Sonata Health User Guide - Great-West Life

User Guide

Sonata Health User Guide
This guide provides practical information for using your Sonata Health plan. It includes additional
information on the features of Sonata Health, how to access services and how to claim benefits.
This is not your Sonata Health policy. The actual terms and conditions of your Sonata Health
plan are set out in the policy issued to you by Great-West and included in your Sonata Health
information kit. The policy contains important information concerning terms, conditions,
limitations, exceptions and exclusions. Please read it carefully.
Your Sonata Health plan is underwritten by The Great-West Life Assurance Company.
Great-West has been helping Canadians achieve financial security for more than a century.
We are a leading provider of financial security products in Canada, offering a wide range of
insurance, retirement savings and income plans for individuals, families, businesses
and organizations.
Electronic drug claim services with the Assure Card® are provided by a leading full-service pharmacy
benefits manager in Canada, adjudicating drug claims online in the pharmacy. Currently, electronic
adjudication services are provided for 10,500 groups covering more than 3.5 million Canadians.

Coverage highlights
Who’s covered.................................................................................................... 1
Where to find information on your coverage...................................................... 1
Optional coverage
Hospital Accommodation................................................................................... 2
Emergency Travel Medical................................................................................... 2
Accidental Death, Dismemberment and Specific Loss.......................................... 3
Hospital Cash..................................................................................................... 3
Prescription drug coverage
The Assure Card................................................................................................. 4
Using your Assure Card...................................................................................... 5
Submitting claims
Prescription drug claims...................................................................................... 6
Other healthcare claims...................................................................................... 7
Dental claims...................................................................................................... 7
Hospital Accommodation claims......................................................................... 8
Emergency Travel Medical claims........................................................................ 8
Accidental Death, Dismemberment and Specific Loss claims............................... 9
Hospital Cash claims........................................................................................... 9
Included services
Best Doctors....................................................................................................... 9
PVS.................................................................................................................... 9
Administration
Premiums......................................................................................................... 10
Renewing your coverage.................................................................................. 11
Changing your coverage.................................................................................. 11
When your coverage ends................................................................................ 13
Surviving spouse and children coverage............................................................ 13
Tax information
Premiums ........................................................................................................ 14
Sole proprietor or partner................................................................................. 14
Incorporated business....................................................................................... 15
Receipt for tax purposes................................................................................... 16
Contact information........................................................................................ 17
Online services ................................................................................................... 18

Coverage highlights
Who’s covered
Your Sonata Health Policy Specifications document lists everyone who is covered under your
Sonata Health plan.
Where to find information on your coverage
Your Sonata Health policy booklet sets out the health and dental benefits provided by your policy.
If you purchased any of the optional benefits available with Sonata Health Scales 1 to 6 (Hospital
Accommodation, Emergency Travel Medical, Hospital Cash or Accidental Death, Dismemberment
and Specific Loss), your information package will include a benefit booklet for each optional benefit
you purchased.
Your Policy Specifications document shows who is covered under your plan, your monthly premium
and information such as your plan’s reimbursement levels and benefit maximums. It also includes
information on any optional coverage you purchased and ID cards showing your policy number and
effective date.
You may have received a Conditional Offer of Acceptance if:
• You signed and accepted coverage excluding certain medical conditions (the Conditional
Offer of Acceptance sets out the medical conditions for which coverage is excluded), or
• You did not qualify for Sonata Health Scales 1 to 6, and were offered our Guaranteed
Acceptance Plan (GAP).
If you can’t find the information you need, your representative or PDAdmin Group can help you.
Turn to page 17 for contact information.
1

Optional coverage
Scales 1 to 6: While your Sonata Health package offers you comprehensive coverage, the following
optional benefits are also available to you:
• Hospital Accommodation
• Emergency Travel Assistance
• Accidental Death, Dismemberment and Specific Loss
• Hospital Cash
If you purchased any of these options, your information package will include a benefit booklet for
each benefit, which sets out your coverage in detail.
For additional information or to purchase these optional benefits, contact your representative or
PDAdmin Group. Turn to page 17 for contact information.
GAP: There are no options available with the GAP plan, as it already includes similar coverage for:
• Hospital Accommodation
• Emergency Travel Assistance
• Accidental Death, Dismemberment and Specific Loss
For information on submitting claims for these additional benefits, see page 8.
Hospital Accommodation – optional for Scales 1–6; included with GAP
The Hospital Accommodation Benefit pays benefits for semi-private accommodation in a hospital or
for accommodation in a nursing home.
Emergency Travel Medical
Emergency Travel Assistance – optional for Scales 1–6; included with GAP
There are two components to the Emergency Travel Assistance benefit:
• Coverage for emergency treatment when you’re travelling outside of Canada
• Assistance services when you’re in a medical emergency outside of Canada or more than 500
kilometres from your home.
With this benefit, your information package will include Emergency Travel Assistance wallet cards.
2

