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Drug exception application form - Sun Life Financial 2025

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The document is a Drug Exception Application Form from Sun Life Assurance Company of Canada, allowing plan members to request coverage for medications not fully covered by their insurance plan. It outlines the eligibility criteria, necessary information for both the plan member and prescribing physician, and emphasizes that completion of the form does not guarantee approval. The document also includes privacy information and instructions for submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a list of approved drugs at the managed care plan will pay for?

A Prescription Drug List (PDL) also called a formulary is a list of commonly used medications, organized into cost levels, called tiers. These costs are decided by your employer or health plan. View your PDL to learn whats covered by your plan.

What is pharmacy exception processing?

The exception process can be used to override benefit limits that are based on U.S. Food and Drug Administration (FDA)-approved durations of treatment or maximum dosing limits. A plan may limit drug benefit coverage to FDA-approved durations or dosing.

What is the waiver of premium in Sun Life?

Waiver of Premium is a provision that continues your Group Life premium payments if you become totally disabled. If you become totally disabled and your Waiver of Premium claim is approved by Sun Life, we will continue your Life insurance coverage without further payments from you or your employer.

What is a drug exception option?

In some cases, if your drug is in a higher tier and your prescriber thinks you need that drug instead of a similar drug in a lower tier, you or your prescriber can ask your plan for an exception to get a lower coinsurance or copayment for the drug in the higher tier. Plans can change their drug list at any time.

What is the drug formulary exception process?

If you need a medication that is not on your plan list, you can formally ask your insurer to cover the medication for you by submitting a formulary exception. Once the exception is filed, the plan should provide a decision within 72 hours.

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What are the drug exception options?

Non-formulary drug exception: a request to cover a non-formulary drug. Tier exception: a request to treat a drug as if it were in a lower tier, reducing your out-of-pocket costs. Brand exception: a request to cover a brand-name drug, if your policy only covers the generic form of the drug.

What does waiver of premium mean on life insurance?

A waiver of premium rider is an insurance policy clause that waives premium payments if the policyholder becomes critically ill, seriously injured, or physically impaired. Other stipulations may apply, such as meeting specific health and age requirements.

How hard is it to get a formulary exception?

you have pretty good odds of getting the formulary exception approved when it is a continuation of therapy (in your case) vs a new therapy. they will just have to document what youve tried and failed, and how what youre on now is working well for you and usually it is approved when you are already on the medication.

What is an exception request in health insurance?

You can get an exemption so that you wont have to pay a penalty for not having qualifying health insurance. Some exemptions require an exemption application through Covered California. Other exemptions do not require an application: Instead, you can claim them when you file your state tax return.