North2South Brochure - Eng Nov3.qxp:Layout 1 - Sun Life

Introduction..................................................................................................1

Eligibility.........................................................................................................2

Plan sponsor eligibility ......................................................................2

Plan member eligibility .....................................................................2

What’s different about U.S. benefits? ...............................................2

Core medical benefits ..............................................................................3

About Aetna Open Choice® .........................................................3

Dental benefits ...........................................................................................4

Vision care benefits ..................................................................................4

Short-term disability (STD).....................................................................5

Long-term disability (LTD) ......................................................................5

Life and Accidental Death & Dismemberment (AD&D)..............5

About Aetna ................................................................................................6

About SLF U.S..............................................................................................6

SIMPLICITY• North2South Benefits Solution offers effective coverage for 2 to 24 full-time

employees of Canadian plan sponsors who live and work in the U.S.• Your plan will be built around comprehensive U.S. medical benefits.

CONVENIENCE• You can work directly with a Canadian Advisor to build your plan – you do not

need to find a U.S. Advisor.• All eligible employees are covered with no medical or other evidence of

insurability required for timely applicants.• We’ll walk you and your employees step-by-step through the process.

CONFIDENCE• Ensure a highly competitive offering through the flexibility of a full range of

value-added optional coverages including three levels of dental benefits, vision care, life and AD&D insurance, and short and long-term disability plans, layeredon top of a solid medical plan base.

• Your plan will provide world-class service delivered by market leaders.

North2South Benefits Solution delivers simplicity, convenience and confidence toCanadian plan sponsors with a small number of U.S. employees:

North2South Benefits Solution™ Sun Life Financial Group Benefits

North2South Benefits Solution™ from Sun Life Financial is

a comprehensive, flexible program built around four

standard medical benefit options. You choose the

medical plan design that best fits your group’s needs,

then round out your program by selecting from a full

range of dental, vision, short- and long-term disability

plans, as well as life and AD&D coverage.

The standard medical components of North2South Benefits

Solution are provided by Aetna Global Benefits®, the

international business segment of Aetna1. With more than 19

million medical plan members and a health care network

comprising more than 900,000 health care professionals and

more than 5,000 hospitals, Aetna is one of America’s leading

diversified health care benefits companies.

The non-medical components are provided by Sun Life

and Health Insurance Company (U.S.)2. Sun Life Financial’s

U.S. division is a Top 10 group insurance carrier in the

U.S.3 Through their E-Z Choice program, they deliver big

benefits for small businesses.

North2South Benefits Solution combines the world-class

products and customer service of industry-leading

providers with the simplicity of a comprehensive offering

that requires no medical or other evidence of

insurability for timely applicants. With North2South

Benefits Solution you get the clarity and confidence

you – and your U.S.-based employees – need in a benefit

plan.

North2South Benefits Solution™PLAN DESIGN AT A GLANCE

MEDICAL

Plan 1

Plan 2

Plan 3

Plan 4

DENTAL

LIFE and AD&D

STD

LTD

Core 1500 Plan

Core 1200 Plan

Core 1000 Plan

VISION

Dependent Life

If you are a Canadian employer with 2 to 24 U.S. employees, making sure your people have the coverage they need can seem like a daunting challenge. You simply don’t have the expertise orresources to manage the fundamental differences in health care systems – in addition to the complexity of federal and state legislation.

Introducing a simple, flexible, effective solution to help keep you positioned

as an employer of choice south of the border.

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Canadian P lan sponsorel ig ib i l i tyNorth2South Benefits Solution has been carefully

designed to meet the needs of the following plan

sponsors:

• Sun Life Financial Canada must provide group

benefits for your Canadian plan members.

• The total number of employees worldwide

must be greater than 50.

• You must have 2 to 24 employees in the U.S.

with no more than 20 U.S. employees resident in a

single state.

U.S . P lan memberel ig ib i l i tyTo be eligible for North2South Benefits Solution

coverage employees must:

• Work and reside in the U.S. for the Canadian

company, or a subsidiary, division or branch

of the Canadian company, and

• Be full-time employees, actively at work for a

minimum of 30 hours per week.

Coverage for active plan members terminates at

retirement (unless otherwise specified).

While Canadian and U.S. employee benefit programs are

similar in many ways, there are important differences

when it comes to medical and dental benefits.

In the absence of a comprehensive public health care

system, American insurers have developed a system

called “managed care” built around PPOs (Preferred or

Participating Provider Organizations).

A PPO is simply a network of physicians, dentists, other

health care professionals and hospitals that have a

negotiated discount agreement with an insurer.

Plan members are then given the choice of who they

want to provide their medical care. There is also the

incentive of reduced out-of-pocket expenses and higher

reimbursement levels to use a network provider as

opposed to going outside the network.

There is a wide variety of federal and state legislation

that may impact your plan. You will be advised about any

specific requirements before your North2South Benefits

Solution plan is finalized. You will be asked to appoint a

U.S. citizen or resident as your representative to sign

final contracts, in some cases.

What ’s d i f ferent about U.S . benef its?

