Making a Claim
In provinces with a program to cover expenses also covered under the NAV CANADA Health Care Plan (for example, prescription drugs, artificial limbs and other assistive devices, dental services, etc.), first, submit your claim to the province. Then, submit any eligible expenses remaining under the Health Care Plan.
Claiming under the NAV CANADA plan
Using the Pay Direct Drug Card
If you are a retiree covered under the Health Care Plan, you have access to the Pay Direct drug card feature. This card can be used for prescription drug expenses for you and your registered dependents.
If you do not use your Pay Direct drug card, your pharmacist may charge you more than the customary mark-up rate, and these higher charges are NOT covered by the Health Care Plan.
If you and your spouse are both covered under the NAV CANADA Health Care Plan and you are covered as a dependent under family coverage on your spouse’s Health Care Plan, you will not have access to your own Pay Direct drug card as a dependent under your spouse's plan.
If you buy prescription drugs through our mail-order Preferred Pharmacy, you will not need to claim with Sun Life, since our mail-order Preferred Pharmacy will invoice Sun Life directly for the applicable eligible expenses paid by the Plan.
Paper Claim Form
Pay the expense and get a receipt,
mail the claim form and original receipt to Sun Life.
Coordination of Benefits
If you and your spouse are covered by more than one Benefit Plan, you may be able to claim up to 100% of eligible expenses, depending on what is eligible under your spouse’s plan. You can also coordinate benefits if you and your spouse are both covered under the NAV CANADA Health Care Plan and both have family coverage.
Always submit expenses first to the plan that covers you as a full-time or part-time employee (if, for example, you are covered under another plan as a spouse or retiree).
- To your NAV CANADA plan
- To your spouse's plan, if a balance remains
- To your spouse's plan
- To your NAV CANADA plan, if a balance remains
- To the plan of the parent whose birthday falls earlier in the year (if both parents have the same birth date, to the plan of the parent whose surname begins with the first letter in the alphabet)
- To the plan of the other parent, if a balance remains
If you are separated or divorced and are claiming for your children
Claims must be processed in the same order as if you have shared custody of your children. As long as you are the legal parent of the child, you can process his or her claims.
Claims must be submitted first to the plan of the parent with primary custody, then, to the plan of the other parent, if a balance remains.
Coordination of Benefits with the Pay Direct Drug Card
If your pharmacist is aware that there is a secondary plan and he/she is prepared to accommodate you, they will be able to transmit a claim under the secondary plan, indicating what amount was allowed under the primary plan. This may permit 100% reimbursement of the cost of the prescription.
However, in this case both you and your spouse must have coverage with Sun Life (and both must have a drug card) or your spouse must have a drug card with a carrier who uses Telus Health Solutions (formerly known as Emergis) as their pay-direct provider.
If your spouse’s health care coverage is not with Sun Life and/or does not have pay-direct with Telus Health Solutions, you will not be able to use your pay-direct drug card for those expenses and must submit a paper claim form for the coordination of benefits portion.
Expense claims must be received by Sun Life no more than 90 days after:
Checking Health Claims Status
Call the Sun Life toll-free customer service number, and select the option “Medical and Dental Claims Information”, Monday through Friday 7 am to 8 pm, Eastern Standard Time, at 1-800-361-6212.
Alternatively, go online to the Sun Life Member Services web site at www.mysunlife.ca/navcanada using your Access ID and PIN. You can get an Access ID and PIN number by calling Sun Life at the above number.