For Medical Professionals or Billing Agencies only
- UHIP Services
- Physician services that need pre-approval
- UHIP reimbursement rate
- Joining the Sun Life Preferred Provider Network (PPN)
- Checking UHIP eligibility
- Two ways to submit your bill to UHIP
What is UHIP?
UHIP stands for University Health Insurance Plan. UHIP offers basic health care for eligible international non-residents studying or working at a participating Ontario universities.
The difference between UHIP and OHIP
OHIP provides basic medical health insurance for permanent residents of Ontario and is funded by provincial taxes, whereas UHIP provides similar coverage for international non-residents studying or working at an Ontario university. UHIP is a non-profit plan funded through member premiums. It is similar, though not equivalent, to OHIP.
For example, Unlike OHIP+, UHIP does not provide coverage for prescription drugs to students under age 25.
The plan provides medical services and supplies that OHIP covers for Ontario residents. These include:
- In-patient and out-patient hospital services.
- Physician services.
- Lab and diagnostic testing.
- Home care services.
- Some other specific programs available to an Ontario resident by the Ministry of Health and Long Term Care (for example, Assistive Devices Program (ADP)).
Physician services that need pre-approval (except in an emergency)
- Elective in-patient and out-patient surgery (for example, rotator cuff surgery) or treatment (for example, cancer, inpatient/outpatient psychiatric program).
Medically necessary MRIs and CAT scans or referrals to a surgeon don’t need preauthorization.
- For UHIP members in the Greater Toronto Area, please use these forms to request MRI/cat scan services or a surgical service. Both providers are part of the Sun Life Preferred Provider Network:
UHIP reimbursement rate
UHIP reimburses at 125% of the OHIP Schedule of Benefits.
Joining the Sun Life Preferred Provider Network (PPN)
Please email Sun Life at firstname.lastname@example.org if you would like to join.
Keep in mind:
- PPN providers must direct bill Sun Life for UHIP members.
- The maximum rate of reimbursement is 125% of the OHIP Schedule of Benefits.
- The clinic name will appear on the Sun Life Preferred Provider Network website.
Checking UHIP eligibility
You can instantly confirm if your patient is eligible by using the Sun Life Eligibility Tool.
UHIP members must show their UHIP card to their health care provider. Please directly bill members who don’t show you their card.
When billing members directly, you must include the following on the receipt or claim form:
- OHIP code(s).
- Diagnosis or diagnosis code.
- Cost of service.
What information is on a UHIP Member ID card?
- Member ID: You’ll need this for billing.
- Policy number: You’ll need this for billing.
- Effective date: start date of UHIP coverage.
- Termination date: end date of UHIP coverage.
- Dependant information: lists the eligible dependants covered under UHIP.
- Some universities enroll member and dependants separately on 2 different records.
- Dependants will be enrolled with a member ID that starts with an alpha prefix of ‘DP’.
- In these cases, the members and dependants will each have their own UHIP coverage card.
You need to see the dependant name on a coverage card to ensure eligibility.
Two ways to submit your bill to UHIP
- Complete a claim form
Create an invoice and mail it to Sun Life Financial at:
Sun Life Assurance Company of Canada
PO BOX 2015 STN Waterloo
Waterloo, ON N2J 0B1
|Provider information||Service information||Claimant/member information|
When and how you are reimbursed
Sun Life will mail you a cheque and explanation of benefits within 7 days of receiving the completed UHIP claim form/bill.
If you prefer direct deposit (electronic fund transfer):
Questions about your submitted claim?
Please call 1-855-301-4786 and follow the prompts.
When asked for the member contract number, enter the pound key (#) 3 times to reach a representative.
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1Cost of service: UHIP reimburses up to a maximum of 125% of the OHIP Schedule of Benefits. For example, the OHIP reimbursement rate for A007 is $33.70. The charge should be $42.13 or less on the UHIP Claim Form or bill.