SD34 – Principals & VPs
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
Orthopedic 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 – $1,000 per calendar year
Physiotherapy
Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $1,000 per calendar year
Chiropractor
Choice 1 – $200 per calendar year;
Choice 2 – $500 per calendar year;
Choice 3 – $1,000 per calendar year
Psychological Counselling Services
Choices 1 & 2: $960 per calendar year;
Choices 3: $1,200 per calendar year;
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 – $1,000 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