Frequently asked questions:
changes to the group insurance plan
Browse through frequently asked questions about the changes to the group insurance plan as of January 1, 2025.
About annual deductibles & threshold scenarios
Carefully considered modifications were made to the health and dental care components of the plan to preserve your financial security and that of the group insurance plan.
It is a fixed amount you are required to pay out-of-pocket before receiving a reimbursement from the plan. Concordia’s deductible is $3 per medical product which has a Drug Identification Number (DIN). This includes each purchase or renewal of prescription drugs, as well as medical products available at the pharmacy counter, such as blood glucose test strips and insulin pumps.
The annual threshold is the amount of eligible expenses that must be reached per certificate before receiving 100% reimbursement from the plan for prescription drugs for the rest of the plan year.
By introducing a deductible per prescription, we ensure that only the cost of prescription drugs and medical products with a DIN are subject to this out-of-pocket expense, rather than applying it broadly to more areas of health care coverage as with an annual deductible.
If you take prescription drugs on a regular basis to treat stable medical conditions, ask your pharmacist for a renewal every 90 days instead of 30 days. In addition to limiting your pharmacy visits, you will save on the deductible and the pharmacist dispensing fees.
If the cost of your prescription of medical product with a DIN is less than the $3 deductible, you will only be responsible for paying the actual cost of the item. Since the total cost does not exceed the deductible amount, there will be no reimbursement from the plan.
No, and here is an example to explain why:
Rachel — who is under age 65 — and her eligible dependents claim 4 prescription drugs per month at a cost of $250 each, totaling $1,000 per month. For each claim, they pay a $3 deductible and receive an 80% reimbursement, as the drugs are on the RAMQ list. Here’s what they pay monthly for those prescriptions:
- $3 per prescription (4 x $3, totaling $12)
- 20% of the cost, after the deductible, representing the portion not reimbursed by the plan
Rachel and her dependents pay $209.60 per month for these prescriptions. What counts towards the threshold is the amount they pay plus what was reimbursed by the plan, totaling $1,000 per month. After three months, they will reach the threshold and receive 100% reimbursement for eligible prescription drugs until the end of the plan year. They will have paid $628.80 in total ($209.60 x 3) before reaching this threshold.
As shown in this example, you don’t have to spend $3,000 on prescriptions to receive 100% reimbursement for eligible prescription drugs for the rest of a plan year.
No, you will not. Once the $3,000 threshold is reached, you and your eligible dependents have nothing to pay out-of-pocket for eligible prescription drugs for the rest of the plan year.
The deductible paid per prescription, the portion of the prescription drug cost not reimbursed by the plan, and the portion that is reimbursed by the plan. In certain cases, the pharmacist’s dispensing fees may surpass the reasonable and customary (R&C) limits, which could result in not all expenses being eligible or counted towards the threshold.
Per "certificate" means all the individuals insured under your coverage, which includes you and your eligible dependents.
About the Health Care Spending Account (HCSA)
The HCSA is an annual allowance to be used as needed to reimburse medical and dental expenses that are not covered or partially covered by the plan. Every year on January 1, the University will deposit an amount in your HCSA. You and your eligible dependents will then be able to use the HCSA like a bank account to claim eligible medical and dental expenses.
Provided you are a member of Concordia health care coverage, you (the employee), your spouse and any other person listed as one of your dependents on your income tax return have access to this account.
Online at mySunLife.ca or on the my Sun Life mobile app.
Health, vision and dental expenses that are not covered or partially covered by the plan such as:
- Eye exams, glasses
- Orthodontics
- Paramedical services
- Medical equipment
- Private hospital room
- Health, vision, dental care and RAMQ premiums
- And more! Consult the Canada Revenue Agency website for the complete list.
An annual allowance is deposited in your Sun Life HCSA at the beginning of each year, and is based on your type of coverage for health care (single, single-parent, couple, family) and your age (whether you are under age 65 or age 65 and over) as of January 1 of each year.
Option 1
Online at mySunLife.ca or on the my Sun Life mobile app.
- Log in and click on "Health Spending Account e-claim" under the Claims tab.
- Review and confirm your banking details, email, and address in Step 1. Make sure everything is correct before proceeding.
- Read the terms and conditions carefully, then check "I agree" to continue.
- Select who the claim is for and move to the next step.
- Choose your "Other expense" as the type. Enter the service date and claim amount, then proceed.
- Upload supporting documents. You must provide proof that premiums were paid in full, then proceed.
Acceptable documents include:
- Pay stub for employees (clearly showing health and dental premium deductions) or CIBC statement for Pensioners (clearly showing the health deduction).
- Statement or letter from HR for employees currently on leave, who pay their Health insurance premiums by cheque.
