Changes to Out-Of-Province Coverage Under the EHC Plan

Your Extended Health Care Plan is NOT intended as full travel insurance and it is strongly recommended that employees obtain additional coverage.

A Message from Human Resources  (Posted 4-December-2007)

Recently, Worldwide Assistance Services Inc., Sun Life's emergency travel assistance provider, changed its name to Europ Assistance USA, Inc. Sun Life wants to assure everyone that this name change will not affect services provided, nor the phone numbers plan members call when they have an out-of-province medical emergency.

Please click here for further details or email them directly at ops@europassistance-usa.com

Before Leaving the Country:

Please click here to view a memo from the Council detailing the changes to the Extended Health Care Plan as it relates to out-of-province or out-of-country emergency coverage.  Employees are now required to call a toll-free number for pre-approval prior to any medical treatments being received outside of Ontario.  Should they not do so, they risk the denial of their claim. 

Note: You should bring this toll-free number along with your policy and certificate number when leaving the country.

What Coverage Do We Have?

The intent of the out of country benefit is for emergency medical treatment. An emergency is an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor (e.g. at a hospital or clinic). This includes non-elective treatment for immediate relief of severe pain or illness that cannot be delayed until you or your insured dependent is medically able to return to your province of residence.

Should a medical emergency related to a condition that existed prior to your departure arise, there are provisions in your plan. However, expenses for regular, non-emergency treatment of a condition which existed prior to your departure will NOT be eligible (ie. Kidney dialysis treatments, chemotherapy for cancer patient, etc). Benefits are payable in Canadian dollars with the exchange rate at the time of claim adjudication being taken into account. Sun Life will only cover services incurred within 180 days of the dependant leaving their home province.

Kindly note that this plan is NOT intended as full travel insurance. It covers a portion of the cost of semi-private hospital room accommodations, out-patient services in a hospital and the services of doctor, up to the difference charged by a doctor and the amount equal to the medical fee schedule of the person's province of residence for emergency health services.

Hospital:

Out-of-Canada hospital bills are considered eligible only if you have Plan I coverage. The amount payable is 85% of the excess of:

• the above billed, exclusive of any charge for room and board above the semi-private level and any charge of non-essentials such as television rentals and gourmet meals, over
• the amount payable by OHIP

The following is an example of what the Plan will pay or you may be required to pay provided you have semi-private hospital accommodation:

Example Assumptions:

•  4 day hospital stay at $1,200 U.S. Per day
• $45 U.S. per day semi-private to private differential
• Exchange rate is 1.5
• All figures in Canadian dollars

EHC Plan 1

Doctors services when rendered outside of Canada are covered under Plan I with the amount payable equaling 85% of the excess of the bill over the OHIP allowance, provided that excess does not exceed the prevailing Ontario Medical Association (OMA) Schedule of Fees for the service in question. Currently, the OHIP schedule is approximately 70% of the OMA schedule. The following example is provided to illustrate the out-of-pocket expenses you could incur.

Ambulances:

Plan I covers 85% of the cost (after OHIP) of out-of-Canada local ambulance service which generally means emergency transportation to or from the nearest hospital qualified to provide the required care.

The cost of airfare home from out-of-Province/out-of-Country is not defined as an eligible expense. This is one of the reasons why you should obtain advice and make a decision about purchasing medical coverage over and above that provided by the Colleges Extended Health Care Plan when traveling out of Canada.

Other eligible medical expenses such as, paramedical services, prescription drugs and vision care are NOT considered out of country benefit. Therefore, these expenses will continue to be assessed as agreed under the terms of the contract, even if incurred out of country.

Dental coverage also does NOT fall under the out of country benefit. Therefore, eligible expenses will continue to be assessed as per the terms of the contract, even if incurred out of country. Currently, eligible expenses are considered against the 2006 Ontario Dental Association's suggested fee guide for General Practitioners.

Again, Europ Assistance USA, Inc must be contacted in the event of a medical emergency. For more information on the out of country medical benefit, please refer to the coverage booklets.

Additional Information:

Please click on one of the links below to get all the detailed information you require about your Benefit Plan (in PDF format), and check back regularly for amendments and additions.

Academic Benefit Booklet (Dated January 2007)

Administrative Benefit Booklet (Dated January 2007)

Support Staff Benefit Booklet (Dated October 2005) 

Retiree Extended Health Care Plan 1  (Dated August 2005)

Should you require further information or clarification, please do not hesitate to contact Sun Life by e-mail at askus@sunlife.com or by telephone at 1 800 361 6212

Please don't hesitate to contact us if you have any questions or Feedback.

Click here for a complete listing of Human Resources Contact Information.