# Advice needed on medical coverage (Manulife to Sunlife) -



## jacofan (Apr 17, 2013)

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## birdman (Feb 12, 2013)

I'm certainly not an expert on the subject and if your friend decided to pursue the matter I would suggest she obtain legal advice. Anyways, I suggest the employer can do what they wish in regards to benefits, salaries, hours of work etc and in your friends case change suppliers for medical coverage. I expect the employer changed companies as the premiums were lower. However, in saying this I would expect that the change could possibly be considered a "change in working conditions" which could be perhaps argued that it is "wrongful dismissal" and the employee could leave her job and sue her employer for appropriate severance. They may not even have to leave the job but suggest to her employer that it is a case of wrongful dismissal. 
Employers have the right to set salaries, wages, benefits, hours of work, and dismiss employees, etc and can change these when they wish. The only issue that comes up with the foregoing is that such changes can be considered wrongful dismissal and leave the company open to legal challenge by the employee. Just because you have certain benefits today it does not mean they are there for life. Other benefits that are changed can include things like cars, car allowances, vacation, bonus structure, pay grades, etc. Some of course are legislated (OT, Stat days, minimum vacation, etc). Anyways, just my take on the matter.


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## Plugging Along (Jan 3, 2011)

If the plan changed for everyone in the compnay, and is being administered the same way, it not wrongful dismissal. Employers can change their compensation any way they want, and it is not illegal. Losing a benefit, if applied for everyone is not illegal. 

Her best hope is to call HR for clarification,


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## Beaver101 (Nov 14, 2011)

^


> Her best hope is to call HR for clarification,


 ... HR may not able to help becuase there may be a privacy issue with this.



> *jacofan:* My sis had to put it on her credit card as she wasn't expecting this big expense. So now - 6 weeks later - *Sunlife said that they will pay it and send her out a cheque but that she "may need to re-qualify" annually*". To me this sounds like BS, she's been fully covered for a couple years before and never had to "requalify".


 ... it doesn't appear Sunlife is not covering the claim but to ensure if she needs this drug continuously, hence, the "re-qualification bs" requirement. Therefore, just ask Sunlife Claims (Health) department as to how your sister is to go about "re-qualifying" for it since she'll need the drug (covered).


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## birdman (Feb 12, 2013)

http://selectpath.ca/organizations/articles/compensation-changes-and-constructive-dismissal/

The above is an article on Constructive Dismissal and touches briefly on the subject.


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## Toronto.gal (Jan 8, 2010)

jacofan said:


> *1.* My sisters employer changed benefit providers from Manulife to Sunlife......Sunlife did not pay for her first prescription (~$6,500 for 3 months) because they said that she *needed documentation about the drug and a letter from her doctor.*
> 2. 6 weeks later - Sunlife said that they will pay it and send her out a cheque but that *she "may need to re-qualify" annually".* To me this sounds like BS...
> 3. My armchair friends said that *it is illegal for a medical coverage plan to be downgraded* for coverage when an employer changes providers...


*1.* What SLF told you is correct. Certain drugs [expensive and not], do require detailed assessment & prior approval to check whether there is a lower/generic equivalent, proper usage, etc., so the review is standard procedure.
https://www.sunlife.ca/Canada/spons...+List+and+Forms?grpcontract=0&vgnLocale=en_CA

*2.* The re-qualification is part of the ongoing approval process as mentioned above, that is all.

*3.* Per the Group Life & Health Insurance guidelines, a replacing contract may have different terms and conditions than the terminated one. 

*'In particular, it is not necessary that the Replacing Contract ensures that there is no loss of coverage under all circumstances to any Plan Member or any other person covered under the Terminating Contract through the Plan Member.'*


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## quyenngoc (Apr 9, 2015)

*very good*

thank you very much, i was understand


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