E-Claims

Answers

Can I submit claims if there is a need for a doctor’s note?

Some Paramedical claims require a doctor’s note (recommendation) before they can be covered by the benefit plan.  If a doctor’s note is required for a Paramedical claim and if the amount of the claim is under $100, Sun Life will complete the e-claim submission and make payment to your bank account.  However, you will be required to submit the doctor’s note to Sun Life, immediately.  If the amount of the claim is over $100, Sun Life will complete the email submission, send you an email confirmation and make payment to your account within a few business days after they receive the appropriate doctor’s note.

Doctors’ notes can be submitted by email, FAX or by regular mail.  The my Sun Life website will provide you with further details.

Is there an audit process?

To ensure that benefit plans are protected, Sun Life currently audits approximately 1 out of 8 e-claims, validates provider information and monitors claiming patterns.

If your claim is audited, the audit will be completed before payment is made to your bank account.  Sun Life may ask you to provide your receipts within 15 days, to support your claim.  Receipts can be scanned and sent by email, sent by fax or by regular mail to Sun Life.  Sun Life usually requires a few days to complete the audit and then make payment, if appropriate.  The my Sun Life website will provide you with further details.

To submit expenses online, do I first need to register for the member website, “my Sun Life”?

Yes.  To use e-claims you need to first register at www.mysunlife.ca. You can get step by step registration information by reviewing “Accessing my Sun Life” or from the video.

To submit an e-claim, you must also first register for direct deposit and e-mail notification of payment.  With this all in place, you will experience real-time adjudication, instant notification as well as direct payment to your bank account within 48 hours.

What do I do with my expense receipts after the claim is paid?

Sun Life requires you to keep your receipts and other claim documentation for 12 months, as e-claims are subject to audit.

What happens when I make my first paramedical e-claim?

For the initial claim, you will be prompted to enter the provider’s details, which Sun Life will validate and store on the system for future claims.  The information you need to enter should be available from your practitioner’s receipt.

Which expenses can I submit online?

You can submit claims for:

• Vision care; glasses and contact lenses,
• Basic dental expenses for preventative services, recall exams & cleaning,
• Drug
• Orthodontics (once an approved treatment plan is on file with Sun Life),
• Paramedical services for
  • Physiotherapy
  • Psychology
  • Chiropractic services and x-rays
  • Podiatrist services
  • Chiropodist services
  • Massage therapy
  • Naturopathy

For certain claims, Sun Life may require you to provide additional information or supporting documentation before processing your e-claim.  The my Sun Life website will guide you through the process.  

Which expenses must I continue to submit on paper?

While processing an e-claim, the my Sun Life system will advise you if the claim must be submitted by paper. Here are some examples:

• Major restorative dental claims such as bridges, crowns or dentures
• Acupuncturist
• Speech Language Pathologist
• Hospital room claims
• Nursing services
• Coordination of benefits claims
• Expenses incurred outside of Canada
• Expenses resulting from a work-related illness or injury, or from a motor vehicle accident

Who do I call if I am having difficulty with the “my Sun Life” website?

If you are having difficulty with submitting claims or with the website, please call the Sun Life Customer Care Centre at 1-800-361-6212. You can also send secure messages from the website to the Customer Care Centre.