Supplemental health

With Sun Life Supplemental Health plans, you can help your health plan work better

  • Employers have the flexibility to expand how they meet their employee population healthcare access needs
  • Employees can increase their financial ability to pay out-of-pocket medical and non-medical expenses (see below scenarios)    

Together, Sun Life's Accident, Critical Illness, Hospital Indemnity, and Cancer Insurance plans offer a holistic suite of coverages. Select all four plans or combine those most relevant to your workforce.

FAST FACTS

  • The average family deductible amount for U.S. employees in employer-based health insurance was $3,811 in 2022. (KFF)
  • Excluding retirement savings, the median savings of Americans under 35 is just $3,240. (MarketWatch)
  • 22% of U.S. adults have no emergency savings. (Bankrate)
  • 100 million Americans have healthcare debt. (KFF)
  • One-third of childhood injuries occur in sports. (Yale Medicine)

Gain insight from one family’s journey as Hospital Indemnity insurance helped during a time of immense hardship.

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SCENARIOS: Sun Life Supplemental Health benefit payments help employees meet out-of-pocket expenses. 

Sample workplace medical plan

Deductible: $2,000 for family plan | Co-pay: $25 primary care; $40 specialty; $250 emergency room | Out-of-pocket maximum: $5,000

Scenario: A child with a sports injury resulting in a torn ACL and dislocated knee.

The Sun Life Accident Plan may pay:

  • $200 Urgent Care
  • $200 Imaging (MRI)
  • $750 Outpatient surgery (arthroscopy with ACL reconstruction)
  • $600 Specialty care (6 visits)
  • $35 Generic medications
  • $400 Durable medical equipment
  • $500 Physical therapy (10 visits)

Totaling $2,685 in addition to medical plan coverage.

Scenario: Routine childbirth 

The Sun Life Hospital Indemnity plan may pay:

  • High plan: $2,000 admission benefit plus $400 for a 2-night stay.
  • Low plan: $1,000 admission benefit plus $200 for a 2-night stay.
  • If the Newborn Nursery Benefit option is selected, additional benefits are paid. 

Totaling up to $2,400 in addition to medical plan coverage. 

Scenario: A cancer diagnosis

The Sun Life Critical Illness plan may pay a benefit of $10,000 to $40,000 to help pay medical or other expenses including travel to appointments. 

 

The Sun Life Cancer plan may pay benefits for covered treatments, like chemotherapy, radiation, and surgery. 

Members can use their Supplemental Health benefits however they want: 

  • To pay out-of-pocket medical expenses not covered by health insurance, including deductible, co-pay and co-insurance amounts
  • To pay non-medical expenses associated with their injury or illness, like travel costs to medical appointments, or additional childcare expenses
  • Other ways, like a family trip that they don’t want to delay any longer

Hypothetical examples are provided for illustrative use only. Payments are provided for covered conditions and vary by plan.

RESEARCH: Read the top reasons for medical-related claims across Sun Life’s health-aligned portfolio.

 These same reasons may pay Supplemental Health benefits that complement your medical plans and wellness initiatives. Except where noted, all data reflects 2022 Sun Life claims.

By paid amount

  1. Invasive Cancer
  2. Heart Attack
  3. Major Organ Failure
  4. Stroke
  5. End-stage Kidney Disease
  6. Cancer in situ
  7. Benign Brain Tumor
  8. Coronary Artery Bypass Graft
  9. Paralysis
  10. Occupational Infectious Disease

By frequency

  1. Invasive Cancer
  2. Heart Attack
  3. Cancer in situ
  4. Major Organ Failure
  5. Stroke
  6. End-stage Kidney Disease
  7. Skin Cancer
  8. Coronary Artery Bypass Graft
  9. Angioplasty/Stents
  10. Benign Brain Tumor

Of all voluntary benefits, Critical Illness has the greatest perceived importance by employers who want to support employee well-being, enrich core benefit plans, and attract new employees ().

McKinsey

By paid amount

  1. Accidental Death Benefit
  2. Hospital Confinement
  3. Hospital Admission
  4. Emergency Room Treatment
  5. Physician Follow-Up Treatment
  6. Diagnostic Exam
  7. Hip or thigh
  8. Accident Emergency Treatment
  9. Physical Therapy
  10. Tendon/Ligament/Rotator Cuff

By frequency

  1. Physician Follow-Up Treatment
  2. Physical Therapy
  3. X-ray
  4. Emergency Room Treatment
  5. Accident Emergency Treatment
  6. Prescription Drug
  7. Diagnostic Exam
  8. Ambulance Transportation
  9. Hospital Confinement
  10. Hospital Admission

By paid amount

  1. First Day Hospital Confinement
  2. Hospital Confinement
  3. Extended Hospitalization
  4. Intensive Care Unit (ICU) Confinement
  5. Newborn Nursery Confinement

By frequency

  1. Hospital Confinement
  2. First Day Hospital Confinement
  3. Intensive Care Unit (ICU) Confinement
  4. Employer Facility - Hospital Confinement
  5. Extended Hospitalization

Hospital Confinement benefits include routine maternity care.