- Before submitting, carefully review all the information in your claim.
- Submit your claim once you've verified everything is correct.
If approved, any reimbursement amount is usually deposited into your bank account within 7 business days, if you are signed up for direct deposit. If you have not registered for direct deposit, a cheque will be mailed to you, which may take approximately 15 business days to arrive.
Option 2
By sending a paper claim by mail.
- Fill out the “Extended Health Care and Health Spending Account Claim Form” and follow the instructions. You can find this form on mySunLife.ca or on Carrefour and Pensioner’s Corner.
- In section 3 titled “Complete this section only if you have a Health Spending Account (HSA)”, make sure you select “You want us to assess this claim under your Extended Health Care benefit first and then assess any unpaid balance under your HSA”.
- You will need to attach the original receipt for each expense claimed and keep photocopies of your records.
- Sign page 2 in section 5 titled “Authorization and signature” and mail your claim at the address provided at the bottom of that page.
Paper claims are typically processed within 5 to 7 business days from the date they are received. If approved, reimbursements will be deposited in your bank account or a cheque will be mailed to you based on the timelines outlined at the end of Option 1.
Option 1
Online at mySunLife.ca or on the my Sun Life mobile app.
- Log in and click on "Health Spending Account e-claim" under the Claims tab.
- Review and confirm your banking details, email, and address in Step 1. Make sure everything is correct before proceeding.
- Read the terms and conditions carefully, then check "I agree" to continue.
- Select who the claim is for and move to the next step.
- Choose your type of expense. Enter the service date and claim amount, then proceed.
- Upload supporting documents, if required.
- Before submitting, carefully review all the information in your claim.
- Submit your claim once you've verified everything is correct.
If approved, any reimbursement amount is usually deposited into your bank account within 7 business days, if you are signed up for direct deposit. If you have not registered for direct deposit, a cheque will be mailed to you, which may take approximately 15 business days to arrive.
Option 2
By sending a paper claim by mail.
- Fill out the “Extended Health Care and Health Spending Account Claim Form” and follow the instructions. You can find this form on mySunLife.ca or on Carrefour and Pensioner’s Corner.
- In section 3 titled “Complete this section only if you have a Health Spending Account (HSA)”, make sure you select “You want us to assess this claim under your Extended Health Care benefit first and then assess any unpaid balance under your HSA”.
- You will need to attach the original receipt for each expense claimed and keep photocopies of your records.
- Sign page 2 in section 5 titled “Authorization and signature” and mail your claim at the address provided at the bottom of that page.
Paper claims are typically processed within 5 to 7 business days from the date they are received. If approved, reimbursements will be deposited in your bank account or a cheque will be mailed to you based on the timelines outlined at the end of Option 1.
If you are registered for direct deposit with Sun Life, reimbursements for claims processed through the HCSA will typically be deposited into your designated bank account within a few days, although it can take up to 7 days. Please ensure that your banking information is current to avoid any delays in receiving your reimbursement.
If you have not registered for direct deposit, a cheque will be mailed to you, which may take approximately 15 business days to arrive.
To register for direct deposit, log in to mySunLife.ca. Once signed in, select the Benefits tab and choose Benefits centre. Look for the Take me to list and choose Direct deposit and online claim statements. Then, choose Register. You will need your banking information and email address to get started.
You receive an allocation on January 1, which can be used until December 31. Any unused amount on December 31 will be carried forward for one additional year. If you do not use your allocated amount within this extended timeframe, it will be forfeited.
You can’t withdraw your HCSA amount, and if you don’t use it, it will be forfeited.
Just like the health care, vision care and dental care premiums, the HCSA is considered a taxable benefit in the province of Quebec. The taxable benefits amount will be determined based on the average amount used by all employees per type of coverage (single, single parent, couple and family) during the year.
The amount associated to your new status will be reflected on January 1 of the following benefit year.
Yes, in most cases, the HCSA can fully offset the cost of the insurance premiums.
If you are registered for direct deposit with Sun Life, reimbursements for claims processed through the HCSA will typically be deposited into your designated bank account within a few days, although it can take up to 7 days. If you have not registered for direct deposit, a cheque will be mailed to you instead.
To register for direct deposit, log in to mySunLife.ca.
- Once signed in, select the Benefits tab and choose Benefits centre.
- Look for the Take me to list and choose Direct deposit and online claim statements.
- Then, choose Register.
- You will need your banking information and email address to get started.
The allocation amount differs between these categories because the cost savings achieved from the plan modifications are redistributed to the groups that contributed to those savings.
Still have questions?
Sun Life Customer Care
1-800-361-6212
Monday to Friday, 8 a.m. to 8 p.m. (ET)
Contact Human Resources
hr-employeeservices@concordia.ca