Emergency Medical Treatment
In a medical emergency, immediately call the toll-free Assistance Centre number on the
back of your Sonata Health Emergency Travel Assistance card. You’ll reach the Assistance
Centre, which will help you find qualified medical care and provide other emergency assistance.
The Assistance Centre operates 24 hours a day, every day, and can help you locate hospitals, clinics
and physicians who can provide appropriate medical care. If you do not notify the Assistance
Centre as required in your policy, any benefits you receive may be reduced as outlined in
your policy.
Hospitals will not accept your Sonata Health Emergency Travel Assistance card as proof of coverage,
but will use it to contact the Assistance Centre, which will, in turn, contact Great-West to verify
your coverage.
It is important that you read your Emergency Travel Medical Benefit Booklet carefully
before travelling. Your coverage is subject to certain limitations and exceptions. An
exclusion applies to pre-existing medical conditions and/or symptoms that existed before your
trip. Your policy explains how this applies and how it relates to your travel departure date, date
of purchase and effective date.
You should also review your provincial coverage before travelling, to ensure you have sufficient
insurance. Your provincial coverage may have time limits on submitting claims that would also apply
to your Sonata Health policy.
Who to call
In a medical emergency while travelling, immediately call the toll-free Assistance Centre number
on the back of your Sonata Health Emergency Travel Assistance card:
• While travelling in Canada or the United States, call 1-800-527-0218
• Outside of Canada or the United States, call collect to Baltimore, U.S., 410-453-6330
To find out more, visit www.greatwestlife.com/sonata.
Accidental Death, Dismemberment and Specific Loss –
optional for Scales 1–6; included with GAP
With this benefit, your Sonata Health Policy Specifications document will show the amount of
coverage, including how much each family member is insured for. The benefit booklet describes the
covered losses and the amount payable for those losses.
Hospital Cash – optional for Scales 1–6; not available with GAP
The Hospital Cash Benefit pays cash to the policy owner if anyone insured under the policy is
hospitalized in Canada.
3

Prescription drug coverage
Sonata Health Scales 1, 2, 3, 5, 6 and the Guaranteed Acceptance Plan (GAP) include prescription
drug coverage. This coverage offers you two convenient features:
• The Assure Card
• The Assure Claims Drug Utilization Review Program
The Assure Card
Paying for your prescriptions has never been so easy
The Assure Card is an electronic payment system that provides on-the-spot processing of
prescription drug claims at almost any pharmacy in Canada.
It’s a convenient, easy-to-use alternative to submitting claim forms and waiting to be reimbursed.
Your personalized Assure Card is provided to you as part of your Sonata Health coverage, and is
administered by Great-West’s pharmacy benefits manager.
The Assure Claims Drug Utilization Review Program
It is not always practical or possible to visit the same pharmacist to have your prescriptions filled.
We also realize how important it is for the pharmacist filling your prescriptions to be aware of your
recent drug history. This helps ensure the safety of you and your family, wherever and whenever
prescriptions are filled. That’s why your Sonata Health policy provides you and your pharmacist with
access to the Assure Claims Drug Utilization Review Program.
Assure Claims promotes safe and effective use of prescription drugs by reviewing the prescription
being filled to help ensure it agrees with the drug manufacturer’s recommended use, and will not
interfere with other prescriptions you have purchased with your Assure Card.
If a risk is detected, the Assure Claims Network issues a warning to your pharmacist indicating the
nature of the concern. Your pharmacist is then able to discuss the risk with you and consult your
physician if required.
4

