SD39 – Principals & VPs
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20039
Reimbursement
80% until $1,000 paid per person per calendar year, 100% thereafter
Annual deductible
$50
Lifetime maximum
N/A
Termination Age
Coverage will terminate on June 30th following the date the Member attains age 75, or earlier retirement.
Medical referral travel benefit
N/A
Survivor extension
Yes, to a maximum of 24 months
Prescription Drugs
Drug formulary
Blue Rx
Pay-direct drug card
Yes
Per prescription deductible
$0
Sexual dysfunction
Covered
Oral Contraceptives
Covered
Fertility
$20,000 per lifetime
Smoking cessation
Not covered
Medical Services & Supplies
Medi-assist
Included
Emergency out-of-province reimbursement
100%
Emergency out-of-province maximum
N/A
Hospital
Private or Semi-Private
Private duty nursing (including in-home)
$20,000 per calendar year
Hearing aids
$3,500 every 48 months
Other services and supplies (subject to reasonable and customary limits as defined by insurer)
Covered
Orthopedic shoes
$500 per calendar year
Orthotics
$500 per calendar year
Vision Care
Maximum
$550 every 24 months
Eye exams
1 every 24 months – separate from vision care maximum
Prescription sunglasses
Covered
Paramedical Services
Massage therapist
$1,000 per calendar year
Physiotherapy
$1,000 per calendar year
Chiropractor
$1,000 per calendar year
Psychological Counselling Services
$1,200 per calendar year
Naturopath
$900 per calendar year
Podiatry
$800 per calendar year
Acupuncture
$1,000 per calendar year
Speech therapy
$800 per calendar year
Osteopath
N/A
Christian Science
N/A
DENTAL CARE
Insurer: Pacific Blue Cross
Policy Number: 20039
Annual deductible
$0
Dental fee guide
PBC Schedule 2
Specialist fee guide
Fee Guide +10%
Termination Age
Retirement
Survivor extension
Yes, to a maximum of 6 months
Basic Services
Reimbursement
85%
Maximum
N/A
Adult check-up
2 per Calendar year
Child check-up
2 per Calendar year
Endodontic/Periodontic Services
Reimbursement
85%
Maximum
N/A
Major Restorative Services
Reimbursement
60%
Maximum
N/A
Orthodontic Services
Reimbursement
75%
Maximum
N/A
Age limit
Covers adults and children
GROUP LIFE
Insurer: Pacific Blue Cross
Policy Number: 79539
Schedule
Employees with dependents and those who elect, subject to a minimum of $15,000 up to $400,000;
less than age 45: 3 x Annual Earnings;
age 45 to 54: 2.5 x Annual Earnings;
age 55 to 59: 2x Annual Earnings;
age 60 and over: 1.5 x Annual Earnings;
Employees who do not elect: Flat $5,000
Maximum
$400,000
Termination age
Retirement
Age reduction
See above schedule
Waiver of premium definition
Matches LTD
Optional life
N/A
GROUP ACCIDENT
Insurer: N/A
Policy Number: N/A
Principal sum
N/A
Maximum
N/A
Optional Accident
N/A