By paid amount

  1. First Occurrence
  2. Injected Cytotoxic Medications
  3. Hospital Confinement
  4. External Radiation Therapy
  5. Oral Cytotoxic Medication
  6. Immunotherapy
  7. Surgically Implanted Devices
  8. Outpatient Hospital Surgical
  9. Excision of skin cancer w/o flap or graft
  10. Refill Pump Dispensed Cytotoxic Medications

By frequency

  1. Injected Cytotoxic Medications
  2. External Radiation Therapy
  3. Oral Cytotoxic Medication
  4. Anti-nausea
  5. Medical Imaging
  6. Outpatient Hospital Surgical
  7. First Occurrence
  8. Hospital Confinement
  9. Biopsy Only
  10. Immunotherapy

By frequency

  1. Lipid panel / Blood test for lipids
  2. Immunizations
  3. Breast Cancer Screening/ultrasound/mammography
  4. Pap smear
  5. Annual physical examination
  6. Diabetes tests
  7. Interscholastic Sports Physical Exam
  8. Fasting Blood Glucose Test
  9. Colorectal Cancer Screening
  10. Echocardiogram
  11. Dental examination
  12. Skin Cancer Screening
  13. Prostate Cancer Screening/PSA blood test
  14. Chest x-ray
  15. Vision examination

Regular preventive screenings encourage early detection and treatment, leading to reduced healthcare costs, increased productivity and reduced absenteeism due to illness. ()

Kaiser

Short-Term Disability, by frequency

  1. Musculoskeletal
  2. Injury
  3. Digestive
  4. Mental
  5. Neoplasm
  6. Genitourinary
  7. Circulatory
  8. Other
  9. Nervous
  10. Endocrine

Long-Term Disability, by frequency

  1. Musculoskeletal
  2. Neoplasm
  3. Injury
  4. Circulatory
  5. Mental
  6. Nervous
  7. Other
  8. Digestive
  9. Genitourinary
  10. Respiratory

Supplemental Health benefits often complement Disability benefits by providing additional financial protection for medical expenses, offering a comprehensive safety net during times of illness or injury.

By reimbursement amount

  1. Malignant Neoplasm
  2. Leukemia, Lymphoma, Multiple Myeloma
  3. Cardiovascular
  4. Orthopedics/Musculoskeletal
  5. Newborn/Infant Car
  6. Respiratory
  7. Sepsis
  8. Neurological
  9. Gastrointestinal
  10. Urinary/Renal

SOURCE: , based on Sun Life book of business data, 2018-2021.

Sun Life 2023 High-cost Claims and Injectable Drug Trends Analysis, based on the Sun Life book of business data, 2018-2021

Conditions may pay a Supplemental Health benefit to covered employees depending on the diagnosis or treatment type (e.g., surgery, inpatient confinement). Read the for more information.

Sun Life 2023 High-cost Claims and Injectable Drug Trends Analysis,  based on the Sun Life book of business data, 2018-2021.

 

  • Payments may be paid once annually when a member submits a claim for a covered wellness screening, and may be payable even for Dental and Vision exams.
  • Payments are available per covered member; a family of four could submit a claim for each person, helping pay their premium or expenses. 

EASY CLAIMS SUBMISSION:

Talk with us about easy claims submissions online for members, medical file feed, Wellness Benefit bulk submissions, and our automated outreach.

Online claims management for employees

Employers can enable automated payments with medical file feeds

Bulk wellness submissions

Integrated benefits platform checks for other eligible benefits

We make employee education and enrollment easy with Benefits Explorer, our streamlined digital experience customized to your employee population. Set-up is a snap and implemented by our experts.  Live benefits counselors can provide support to complement the intuitive, easy-to-understand and engaging online experience.  You can also use your own HCM/benefits platforms.

According to LIMRA BEAT Study, 2023, employees who understand their benefits well are the most confident in their decisions.

 

Help your health plan work better – a focus on Critical Illness

In addition to important financial benefits, our Critical Illness insurance helps expand access to care, reduce costs, and improve outcomes.