Balancing safety with confidentiality
With the Assure Card and Assure Claims, your personal prescription information is completely
confidential. Our pharmacy benefits manager will only release information about your claims
history and warning notices about possible drug conflicts to your pharmacist. No information
concerning what you are being treated for is ever shared.
Using your Assure Card
When you fill a prescription:
• Present your Assure Card to your pharmacist, before he or she fills the prescription.
• Your pharmacist will require the following information about the patient:
• Name
• Address and postal code
• Telephone number
• Date of birth
• Relationship to the policyowner
• Policy number
• Your pharmacist will use the card to verify your eligibility and drug coverage, and to apply
any deductibles or coverage limits.
• Our pharmacy benefits manager electronically pays your pharmacist the amount covered by
your Sonata Health plan. You only pay fees not covered by Sonata Health.
• You do not have to fill out claim forms or wait for reimbursement. It’s all handled on
the spot.
Pharmacies that recognize the Assure Card are also linked electronically with provincial Pharmacare
plans. The pharmacist will know how much your provincial plan will cover, and how much you can
claim under Sonata Health.
Always provide your card when filling a prescription. For security reasons, pharmacies
generally don’t share computer systems, even if they’re part of the same chain. If you forget your
card, you can still get your prescription filled, but you will have to pay the full amount up front,
submit a Healthcare Expenses Statement, and wait for reimbursement.
Keep your information up to date. Be sure to advise PDAdmin Group if your marital status
changes, you adopt or have a baby, or if any children are attending university. Turn to page 17 for
contact information. Also, let your pharmacist know of any changes to your benefits, or if you are
issued a new Assure Card.
If your card is lost or stolen, report it to PDAdmin Group immediately. Your card number will
be cancelled for your protection and a new card will be issued as a replacement. If you find your
original card after receiving your new one, please return the original card to PDAdmin Group.
You will still be covered by your Sonata Health plan if you forget your card. However, you may
have to pay for your prescription in full at the pharmacy, then submit your receipt and a completed
Healthcare Expenses Statement for the amount covered by your plan.
The Healthcare Expenses Statement is available from PDAdmin Group, the Individual
Health Unit, or in the Client Services section of www.greatwestlife.com.
5

Submitting claims
Prescription drug claims
(Does not apply to Scale 4)
Your prescription drug claims are settled right at the pharmacy, with your Assure Card. The Assure
Card is recognized by more than 7,000 pharmacies nationwide. If, for some reason, you can’t use
your Assure Card, you may use a paper claim form.
Using paper claim forms
To submit prescription drug claims that have been made without providing the Assure Card,
complete a Healthcare Expenses Statement and send it, along with your original receipts, to the
Individual Health Unit. Turn to page 17 for contact information.
A small supply of Healthcare Expenses Statement forms has been included in your Sonata Health
information package. If you need additional forms, contact PDAdmin Group, the Individual Health
Unit, your representative, or visit the Client Services section of www.greatwestlife.com.
Dispensing fees
There are two components to the cost of a prescription drug – the ingredient cost and the
dispensing fee.
The ingredient cost is the cost the drug manufacturer charges for the drug. The dispensing fee
is charged by the pharmacy to cover the pharmacy’s business expenses, and can vary widely by
pharmacy. The amount you are charged by the pharmacy is the sum of the ingredient cost plus
the dispensing fee.
Sonata Health plans pay a maximum dollar amount per eligible prescription for dispensing fees.
See your policy booklet for the maximum that applies to your plan.
6

