Making a Medical or Dental Claim

When should I submit my claims?

In most cases, you must submit claims within 18 months of incurring an expense.

For expenses incurred out-of-country, if you did not contact Alliance Global Assistance at the time of emergency, you must submit claims within 30 days of returning home.

If your coverage ends, you have 90 days to submit any outstanding claims.

While it is recommended to submit most claims as quickly as possible, it is also helpful if you hold claims for medical expenses until they total $50 or more.

An eligible expense is deemed to be incurred on the date the service is received or on the date supplies are purchased or rented. For example, if you purchase and pay for new eyeglasses on December 15, but pick them up on January 7, the claim date is December 15.

Note: Some coverage has maximums per benefit year. The benefit year runs from January 1 to December 31 annually.

What is considered “proof of a claim”?

Proof of claims includes:

itemized bills
prescription receipts
reports from doctors or hospitals
hospital records

For any claims that are not submitted in hard-copy or through your provider, be sure to keep your receipts. Sun Life will randomly audit claim submission online so please keep your original receipts and supporting documentation for 12 months. If your claim is chosen for audit, Sun Life will ask you to mail the original receipt before processing your claim.

Claims for multi-appointment procedures

Claims for multiple appointment procedures (other than orthodontic) are paid after the procedure is completed.

You may claim after any orthodontic procedure, whether or not it is part of a series, or after any non-orthodontic procedure that requires only a single appointment.

Registering for mysunlife.ca

By registering for mysunlife.ca (external link) you’ll be able to:

submit most claims for instant processing;
sign up for to have claim payments deposited into your bank account within 24-48 hours;
print an all-in-one coverage card for your wallet;
print your personalized Pay-Direct Drug card
send secure e-mail messages to Sun Life;
print personalized claim forms;
print your out-of-country medical emergency travel card;
and more.

Register online in three easy steps (external link) .

Be sure to keep your password private and secure to prevent fraudulent claim submissions.

If you experience any problems registering online or have any questions, please contact the Sun Life Customer Care Centre at 1-800-361-6212.

Five ways to submit claims

For claim submission, you'll need your Sun Life policy and certificate number. The policy number is 25180 and your certificate number is your TMU employee number.

Direct pay

Your paramedical service provider (e.g. physiotherapist, chiropractor) or dentist may submit your claim electronically to Sun Life for direct pay. If this is the case, you will not have to pay out-of-pocket, however it is important that you review the form for accuracy of the charges.

Pay direct drug card

Accepted at pharmacies across Canada, your Sun Life Pay-Direct drug card is used for prescription drug claims for you and your eligible dependents. The card allows pharmacies to bill Sun Life directly, reducing unnecessary out-of-pocket expenses.

How do I receive my card?

Your drug card will be mailed to you upon your enrolment in the plan.

You can also print your card from mySunLife (external link) website:

Sign in to mysunlife.ca
Click “Take me to…” in the my health and wellbeing section of the website.
Select “Print drug card”

You must use your drug card for every prescription drug purchase otherwise you may not be reimbursed the full amount you paid out-of-pocket.

If you do not receive your card within four weeks of enrolment, please submit a request to HR.

Online claim submission

Submit your paramedical (e.g. chiropractor, massage therapist), vision and dental claims online using the Sun Life password protected plan member services website. In most cases, your claim is processed immediately and you receive an online notice telling you whether the expense is covered and the details of your claim payment.

Step-by-step claim submission

Login to the mysunlife.ca home page
Select Submit a Claim under "Take me to..." or select the type of claim from "Claims" on the menu bar.
You will be guided through the claim process in a few easy steps.

You can also access online e-tutorials that includes my Benefits Paid Fast, an e-claims module (external link) .

Sun Life mobile application

Submit paramedical, prescription drug and dental claims by downloading the free Sun Life app, my Sun life Mobile, on your smartphone. Sign in using your Sun Life access ID and password.

You'll need to pay providers upfront and Sun Life will reimburse eligible expenses to your bank account most often within 24-48 hours.

Hard copy claim submission

To access a pre-filled claim form that includes your contract number, member ID, date of birth, and address sign into mySunlife (external link) , select “my claims” and then “Print claim form".

You can download an empty Extended Health Care Claim Form (external link) or Dental Claim (external link) .

To complete your claim form:

Complete both sides of the claim form. The signature at the bottom of the claim form must be yours, whether the claim is for yourself or one of your dependents. The claim will not be paid if the claim form is not properly completed.
Make a copy of your claim form and receipts for your records. Some medical expenses not reimbursed by the group insurance may be eligible for a tax credit when you file your income tax return.
Mail the completed form with all receipts directly to Sun Life. The mailing address is on the back of the claim form.
Sun Life will mail a reimbursement cheque, if appropriate, to your home address along with an explanation of how your eligibility for payment has been determined. You can also arrange direct deposit to your bank account by contacting Sun Life at 1-800-361-6212 or by registering for mysunlife.ca (external link) .

If you have questions about your coverage or the status of submitted claims, or disagree with any claim settlement, please contact Sun Life at 1-800-361-6212 or visit the Sun Life customer support page for more support details (external link) .

How do I submit claims if my spouse has coverage?

TMU's benefits have been designed so that benefits paid by all group plans combined will provide coverage up to the actual eligible expenses incurred. If you or any of your dependents have coverage under your spouse’s plan, review coordination of benefits for more information.

Questions

Contact Sun Life Customer Care Centre between 8 a.m. - 8 p.m., Monday to Friday (excluding holidays) at 1-800-361-6212. You will need to provide the TMU Health Plan number 25180 and your Sun Life certificate number which is the same as your TMU ID number.