Question for Canadians

Under the terms of your contract, the purchase of a CPAP machine, a compressor unit that blows air into collapsed airway passages to aid patients while they sleep, is eligible at 100% and is subject or considered up to the Reasonable and Customary cost which is $2,000.00. A CPAP machine is eligible once per 5 years per individual. A note or letter of recommendation from the claimant's doctor indicating the level of sleep apnea (i.e. mild, moderate, severe, etc.) is required. There is no deductible applicable.

If the CPAP is approved by a provincial plan, we will pick up the balance and above information will not be requested.

We will review if sleep apnea is moderate to severe. We will not consider for mild sleep apnea, or for snoring.

The following supplies are eligible and included in the Reasonable and Customary for the initial purchase/rental:

- Battery
- Filter
- Humidifier
- Mask
- Mouthpiece
- Nasal seal kit
- Tubing OR headgear OR chin strap
- 12 VDC adapter

The following supplies are eligible for replacement at 100%:

- Filter (once every 12 months)
- Humidifier (as needed)
- Mask (once every 12 months)
- Nasal pillow --- examples of brand names: Mirage Activa Cushion (once every 12 months)
- Mouthpiece (once every 12 months)
- Tubing/headgear/chin strap (once every 12 months)
- Gel cushion for mask (once every 12 months)

The Reasonable and Customary cost for the mask is $400.00.

The following item are ineligible and will not be considered by the provincial plan, or Sun Life Financial:

- Extended warranty
- Yearly pressure checks
- Calibrations or pressure adjustments
- Patient instruction manual
- Battery cable adaptor
- Battery case
- Battery charger

If the provincial plan such as ADP paid a portion, the statement from ADP is required and in this case a doctor’s prescription is not required. If not, we need a letter of recommendation from the claimant's doctor, before we can consider this expense.