Through careful, experienced plan design, North2South Benefits Solutionbalances cost and coverage – while consistently delivering on our promise ofoutstanding service to both plan sponsors and plan members.

North2South Benefits Solution gives eligible Canadian plan sponsors access to “big company” coverage for fewer than

25 U.S.-based employees. Each of the benefits incorporates industry-leading experience in both best practices and

cost containment in convenient and easy-to-understand options. And everything in the program is geared to ensuring

an exceptionally positive experience for both plan sponsors and plan members.

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Medical benef itsMedical benefits are the foundation of North2South Benefits Solution. You build your U.S. program around one of

four PPO plan designs – each one of which includes major medical and prescription drug benefits. In addition to the

traditional range of coverage, our strategic alliance with Aetna Global Benefits gives your plan members full access to

an extensive discount program that includes savings on fitness club memberships and home exercise equipment,

hearing aids and exams, natural products and services – even weight management through Weight Watchers®.

PLAN NAME PLAN 1 PLAN 2 PLAN 3 PLAN 4

Pref

erre

d Be

nefit

s(in

Aet

na n

etw

ork)

Individual deductible (calendar year) N/A $300 $500 $1,000

Family deductible (calendar year) N/A $900 $1,000 $2,000

Coinsurance (can vary depending on service provided) 100% 90% 100% 80%

Individual payment limit (calendar year) N/A $2,000 N/A $2,000

Family payment limit (calendar year) N/A $6,000 N/A $6,000

Co-

pays

per

visi

t Primary care physician office visit $10 $10 $20 $20

Specialist office visit $20 $20 $30 $30

Non

-pre

ferr

ed b

enef

its(o

utsi

de A

etna

net

wor

k) Individual deductible (calendar year) $100 $600 $1,000 $2,000

Family deductible (calendar year) $300 $1,800 $2,000 $4,000

Coinsurance (can vary depending on service provided) 80% 70% 50% 50%

Individual payment limit (calendar year) $1,000 $2,000 $4,000 $2,000

Family payment limit (calendar year) $2,000 $6,000 None $6,000

Coi

nsur

ance

as p

er p

lan

sele

cted Prescription drug co-pays

Generic drugs $10 $10 $10 $15

Formulary brand drugs $20 $20 $20 $25

Non-formulary brand drugs $30 $30 $40 $50

Aetna Open Choice® Aetna’s Open Choice® PPO allows plan members to seek care from any qualified

provider of their choice – with an added advantage. When they access care in the

U.S., they can receive significant discounts for care received from doctors or

hospitals that participate in Aetna’s U.S. PPO network. It’s one of the most

comprehensive in the U.S. and includes doctors and hospitals recruited and qualified

by Aetna to offer care at pre-negotiated rates.

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Dental benefitsNorth2South Benefits Solution offers three E-Z Choice core dental plans from Sun Life and Health Insurance Company(U.S.).4 All three plan designs include preventative, minor, and major restorative coverage with various includedprocedures and plan maximums. Each plan design has the option of adding optional orthodontics coverage.

PLAN NAME CORE 1500 CORE 1200 CORE 1000

InNetwork*

Out ofNetwork

In Network*

Out ofNetwork

InNetwork*

Out ofNetwork

Type 1 expenses (preventative) 100% 100% 100% 100% 100% 100%

Type 2 expenses (minor restorative / basic) 90% 80% 90% 80% 90% 80%

Type 3 expenses (major restorative) 60% 50% 60% 50% 60% 50%

Type 4 expenses (orthodontics – optional) 60% 50% 60% 50% 60% 50%

Individual deductible $50 $50 $50

Family deductible $150 $150 $150

Annual maximum $1,500 $1,200 $1,000

Threshold for carryover amount $700 $600 $500

Maximum carryover amount $500 $400 $350

Lifetime orthodontics maximum (if selected) $1,200 $1,200 $1,000

Cost containment strategiesPPO (Participating Provider Organization) plans offer access to a network of dentists and lower, pre-negotiated rates on most dental

procedures. Employees save on out-of-pocket expenses when they visit an in-network provider. PPO networks vary by state.*

Vision Discount Card Program offers dental plan members discounts on lenses, contacts, exams, laser vision correction, and

more – at no additional charge.

Per person lifetime deductible $50

Vision exam by an M.D. $75

Vision exam by an O.D. $60

Lenses and frames Schedule of plan maximums

Annual maximum number of lenses and/or frames per covered person One pair

V is ion care benefitsNorth2South Benefits Solution offers vision care as an optional rider to any of the three E-Z Choice core dental plans.Vision care coverage is the same regardless of which dental plan you choose and covers the same employees anddependents who have dental insurance. Covered individuals may choose to receive service from any licensed visioncare provider.

4 |


E-Z Choice for Small Groups

Short-term disabi l i ty (STD)E-Z Choice STD coverage combines plan member income security in the event of illness or injury with the Sun Life

and Health Insurance Company (U.S.) Return to Wellness program. This progressive approach to rehabilitation helps

employees return quickly and safely to the workplace, even on a part-time basis.

