Employee benefits (N.Y.)

SLPC 25192 8/13 (exp. 8/15)

For employees covered for Group Life or Disability at work (New York policies).

Group Life insurance

How do I . . .

How do I submit a group life claim?

What's needed: Download and complete either the Death Claim Packet (for all death claims) or the Life and Disability Claim Packet (for all Waiver of Premium, Accelerated Benefit, Accidental Dismemberment, or Permanent Total Disability claims). Be sure to include all required documentation with your claim submission. Required documentation may include a certified death certificate (for death claims) and/or the insured's original insurance enrollment form (available from the insured's employer).

Mail to:
Sun Life Insurance and Annuity Company of New York
Group Life Claims, SC 3225
One Sun Life Executive Park
P.O. Box 81100
Wellesley Hills, MA 02481

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What is waiver of premium?

Waiver of premium is a provision that continues your Group Life premium payments if you become totally disabled.

If you become totally disabled and are covered under a Sun Life Insurance and Annuity Company of New York group life policy that includes waiver of premium, we will continue your life coverage without further payments from you or your employer. To be eligible for waiver of premium, you must be totally disabled prior to age 60.

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How do I file a waiver of premium claim?

What's needed: Download and complete sections B and C of the Life and Disability Claim Packet. Be sure your employer completes section A of the claim packet. Also, provide section D to your attending physician to complete and submit.

Notice of waiver claim must be submitted within 12 months of your last date actively at work and proof of claim must be submitted within 15 months of your last date actively at work. In order to be eligible for waiver, you must be totally disabled prior to age 60.

Mail to:
Sun Life Insurance and Annuity Company of New York
Group Life Claims, SC 3225
One Sun Life Executive Park
P.O. Box 81100
Wellesley Hills, MA 02481
 

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How do I change the beneficiary on my policy?

What's needed: Download and complete the Beneficiary Designation Form and submit it to your employer for processing. (Your employer's Human Resources department keeps a record of your designation.)

Exception: If you are on waiver of premium, mail or fax the Beneficiary Designation Form directly to Sun Life (N.Y.):

Mail to:
Sun Life Insurance and Annuity Company of New York
Group Life Department, SC 3225
One Sun Life Executive Park
Wellesley Hills, MA 02481
Fax to: 781-446-1517

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Can I continue my life insurance coverage if I retire or leave my job?

Yes. After your date of termination or retirement, you have 31 days to notify Sun Life (N.Y.) of your intention to convert your group term coverage to an individually owned whole life policy. If you opt to convert, you will be responsible for paying the life premium. The cost of conversion coverage is different from your group coverage.

What's needed:

  • Your employer must download and complete the Employer section of the Notice of Group Life Conversion.
  • You complete the rest of the Notice. The Notice contains information to help you calculate your premium.
  • You must complete the Conversion application. To be eligible for conversion, you must submit your application within 31 days of termination or retirement.

Mail to:
Sun Life Insurance and Annuity Company of New York
Group Life Conversion, SC 1219
One Sun Life Executive Park
Wellesley Hills, MA 02481
 

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Disability Claims - General Information

How do I . . .

What is needed to file a disability claim?

To file a short-term or long-term disability claim, you will need to complete a claim statement which asks for the following information:

  • Your employer's group policy number
  • Your Social Security number
  • Your name, address, and telephone number
  • Information about your employment and income
  • Information about your condition
  • Your attending physician's name, address, and telephone number
  • The name and address of the hospital you visited (if applicable)
  • Medical records and/or treatment notes (upon request)

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How do I get claim status information?

As soon as you receive a claim number from us via mail, you can call or visit us online to get up-to-date information about your claim.

Phone: Call 800-247-6875 and follow the prompts for automated service

Online:

  • Go to mysunlifebenefits.com
  • Select Check Claim Status
  • Enter your claim number and Social Security number and select Log In

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How to I get definitions of disability terms?

