SD34 – Exempt Staff

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20034

Reimbursement

Choices 1 and 2 – 80% of the first $1,000 and 100% thereafter;
Choices 3 – 100%

Annual deductible

Choice 1 – $100 per calendar year;
Choice 2 – $25 per calendar year;
Choices 3- No Deductible

Lifetime maximum

Choice 1 & 2 – $1,000,000 per lifetime;
Choice 3 – Unlimited

Termination Age

June 30th following the date the member attains age 75, or retirement

Medical referral travel benefit

N/A

Survivor extension

Yes;
Choice 1 – to a maximum of 6 months
Choice 2 – to a maximum of 12 months
Choice 3 – to a maximum of 24 months

Prescription Drugs

Drug formulary

Prescription Required

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

Choice 1 & 2 – Not covered;
Choice 3 – Covered

Oral Contraceptives

Covered

Fertility

Choice 1 & 2 – Not covered;
Choice 3 – $20,000 lifetime maximum

Smoking cessation

Not covered

Medical Services & Supplies

Medi-assist

Included

Emergency out-of-province reimbursement

100%

Emergency out-of-province maximum

N/A

Hospital

Choice 1 – Semi-Private;
Choices 2, 3 – Private or Semi-Private

Private duty nursing (including in-home)

Covered; acute cases as ordered by physician ($20,000 per calendar year)

Hearing aids

Choice 1- Not covered;
Choice 2 – $1,750 every 48 months;
Choice 3 – $3,500 every 48 months

Other services and supplies (subject to reasonable and customary limits as defined by insurer)

Choices 1 and 2 – 50% for Lymphadema Pumps, Blood Glucose Monitors and Insulin Injectors regardless of total paid claims;
Choice 3 – 100% for Lymphadema Pumps, Blood Glucose Monitors and Insulin Injectors regardless of total paid claims;/Choices 1 and 2 – 80% of the first $1,000 and 100% thereafter for other claims; Choices 3 – 100% for other claims

Othopedic shoes

$500 per calendar year (combined with orthotics)

Orthotics

$500 per calendar year (combined with Orthopedic Shoes)

Vision Care

Maximum

Choice 1 – Not covered;
Choice 2 – $300 for vision care every 24 months;
Choice 3 – $550 for vision care every 24 months

Eye exams

Choice 1- Not covered;
Choice 2 &3 – 1 eye exam every 24 months months (subject to PBC’s R&C limit)

Prescription sunglasses

Choice 1 – Not covered;
Choice 2& 3 – Covered

Paramedical Services

Massage therapist

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Physiotherapy

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Chiropractor

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Psychology

All choices – $960 per calendar year, combined with industrial psychologists and clinical counsellors.
Reimbursed at 100%.

Naturopath

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Podiatry

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Acupuncture

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Speech therapy

Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $900 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20034

Annual deductible

N/A

Dental fee guide

PBC Schedule 2

Specialist fee guide

Fee Guide +100%

Termination Age

The end of the month in which employment terminates, or the end of the month following the month in which you retire, whichever is earlier

Survivor extension

Yes, to a maximum of 6 months

Basic Services

Reimbursement

Choice 1 – 80%;
Choice 2 & 3 – 100%

Maximum

Choice 1 – $1,000 per calendar year;
Choice 2 & 3 – Unlimited

Adult check-up

As indicated in the Fee schedule/Fee guide

Child check-up

As indicated in the Fee schedule/Fee guide

Endodontic/Periodontic Services

Reimbursement

Choice 1 – 80%;
Choices 2, and 3 – 100%

Maximum

Choice 1 – $1,000 combined;
Choices 2 and 3 – Unlimited

Major Restorative Services

Reimbursement

Choice 1 – 50%;
Choice 2 – 60%;
Choice 3 – 80%

Maximum

Choice 1 – $1,000/calendar year combined with Basic Services;
Choice 2 – $1,500/calendar year;
Choice 3 – Unlimited

Orthodontic Services

Reimbursement

Choice 1 – Not covered;
Choice 2 – 60%;
Choice 3 – 75%

Maximum

Choice 1 – Not Covered;
Choice 2 – $2,500/lifetime;
Choice 3 – $5,000/lifetime

Age limit

Choice 1 – Not Covered;
Choice 2 – Dependent children only under age 20;
Choice 3 – Covers adults and children

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

Choice 1 – 1 x annual earnings;
Choice 2 – 2 x annual earnings
Choice 3 – 3 x annual earnings;
Choice 4 – 4 x annual earnings;
Choice 5 – 5 x annual earnings

Maximum

Choices 1, 2 and 3 – $250,000;
Choice 4 and 5 – $500,000

Non-evidence Maximum

Options 1, 2 and 3 – $250,000
Option 4 and 5 – $325,000

Termination age

The end of the month in which employment terminates, or the end of the month following the month in which you retire, whichever is earlier

Age reduction

N/A

Waiver of premium definition

Matches LTD

Optional life

N/A

GROUP ACCIDENT

Insurer: AIG Insurance Company of Canada

Policy Number: Basic – 9428791 | Optional – 9428793

Principal sum

Matches Basic Life

Maximum

$500,000

Optional Accident

Available