Other healthcare claims
For all medical, vision and drug claims (other than prescription drugs where the Assure Card has
been used), please use the Healthcare Expenses Statement. Mail the completed form, along with
your original receipts, to the Individual Health Unit. Turn to page 17 for contact information.
Dental claims
Great-West is linked electronically with many dentists across Canada. If your dentist has a link with
Great-West, your claim can be settled right in the dentist’s office. The dentist submits the claim
electronically and receives confirmation of coverage. You only pay for any expenses not covered by
Sonata Health. Some claims, such as those for major dental work, must be submitted using paper
claim forms.
Before submitting your first claim, your dentist will need your Sonata Health policy number. Your
policy and ID number are shown on your Policy Specifications document and on your ID card.
Dental fee guides
Great-West assesses dental claims using current fee guides developed and maintained by provincial
dental associations. These fee guides offer a reasonable and consistent basis for assessing claims
in each province. Since a fee guide is no longer published in Alberta, to assess claims incurred
in Alberta, Great-West uses the 1997 Alberta Dental Association fee guide, plus an inflationary
adjustment determined by Great-West.
Prompt claims payment
There are several things you can do to ensure your claims are paid as quickly as possible:
• We need all the information that we ask for on the forms, so be sure to answer all the
questions. Otherwise, we’ll return the form and ask you to provide the missing information.
• Be sure to include your policy number on all claim forms. You can find your policy number
on the Policy Specifications page, in your Sonata Health information package or on your
personalized ID card.
• Make sure that you’ve attached all the receipts supporting your claim and that all receipts are
originals. We cannot accept photocopies. Your original receipts will not be returned. You will,
however, receive an itemized statement for your records.
• Please sign and date the claim form in ink.
• If you’re uncertain about how to complete a form, call the Individual Health Unit at
1-866-430-2863.
You can ask Great-West to send payments directly to hospitals, dentists or providers of out-ofcountry
emergency medical treatment. Otherwise, Great-West will mail all cheques, and a complete
explanation of benefits paid, directly to your home address. You can have your claims paid faster
and more conveniently by signing up for direct deposit; your explanation of benefits paid will still
be mailed to your home address.
Direct deposit
If you completed the direct deposit section on your application for Sonata Health coverage, your
health and dental claim payments will be directly deposited into the account you requested.
If you did not request direct deposit and would now like to take advantage of this convenient and
secure option for your claim payments, please contact your representative or the Individual Health
Unit, or visit the Client Services section of www.greatwestlife.com.
7

Using paper forms for dental claims
You can also submit claims by mail. You received a small supply of claim forms in your Sonata
Health information package. Complete the Policyowner Information and Patient Information
sections of the form and have your dentist complete the Dentist section. Send the form to the
Individual Health Unit. Turn to page 17 for contact information.
You will receive an explanation of benefits for your records. Unless you indicate that you want
the payment to go directly to the dentist, Great-West will send all cheques directly to you.
It is a good idea to submit a treatment plan before proceeding with any treatment costing more
than $200. Great-West will provide you with an estimate of the amount payable under your Sonata
Health policy. The estimate will be valid for 90 days. Send the treatment plan to the same address
as the claim forms.
Your Sonata Health information package includes an initial supply of the forms you are most likely
to need. Included are:
• Healthcare Expenses Statement
• Dentalcare Claim Form
If you need additional forms, contact PDAdmin Group, the Individual Health Unit or your
representative, or visit the Client Services section of www.greatwestlife.com.
Hospital Accommodation claims
Great-West pays benefits for semi-private accommodation in hospitals and accommodation in nursing
homes. Most hospitals and nursing homes use their own claim forms and will submit your claim directly
to Great-West on your behalf. You will need to supply the hospital or nursing home with your policy
number. Your policy number is shown on your Policy Specifications document and on your ID card.
If the hospital or nursing home will not submit the claim on your behalf, complete the Healthcare
Expenses Statement and mail it, along with your original receipts, to the Individual Health Unit. Turn
to page 17 for contact information.
Emergency Travel Medical claims
Before entering a hospital or being treated for a medical emergency, call the toll-free
number on your Sonata Health Emergency Travel Assistance card immediately or have
someone call on your behalf. Your benefit amount may be reduced if you do not call
before being treated. In addition to helping you find appropriate medical care, the Assistance
Centre will obtain Great-West’s approval, where required, and will arrange to have hospital and
doctor bills sent directly to us for payment.
Great-West will pay your provincial health plan’s share of the claim for you, on the province’s behalf.
The provincial health plan requires you to sign a release permitting them to reimburse Great-West for
their portion of the claim.
If you have paid a medical provider, contact Great-West’s Individual Health Unit when you return
home. Turn to page 17 for contact information.
8

