Update on Benefits

July 09, 2018

 

Requirements for Prescriptions

In order to be eligible under the PSHCP, drugs as well as some services, products and devices require prescriptions. Drugs must be prescribed by a physician, dentist or other qualified health care professional if the applicable provincial/territorial legislation permits them to prescribe them. Vision care benefits must be prescribed by an ophthalmologist or optometrist, and services of medical practitioners, products and devices must be prescribed by a physician.

It is important to note that most prescriptions are only valid for a specific amount of time. Make sure the date of issue is indicated on a new prescription when submitting it to Sun Life or your claim will be declined. You should also verify that it is still valid before incurring any expenses as claims will also be declined if your prescription has lapsed and needs to be renewed. This confirms that drugs, products and services are still medically necessary and meet the patient’s condition.

The table below highlights the length of time a prescription remains valid under the Plan:

BENEFIT

DURATION OF PRESCRIPTION

Services of a physiotherapist

One year

Services of a massage therapist

One year

Services of a speech language pathologist

One year

Services of a psychologist

One year

Services of a social worker (only eligible if the member resides in an isolated post)

One year

Services of a nurse

One year, unless otherwise advised by the Administrator

Services of an electrologist

Three years

Orthotics

Three years

Orthopaedic shoes

One year

 

You should contact Sun Life at 1-888-757-7247 (toll free in North America) or in the National Capital Region at 613-247-5100, Monday to Friday from 6:30 a.m. to 8:00 p.m. EST for additional information related to the prescriptions requirements.

Therapeutic Mattresses

To be considered under the Miscellaneous Expenses Benefit, expenses must be reasonable and customary charge and prescribed by a physician unless otherwise specified. Eligible expenses include the rental or purchase (at Sun Life’s discretion) of cost-effective durable equipment that is:

  • manufactured specifically for medical use;
  • for use in the patient's private residence;
  • approved by the Administrator for cost effectiveness and clinical value; and
  • designated as medically necessary.

Therapeutic mattresses are eligible under this benefit, however, their purchase is limited to one every five years and a maximum eligible expense equal to cost less all eligible therapeutic mattress repairs incurred during the previous five years. The intent of this provision is to provide coverage for medically necessary therapeutic mattresses such as those prescribed for the treatment of pressure ulcers and skin breakdown caused by a person being bedridden or for burn victims.

There is no benefit under the Plan for a mattress that is not manufactured specifically for medical use, such as an orthopaedic mattress. 

We encourage you to contact Sun Life to confirm coverage before incurring such expenses.