Benefit Enrolment FAQs

The benefit year runs from July 1 to June 30.

In order to have your claims processed, Sun Life must receive your claim prior to the September 30^th following the end of the benefit year in which the claims were incurred.

To be eligible for group benefits, you must:

• Be a resident of Canada
• Be enrolled in your provincial health care plan
• Hold an appointment at McMaster University for a minimum duration of twelve (12) months or more

Your dependents become eligible for coverage on the date you become eligible or the date they first become your dependent, whichever is later.  You must enroll for coverage for yourself in order for your dependents to be eligible.

There is no waiting period for you or your dependents for your group plan.

If you are eligible to receive additional health benefits through the University’s insurance provider, Sun Life (as indicated in your letter of offer), your qualified dependents will also be eligible to receive these benefits.  According to Sun Life, your dependent must be your spouse or your child and a resident of Canada or the United States and maintaining provincial health coverage (or University Health Insurance Plan coverage).

• A spouse includes someone who is legally married to you, or your partner of the same sex or opposite sex who has been publically represented as your spouse for at last the last 12 months. You can only cover one spouse at a time.
• A child includes unmarried children, legally adopted children, and children for whom you are the legal guardian. This would also include your spouse’s children if your spouse has sole responsibility by decree of divorce for support and maintenance of this child.  Children will be considered dependents up to age 21, or up to age 25 in the case of a full time student wholly dependent on you for support.

To add a dependent to your Sun Life benefits, you must complete the ‘Extended Health and Dental Positive Enrolment Form’ and submit it to your HR Area Office.  Be sure to include all eligible dependents as only the most recent form submitted is kept on file.

My Sun Life provides you with easy online access to your benefits information and the ability to submit claims online.  To sign up you will need to enter your contract number and member ID (which you should receive during your Welcome Meeting from your HR Representative).  Depending on your plan, My Sun Life provides a convenient location to:

• Submit your claims online for instant processing
• Sign up for direct deposit to receive your claim payments faster
• View your claim statements as well as your claims history
• Check when your plan will cover your next purchase of glasses or lenses
• See when you, or your family members, are eligible for your next dental check-up
• View details of what’s covered under your plan
• Print an “all-in-one” coverage card to keep in your wallet

Additionally, My Sun Life offers a mobile app available through Google Play, the App Store, or BlackBerry World.  Through the app you can access all the same features as the My Sun Life website.

For more information, visit https://hr.mcmaster.ca/employees/total-rewards/benefit-information/

MAKING E-CLAIMS: Most benefit claims can be submitted online directly to Sun Life for instant processing through My Sun Life. Most claims are processed instantly and you can access your claim statement right away.  You will receive an email letting you know when your claim payment has been deposited to your bank account, usually within 24 to 48 hours.

• Sign up for direct deposit through My Sun Life
• Using the claims menu, select the type of claim (e.g., dental, paramedical) and you will be guided through in a few easy steps.
• Keep all original receipts in case Sun Life needs additional proof of service.

PAPER-BASED CLAIM SUBMISSIONS: If you need to mail a claim, you can download a paper claim form from My Sun Life with your personal information already filled in, or get a copy of the ‘Extended Health Care Claim Form’ from Human Resources.. Just complete the remaining information then print, sign, attach your receipts and send it to Sun Life at the address shown on the form.  Be sure to keep a copy of all receipts and claims submitted.  Reimbursements will be mailed directly to your home address if you are not enrolled in the direct deposit program.

Visit Human Resources Services for more information.

If you or your dependents are covered for Extended Health or Dental Care through Sun Life and another plan, your Sun Life benefits will be coordinated with the other plan following insurance standards.  These standards determine which plan you should claim from first.  If you have any questions about where to submit your claims, your HR Representative can help you.  Some guidelines for claim submission include:

• If you are claiming expenses for your spouse and your spouse is covered for those expenses under another plan, you must send the claim to your spouse’s plan first.
• If you are claiming expenses for your children, and both you and your spouse have coverage under different plans, you must claim under the plan of the parent with the earlier birthday (month and day) in the calendar year.
• The maximum amount that you can receive from all plans is 100% of actual expense.