Great-West will send you the necessary forms and assist you in preparing and submitting a claim.
Claim forms are also available in the Client Services section of www.greatwestlife.com, or by calling
Great-West’s Individual Health Unit.
You should contact your provincial health plan representatives before leaving the country to
determine the extent of coverage. Many provincial health plans have time limits for submitting
claims. These time limits will apply to your Sonata Health claim as well.
If your provincial health plan refuses payment, you may be asked to reimburse Great-West for any
amount we have already paid on its behalf.
Accidental Death, Dismemberment and Specific Loss claims
To make a claim for Accidental Death, Dismemberment and Specific Loss benefits, contact your
representative or the Individual Health Unit. They will assist you in making your claim.
Hospital Cash claims
You will receive your cash benefit automatically when you submit your claim for other hospital
expenses. You do not have to file a separate claim or provide receipts.
Included services
Best Doctors ®
Best Doctors provides you and your local doctor or specialist with access to the latest technologies,
the opinions of world-class specialists and clinical guidance. Best Doctors can assist you with
confirming a diagnosis, and can suggest the most effective treatment plan by drawing on a global
database of 50,000 peer-ranked specialists.
To access Best Doctors services, call 1-877-419-BEST (2378). Detailed information about Best Doctors
is included in your Sonata Health information package.
PVS
The PVS program gives you a discount on prescription eyewear and hearing aids purchased from a
registered PVS location.
The discount applies to frames, prescription lenses, contact lenses and lens extras, such as scratch
guard, tints, etc. Most locations will also apply the discount to non-prescription eyewear and
accessory items.
If your plan provides coverage for visioncare or hearing aids, submit your claim as usual. For the
nearest PVS location, call the PVS information centre toll-free at 1-800-668-6444 or visit the PVS
website at www.pvs.ca
PVS also entitles you to a discount on laser eye surgery obtained through an organization that is
part of the PVS network.
9

Administration
Premiums
Your first year premium is set on your plan’s effective date, as shown in your Policy Specifications
document. Your premium is based on:
• The Sonata Health plan you chose
• Any optional coverage you chose
• Whether you’re insuring just yourself or yourself and your family
• Your age
• Your home province or territory
• Your medical history
If you chose family coverage, your premium is also based on the ages, provinces or territories of
residence and medical histories of your family members.
You can pay monthly or annually for your Sonata Health plan.
Monthly payments
A letter indicating your monthly premium payment* and due date is included in your
Sonata Health information package. You have two options for payment:
• Automatic debit from your bank account
• Automatic charge to your Visa or MasterCard
*Your monthly credit card or bank statement will show a payment to PDAdmin Group for your Sonata Health premium.
PDAdmin Group is an agent of Great-West, and collects your premium on behalf of Great-West.
10

Payments
If you choose to make an annual premium payment, your full payment is due in advance. You have
two options for payment:
• Cheque
• Visa or MasterCard
You have a grace period of 30 days after the date your premium is due in which to pay your
premium without losing your coverage.
If your premium payment is returned due to non-sufficient funds, NSF charges may apply.
Premium changes
There are several points at which your premium can change:
• At renewal
• If you add or remove coverage for a dependant
• If you change the level of coverage for your Sonata Health plan
• If you add or remove optional coverage
• If you or an insured family member moves to another province or territory
Renewing your coverage
Your policy is for a term of one year beginning on the effective date shown on your Policy
Specifications document.
Great-West will automatically renew your Sonata Health policy each year, on your policy’s annual
renewal date. Your Policy Specifications document shows your annual renewal date. Your Sonata
Health coverage can continue until you reach age 65.
At each renewal, Great-West will re-establish your premium. Your new premium will take effect on
the annual renewal date. It will reflect such things as increasing healthcare costs, shifts in expenses
from provincial to private plans, and whether you or members of your family have moved into a
new age band. This means that your premium may increase on renewal. You will be notified at
least 31 days before any change in premium.
Changing your coverage
Scales 1 to 6:
You can upgrade your Sonata Health coverage at any time. You will have to provide updated
medical information at the time you apply to upgrade your coverage. Any upgrade in coverage
must be approved by Great-West, based on your medical information.
You can also downgrade the level of your Sonata Health coverage. You can only downgrade your
coverage after you’ve been covered at a higher level for at least one year.
You can add optional coverage at any time – Hospital Accommodation Benefit, Emergency Travel
Medical Benefit, Hospital Cash Benefit, and Accidental Death, Dismemberment and Specific Loss
Benefit – if you did not purchase this coverage when you purchased your Sonata Health policy. You
will have to complete a Supplementary Application form to make this additional purchase.
You may cancel your optional coverage only at your annual policy renewal date.
11

