Making a Claim
Submitting 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.
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.
Claims Submission Deadlines
Health Care Plan
Expense claims must be received by Sun Life no more than 90 days after:
- the end of the year in which the expense is incurred, or
- termination of coverage.
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.