Members who receive benefits for cancer have access to AbleTo virtual behavioral health therapy and coaching, especially helpful during a time when access to mental healthcare is challenging

AbleTo virtual behavioral health therapy and coaching

Health Navigator Help Line provides employees with expert guidance and support for their health-related needs like physician recommendations, preparing for an upcoming medical appointment, or answering medical billing or claims questions. Utilization of Health Navigator Help Line can lead to improved health outcomes for employees.

Health Navigator Help Line

Sun Life Stop-Loss clients who offer Critical Illness to employees, automatically receive an increased Stop-Loss reimbursement when there is a Stop-Loss claim for cancer—regardless of whether the member elected coverage.

Sun Life Stop-Loss

Member Feedback

"When my husband was scheduled to have surgery, I remember [our Sun Life claims representative] working above and beyond to make sure we were able to have the critical illness payment approved and issued as soon as possible. 

She was very thorough on what documents/information was needed to complete the claim and did a superb job at following up on the status of the claim.

Our experience with everyone at Sun Life has been very pleasant.

Everyone that we have worked with has been very supportive and caring."

The AbleTo virtual behavioral health program is available to eligible members receiving short-term disability benefit payments for cancer (provided their employer also has Sun Life LTD) or receiving critical illness cancer benefit. Not available with stand-alone critical illness policies issued in New York. Sun Life is not responsible or liable for the care, services, or advice provided by AbleTo, and reserves the right to discontinue this service at any time.

Value-added services are not insurance, are offered only on specific lines of coverage, and carry a separate charge, which is added to the cost of the insurance. The cost is included in the total amount billed. The entities that provide the value-added services are not subcontractors of Sun Life and Sun Life is not responsible or liable for the care, services, or advice provided by the value-added service providers.

Health Navigator Help Line is provided by PinnacleCare. PinnacleCare is a member of the Sun Life Financial Inc. (“Sun Life”) family of companies. PinnacleCare and its employees do not diagnose medical conditions, recommend treatment options or provide medical care, and any information or services provided should not be considered medical advice. Any medical decisions should be made only after consultation with and at the direction of the medical provider. Any person or entity who provides health care services following a referral or other service provided does so independently and not as an agent or representative of PinnacleCare.

Sun Life reserves the right to discontinue any of the Services at any time. Employers who provide group insurance coverage and make available value-added services within an I.R.C. Section 125 cafeteria plan should consult a tax professional to determine whether those services are Qualified Benefits for Section 125 plans. Value-added services are not available in New York and may not be available in all other states.

The Wellness Benefit as applicable to certain coverages provides one Wellness Benefit per calendar year per covered person from the list of covered benefits. See policy for details of covered items and services. Only tests and procedures listed in the policy are eligible for benefit payment. Some policies do not contain the Wellness Benefit. 

These coverages do not constitute comprehensive health insurance (often referred to as “major medical coverage”) and do not satisfy the requirement for Minimum Essential Coverage under the Affordable Care Act.

The Supplemental Health Insurance plans described above are limited benefit policies. They do NOT provide basic hospital, basic medical, or major medical insurance. The certificates may have exclusions, limitations, and benefit waiting periods for certain conditions, all of which may affect any benefits payable. Benefits payable are subject to all terms and conditions of the certificates. For more information, please refer to the certificate. The policies, certificates and riders, if applicable, may not be available in all states and may vary based on state laws and regulations.

In New York, to be eligible for Hospital Indemnity insurance or Specified Disease coverage, the Insured must also be covered under major medical, or at least basic hospital and basic medical insurance. The expected benefit ratio for the Specified Disease policy is 70%. The expected benefit ratio for the accident policy is 65%. This ratio is the portion of future premiums which the Company expects to return as benefits, when averaged over all people with the policy.

Group Supplemental Health Insurance products are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) (SLOC)) in all states, except New York, under Policy Form Series 12-GP-01, 15-GP-01, 12-AC-C-01, 16-AC-C-01, 15-GP-01, 13-SD-C-01, 16-SD-C-01, 16-CAN-C-01, 20-HI-C-01. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 12-GP-01, 15-GP-01, 15-SD-GP-01, 12-GP-SD-01, 13-SD-C-01, 12-AC-C-01, 20-HI-C-01, 12-GPPort-P-01, 20-HIPORT-C-01. Product offerings may not be available in all states and may vary depending on state laws and regulations. All products, brands, and names are the property of their respective owners.

This advertisement is not approved in these states: AZ, GA, OR, WA, WY

Supplemental Health products are not available in NM

Value-added services are not available in NY 

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