Guaranteed Acceptance Plan (GAP):
If you chose this plan, you can apply to upgrade your coverage. However, if you were offered GAP
based on your medical history, you can’t re-apply or upgrade your coverage.
To add or remove coverage for a dependant
Your Policy Specifications document lists all the dependants covered under your Sonata Health
policy. To add or remove coverage for a dependant, contact your representative or PDAdmin Group.
To change a beneficiary
All beneficiary changes must be made in writing. Complete the Change of Beneficiary form and
return it to the address on the form. You will receive written confirmation of the beneficiary change.
If you live in Quebec, indicate whether your beneficiary is revocable or non-revocable. If you
designate your beneficiary as non-revocable, you will not be able to change that beneficiary unless
you have the written consent of your beneficiary.
To get forms, including the Supplementary Application, Change of Beneficiary, Accidental Death,
Dismemberment and Specific Loss, and Direct Deposit forms, contact your representative or
PDAdmin Group, or visit the Client Services section of www.greatwestlife.com.
To change your bank account
Changes that affect your monthly premium payment may be submitted, in writing, to
PDAdmin Group.
To change your account information for direct deposit of your health and dental claim payments,
you must complete the form in the direct deposit brochure, M6656. Send the completed form to
the Individual Health Unit, along with a cheque marked “void.”
Other changes
To change your address or to make corrections to information (such as birthdates or spelling of names),
call, mail or email your change to PDAdmin Group. Turn to page 17 for contact information.
Making changes
Your representative, or PDAdmin Group, can provide the necessary forms and help you make any
changes to your plan. Changes to your coverage will affect your premium. Turn to page 17 for
contact information.
12

When your coverage ends
Your coverage will end automatically 30 days after you stop paying your premiums. Coverage will
also end:
• If you are no longer a permanent resident of Canada,
• If you are no longer covered under the provincial government health plan,
• When you reach age 65, or
• In the event of your death
If you’ve insured dependants under your Sonata Health plan, coverage for your dependants will
end if they are no longer permanent residents of Canada, they are no longer covered under the
provincial government health plan or they die. Coverage for your spouse will end when she or he
turns age 65 or is no longer your spouse.
Coverage for a child who is not a full-time student will end when the child turns 21 or works more than
30 hours a week. Coverage for a child who is a full-time student will end when the child turns 25.
Check your policy for information on when coverage ends for a child who is incapable of
supporting him or herself because of a physical or psychiatric disorder.
To reinstate your coverage
If your policy was terminated because your premiums weren’t paid, you can apply to have your
policy reinstated. Notify PDAdmin Group in writing within 60 days of the termination of your policy.
You will have to pay all overdue premiums and any additional fees, including any NSF charges, with
interest.
If your policy was terminated for any reason other than not paying premiums, you can re-apply
for coverage but not for at least two years from the date your coverage ended. Contact your
representative or PDAdmin Group for an application and assistance in re-applying.
To cancel your coverage
To cancel your coverage or coverage for your dependants, please advise your representative or
PDAdmin Group in writing. Your coverage will end on the last day of the month in which you
cancel your coverage. If you’ve paid premiums in advance, your premium will be refunded from the
first of the month following your cancellation.
Surviving spouse and children coverage
Great-West will automatically continue coverage for your spouse and children upon your death,
unless your spouse terminates your policy. Your spouse will receive a new Policy Specifications
document that lists the spouse as the policyowner and shows the change in premium. PDAdmin
Group will mail the new Policy Specifications document within 31 days of receiving written notice
of your death.
13

Tax information
Sole proprietors, partners and incorporated businesses may be able to claim Sonata Health
premiums as a business expense for federal income tax purposes.
Premiums
Premiums for benefits provided by a private health services plan, as defined by the Income Tax Act
(Canada), may qualify as a business expense. A private health services plan is an insurance contract
or plan that provides coverage for hospital and/or medical expenses. Great-West sends you an
annual statement of the Sonata Health premiums that may be tax-deductible as a business expense.
Premiums related to non-hospital/medical expense coverage are excluded from this statement.
Sole proprietor or partner
If you are a sole proprietor or partner, you may be able to deduct premiums paid or payable to a
private health services plan if the following conditions are met:
• Net income from self-employment (excluding losses and premiums for a private health
services plan) for the current or previous year is more than 50 per cent of total income, or
• Income from sources other than self-employment is $10,000 or less for the current or
previous year
• You are actively engaged in the business on a regular and continuous basis, and
• The premiums are paid or payable to insure you, your spouse or common-law partner, or any
member of your household
14