Log into the Claim Status section of our Plan Members website using your claim number and Social Security number. Then, select the Terms and FAQs tab.

Definitions of basic disability terms are listed alphabetically in the Glossary of Terms. Select the letter of the term you want defined. NOTE: The Glossary of Terms provides a general, summarized explanation of terms used in your employer's Group Policy. The Group Policy is the document that describes the insurance company's contract to provide benefits. If the terms listed in this glossary and the Group Policy differ, the Group Policy will govern. See your employer for a copy of the Group Policy.

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What is the difference between a waiting period and elimination period?

Waiting Period: The length of time that a new employee (or one who has recently enrolled in the Group Policy) must wait before he or she is covered under the policy. The length of the Waiting Period varies by employer. Check with your employer, or see your Employee Benefits booklet for the specific provisions of the Group Policy.

Elimination Period: The period of time that a claimant must be continuously disabled prior to becoming eligible for consideration of benefits. Elimination Periods vary by employer. For your Group Policy's Elimination Period, check with your employer or see your Employee Benefits booklet.

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How long will it take to make a claim decision?

As soon as we receive all of the information requested on the claim form, and all supporting documentation that may be required, we begin working to deliver a timely and sound claim decision.

Each disability claim we receive is handled according to its own circumstances and facts. Please be assured that, should processing of your claim be delayed for any reason, we will notify you as soon as possible.

A complete description of all of the procedures and guidelines pertaining to claim processing are specified in your employer's Group Policy. For more information, ask your employer or see your Employee Benefits booklet.

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Short-Term Disability

How do I . . .

How do I know what is considered a short-term disability claim?

Short-Term Disability (STD) insurance pays benefits for your own medical condition that prevents you from performing the material and substantial duties of your occupation. Benefits begin soon after a disability starts. STD benefits continue for a limited amount of time, usually 6 to 26 weeks depending on the condition.

If you expect to be absent from work for longer than your STD plan's Elimination Period, then you may file an STD claim. Use these general definitions to familiarize yourself with the differences between short-term and long-term disability.

  • Short-Term Disability (STD) insurance usually pays benefits for illnesses or injuries soon after they start, continuing for a limited amount of time, usually 6 to 26 weeks depending on the condition.
  • Long-term Disability (LTD) insurance provides benefits after STD ends. LTD is for chronic or catastrophic disabilities that started six months ago or longer.

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How do I file a short-term disability claim?

What's needed: To notify Sun Life (N.Y.) and your employer of a short-term disability claim, follow these steps:

  1. Open the printable form (requires Acrobat Reader)
  2. Fill in all sections of the form. Your employer and physician must complete their sections of the form as well. You must sign and date the Authorizations.
  3. Return the signed forms to:
    Sun Life Insurance and Annuity Company of New York
    Group Short-Term Disability, SC 3212
    One Sun Life Executive Park
    P.O. Box 81915
    Wellesley Hills, MA 02481
    Fax to: 781-304-5599

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Does Sun Life Insurance and Annuity Company of New York pay short-term disability benefits for work-related injuries?

Sun Life Insurance and Annuity Company of New York is not responsible for paying claims for work-related injuries. Such claims should be directed to your employer's workers' compensation insurer.

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Does FMLA affect my short-term disability claim?

Under the Family and Medical Leave Act (FMLA), eligible employees of qualified organizations have the right to take up to 12 weeks of unpaid leave during a 12-month period.

While FMLA doesn't offer any benefits that would affect a short-term disability, FMLA does guarantee you job availability once you return from your medical leave.

Health care coverage may be continued during the leave at the same contribution level as before. The employer can recoup premiums that were paid for continued benefits if the employee does not return to work. Please contact your employer for more information.

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Maternity

How do I . . .

How do I find out when my maternity benefits begin?

Benefits are based on appropriate doctor certification. Typically, you become eligible for benefits on the day you deliver. Please note, there may be a short period of time, called an Elimination Period, before benefit checks actually begin. Ask your employer or refer to your Employee Benefits booklet to determine the length of your Elimination Period.