Benefit schedule 66.67% of basic weekly earnings

Maximum weekly benefit* Groups of 2 - 5 employees = $1,000/week

Groups of 6 or more employees = $1,500/week

Benefit duration (choice) 13 weeks OR 26 weeks

Commencement of benefits 1st day of accident, 8th day of sickness

* Benefits for groups in California , Hawaii, Rhode Island and New Jersey are subject to a weekly maximum of 20% of weekly earnings and are not reduced by benefits received from any other source. Benefit not available in NY.

Long-term disabi l i ty (LTD)E-Z Choice LTD coverage also combines plan member income security in the event of a lengthy illness or injury with

the Sun Life and Health Insurance Company (U.S.) Return to Wellness program. Elimination periods dovetail with STD.

Benefit schedule and maximum 60% of basic monthly earnings to a maximum of $6,000/month

Elimination period (choice) 90 days OR 180 days

Benefit duration Base Plan - Standard RiskAge 65 (or greater) for disabilities resulting from an accident, 5 years for sickness.

Base Plan - Preferred Risk*Age 65 (or greater) for disabilities resulting from an accident or sickness.

Transitional PlansMaximum 24 months for employee groups from certain industry classifications.

* Preferred risk employees are in-office executives, administrative, sales, supervisory and clerical employees who have no manual labour duties and spend at least 80% of their time inside the office.

NOTE: Benefits cease at age 65 or the employee’s normal Social Security retirement age, or as defined by state legislation.

L i fe and Accidental Death & Dismemberment (AD&D)E-Z Choice Life insurance provides financial protection in the event of death from any cause. Because AD&D coverage

is automatically included, the benefit is effectively doubled in the event of accidental death. In addition the

automatic AD&D provides a schedule of dismemberment benefits.

Basic Life Insurance and AD&D

Groups of 2 - 5 employees = $25,000



Dependent Life Insurance(Optional benefit available to groupsof 5 or more insured employees.)

Spouse = $5,000Children = $1,000/child aged 6 months to 19 years – age 25 if still in school

($100/child aged 15 days to 6 months)

NOTE: Life and AD&D benefits cease with termination of employment.

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1 Medical plans and programs are provided by Aetna Global Benefits and underwritten by Aetna Life Insurance Company and Aetna Life and Casualty (Bermuda) Ltd.

2 Group insurance policies marketed under E-Z Choice are underwritten by Sun Life and Health Insurance Company (U.S.) (located atWellesley Hills, MA) in all states under Policy Form Series GP-A and GP-D. Product offerings may not be available in all states and mayvary depending on state laws and regulations. Limitations and exclusions may apply; see the Policy or Certificate for details. Thegroup disability policies advertised provide disability income insurance only. They do NOT provide basic hospital, basic major medicalor major medical insurance as defined by the New York State Insurance Department.

3 Based on inforce premium. Source: For Life, JHA 2008 U.S. Group Life Market Survey; for Disability, JHA 2008 U.S. Group DisabilityMarket Survey; for Stop-Loss, internal information and general market research.

4 In states where the plans described are pending approval, alternate plan designs are available.

"Aetna" is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Thesecompanies include Aetna Health Inc.; Aetna Health of the Carolinas Inc.; Aetna Health of Illinois Inc.; Aetna Health of California Inc.;Aetna Dental Inc.; Aetna Dental of California Inc.; Aetna Life Insurance Company; Aetna Health Insurance Company of New York; andAetna Health Insurance Company.

Aetna and Aetna Open Choice are registered trademarks of Aetna, Inc., used under license.

Weight Watchers is a registered trademark of Weight Watchers International Inc., used under license.

Sun Life Financial is a registered trademark of Sun Life Assurance Company of Canada, used under license.TM Trade-mark of Sun Life Assurance Company of Canada, a member of the Sun Life Financial group of companies.

© 2009, Sun Life Assurance Company of Canada. All rights reserved.

Printed in CanadaSLPC 21102 10/09 (exp. 10/11)

For more information about our North2South Benefits Solution pleasecontact your Sun Life Financial group representative.

About Aetna

Aetna is one of the leading U.S. diversified health care benefits companies, serving approximately 36.8 million

people with information and resources to help them make better informed decisions about their health care.

Aetna offers a broad range of traditional and consumer-directed health insurance products and related

services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical

management capabilities and health care management services for Medicaid plans. Aetna’s customers include

employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units,

government-sponsored plans, labor groups and expatriates. For more information, go to www.aetna.com or see

Aetna's Annual Report at www.aetna.com/2008annualreport.

About Sun Life and Health Insurance Company (U.S.)

The Sun Life Financial group of companies operates under the marketing name “Sun Life Financial.”

Sun Life Financial is among the largest and highest-rated financial services companies in North America. A

member of the Forbes Global 500, we provide wealth and protection services for 25 million customers world-

wide. In the United States, E-Z Choice benefit programs are underwritten by Sun Life and Health Insurance

Company (U.S.), one of the Sun Life Financial companies.

GB10068-E

Documents

North2South Brochure - Eng Nov3.qxp:Layout 1 - Sun Life