A sole proprietor or partner who does not have any employees
If you are a sole proprietor or partner with no employees you may deduct up to a maximum of:
• $1,500 for yourself
• $1,500 each for your spouse or common-law partner and household members 18 years of
age or older at the start of the period when you were insured, and
• $750 for each household member under the age of 18 at the start of the period.
A sole proprietor or partner who has employees
If you are a sole proprietor or partner who has employees, the rules are very technical and complex.
You may not be able to deduct any premiums for a private health services plan as a business
expense if you do not offer coverage to your employees. Instead, the premiums may be claimed as
a medical expense for the purposes of the medical expense tax credit.
As the sole proprietor or partner, you may be able to deduct premiums for a private health services
plan in respect to yourself, your spouse or common-law partner, or household members based on
the following criteria:
• The percentage of insurable employees who are full-time, arm’s-length employees
• The cost of the coverage provided to each employee that would be equivalent coverage for you
• The percentage of the premium for each employee that is paid by you
• The portion of the year that you had employees
As a sole proprietor or partner, you should refer to the Canada Revenue Agency’s Business and
Professional Income guide. This guide is available on the Canada Revenue Agency’s website at
www.cra-arc.gc.ca.
Incorporated business
If you are an owner-operator of an incorporated business, you may be able to deduct premiums paid
or payable to a private health services plan if the following conditions are met:
• You work as an employee in the business
• You offer similar coverage to the employees, and
• The benefits are reasonable in the circumstances, among other considerations
If coverage is offered only to major shareholders of the corporation (for example, only to owner-managers)
and not to other employees, premiums paid may not be deductible from the company’s business income
and may be considered a taxable benefit to the owner-managers.
For more information about the tax deductibility of your Sonata Health premiums, we strongly
recommend that you consult with your professional advisor about your particular circumstances.
The above information is intended as general information only, and is not intended to be legal or
tax advice.
15

Receipt for tax purposes
Early in the new year, you will receive a notice showing the portion of your premium that can be
used for income tax purposes. The notice will show either:
• The portion of your premium that is deductible if you are filing a claim as a sole proprietor,
partner or incorporated business
or
• The portion of your premium that you can use in calculating the medical expense tax credit
on your personal income tax return.
If your Sonata Health coverage ended during the year, you will receive your tax information shortly
after your policy terminates.

Contact information
For claims information
Contact Great-West’s Individual Health Unit to submit claims or if you have questions
about your claims.
By phone:
Call toll-free 1-866-430-2863
Monday to Friday, 8 a.m. to 5:30 p.m. (EST)
By e-mail:
Write to individual.health@gwl.ca
By mail:
The Great-West Life Assurance Company
Individual Health Unit
P.O. Box 6000
Winnipeg, MB R3C 3A5
For Best Doctors services
To be connected with world-class medical specialists, call toll-free 1-877-419-BEST (2378)
For PVS
For information on the PVS discount, or the nearest PVS location, call the PVS information centre
toll-free at 1-800-668-6444 or visit the PVS website at www.pvs.ca.
For general inquiries and assistance
Your Sonata Health policy is underwritten by The Great-West Life Assurance Company and
administered by PDAdmin Group. If you would like more information on your policy, want to make
changes or have any questions, contact your representative or PDAdmin Group.
By phone:
416-499-4125 or toll free 1-800-268-3489
8 a.m. to 6 p.m., Monday to Friday (EST)
By mail:
PDAdmin Group
211 Consumers Road, Suite 200
Willowdale, Ontario M2J 4G8
By e-mail:
sonatahealth@pdadmin.com
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Online services
To find forms, contact information and additional resources for your Sonata Health plan, visit the
Client Services section of www.greatwestlife.com. Select Owner of an individual insurance or
investment product – Health and Dental Insurance – Sonata Health.
For additional information about Sonata Health plans and optional benefits you can add, visit
www.greatwestlife.com/sonata.
For more information about Great-West Life, visit www.greatwestlife.com.
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Great-West Life and the key design and Sonata Health are trademarks of The Great-West Life Assurance Company.
PDAdmin Group is a trademark of PlanDirect Insurance Services Inc., used under license by The Great-West Life Assurance Company.
Best Doctors and the trademarks noted in relation to services offered by Best Doctors, Inc. are trademarks of Best Doctors, Inc.
The Assure Card and Assure Claims are registered trademarks of Telus Health Solutions.