an emergency evacuation, including, but not limited to, air ambulance, land ambulance, and private motor vehicle) are those required by the regulations of the conveyance in which you are transported.
If you, your spouse, or child sustain a covered injury and are confined to a hospital more than 150 kilometres from home, the plan pays reasonable and customary charges to bring a member of your immediate family (that is, your legal or common-law spouse, parents, grandparents, children over age 18, brother, or sister) by the most direct route by licensed common carrier to be with the person. The attending physician must recommend this visit in writing. The maximum payable is $10,000.
Published on February 01, 2016