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When do my benefits end?

Short-term disability benefits typically end six weeks after your delivery date. If you have medical complications that prevent you from doing your job, we will review the medical records provided by your doctor and may extend your benefits beyond this timeframe.

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Will I receive short-term disability benefits if I stop working before my due date?

If you have medical complications that prevent you from doing your job, we will review medical records provided by your doctor and may provide benefits prior to your expected delivery date.

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Long-term Disability

How do I . . .

How do I know what is considered a long-term disability claim?

You should only file a long-term disability claim if you have been unable to work because of a disabling illness or injury for 6 to 12 months. Use these general definitions to familiarize yourself with the differences between long-term and short-term disability.

  • Short-Term Disability (STD) insurance usually pays benefits for illnesses or injuries soon after they start, continuing for a limited amount of time, usually 6 to 26 weeks depending on the condition.
  • Long-term Disability (LTD) insurance provides benefits after STD ends. LTD is for chronic or catastrophic disabilities that started six months ago or longer.

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How do I file an LTD claim?

What's needed: Download and complete the LTD Claim - Employee's Statement and submit with supporting medical evidence of total disability. Your employer must submit the LTD Claim - Employer's Statement. Your physician must submit the LTD Claim - Attending Physician's Statement. You should submit your claim as soon as you determine that your disability will last beyond the elimination period.

Mail to:
Sun Life Insurance and Annuity Company of New York
Group Long-term Disability, SC 3208
One Sun Life Executive Park
P.O. Box 81830
Wellesley Hills, MA 02481
Fax to: 781-235-0784

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How do I find out how long my benefits will last?

The maximum benefit period is based on the schedule of benefits in your employer's Group Policy. Most policies have an "Own Occupation" standard that requires you to be unable to perform the duties of your own occupation in order to receive benefits. Depending on the terms of the Group Policy, "Own Occupation" benefits may last for two, three or five years.

After the "Own Occupation" period ends, most Group Policies switch to an "Any Occupation" standard that requires you to be unable to perform the duties of any occupation for which you are qualified by education or experience in order to receive benefits.

Your benefits while under the "Any Occupation" standard will end at retirement or at a specific age, depending on your employer's Group Policy. For the exact terms and conditions of your eligibility for, and entitlement to, LTD benefits, please see your employer's Group Policy, check with your employer, or see your Employee Benefits booklet.

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SunAdvisor/Sick Leave

How do I . . .

What is considered a sick leave claim?

A sick leave claim generally is the same as a short-term disability claim. It covers an employee's pay during short-term absences from work (more than a few days, but less than 6 months) due to your own medical condition that prevents you from performing the material and substantial duties of your occupation. "Sick leave" is a general term used by some employers to distinguish their plan from short-term disability insurance or payroll.

If your employer has such a plan, and you are absent for the number of days specified by your employer, then you should notify your employer that you will be starting a sick leave.

SunAdvisor is a service of Sun Life (N.Y.) that provides claims expertise to employers who are administering their own sick leave or short-term disability plan.

Sun Life Insurance and Annuity Company of New York does not insure benefits under the employer's benefits plan when providing SunAdvisor services. The employer remains responsible for the risks and liabilities covered by its benefits plan.

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How do I file a SunAdvisor/Sick Leave claim?

What's needed: To notify Sun Life (N.Y.) and your employer of a sick leave claim, follow these steps:

  1. Open the printable form (requires Acrobat Reader)
  2. Your employer and physician must complete their sections. You must sign and date the Authorizations.
  3. Return to:
    SunAdvisor, SC 3212
    One Sun Life Executive Park
    P.O. Box 81915
    Wellesley Hills, MA 02481
    Fax to: 781-304-5519

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How do I find a dentist in my network?

Visit mysunlifebenefits.com:

  • select My Dental benefits
  • select the correct ID card
  • select Find a dentist
  • search for your dentist

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