Eligibility: Plan members are only eligible for this coverage if they meet the clinical criteria as defined by Sun Life. Conditions eligible for coverage currently include Cancer, Multiple Sclerosis, Rheumatoid Arthritis, HIV/AIDS, and palliative care. Additionally, these conditions require that specific symptoms are present.
If you want to add medicinal marijuana coverage to your benefits plan, but you are not currently with Sun Life, you don’t have to change carriers. Medical marijuana is listed as an eligible medical expense with the CRA*, meaning that it can be claimed against a Healthcare Spending Account (HSA). HSAs are offered by most insurance carriers and can be added onto a traditional benefits plan with relative ease.
With that being said, although HSA’s are generally open to the CRA eligibility list, this does not mean it will automatically be covered. Plan members will still have to follow ACMP Regulations. Before submitting a claim, we recommend speaking to your insurance carrier representative to know if your expenses will be covered and what documentation is required.
One of the main reasons why medical marijuana insurance claims are denied is because of their lack of a Drug Identification Number (DIN). Health Canada assigns a DIN to a drug after it has gone through research trials and testing. Having a DIN is the industry standard for allowing the drug to be sold or reimbursed. For insurance companies, this means no DIN, no coverage. But it is easy to see that the landscape is changing.
Starting March 1, 2018, Sun Life has introduced medical cannabis as an optional coverage add-on to it's Extended Health Care benefit. This means that employers who have Sun Life plans now have the option to purchase medical marijuana coverage for their group benefits plan.
Approval: Plan members must submit an approval form for adjudication by Sun Life. They must also comply with ACMP Regulations which means providing a physician’s letter and registering with a Health Canada authorized medical cannabis producer.
Although this may not be the all-encompassing coverage with easy access that a lot of people are looking for, it is still a step in that direction and should be recognized as such.
“These new changes reflect our commitment to evaluating new products and services to ensure we are meeting the needs of our Clients, helping them live healthier lives.”
Sun Life’s chief executive Dean Connor told The Canadian Press the move was influenced by rising interest from employer clients. “Medical marijuana has become a very important part of their treatment program and pain management program,” he said, referencing patients who have cancer, multiple sclerosis, rheumatoid arthritis or those requiring palliative care.
If Sun Life receives prior approval requests for other conditions, it will examine each specific situation to determine whether medical marijuana is medically necessary, according to the update. “When assessing eligibility for coverage and claims, we consider guidance provided by Health Canada, physicians’ licensing authorities and national medical professional organizations.”
Coverage of the drug will be added as an extended health-care benefit at the request of plan sponsors. It will include a yearly maximum, ranging between $1,500 and $6,000, a prior approval process and coverage criteria.
The insurance company said it reassessed its position on medical marijuana based on a review of current medical evidence. “After careful consideration and based on sound clinical evidence, we will be offering medical cannabis as an option for employers to incorporate into their extended health coverage for employees,” said Dave Jones, senior vice-president of group benefits at Sun Life.
Initially, coverage will only be available to plan members for specific conditions and symptoms, including: cancer pain or nausea and vomiting associated with cancer treatments; pain or spasticity associated with multiple sclerosis; rheumatoid arthritis with pain that hasn’t responded to standard therapy; neuropathic pain or anorexia related to HIV/AIDS; and patients requiring palliative care.
Sun Life Financial Canada is adding optional medical marijuana coverage to its group benefits plans from March 1, 2018.