SD39 – Teachers ALC

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

$25

Lifetime maximum

N/A

Termination Age

Retirement.

Medical referral travel benefit

N/A

Survivor extension

Yes, to a maximum of 6 months

Prescription Drugs

Drug formulary

Prescription Required

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

N/A

Oral Contraceptives

Covered

Fertility

Covered

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)

Fees for a registered nurse for special duty nursing in an acute case when ordered by the attending physician.

Hearing aids

$500 per ear, per 60 month period for adults and dependent children (plus an additional $400 in a 60 month period for dependent children only)

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

Covered

Othopedic shoes

One pair per person on prescription by a physician/podiatrist. Replacements only as necessary due to normal wear and tear.

Orthotics

Included with Orthopedic shoes

Vision Care

Maximum

$200 every 24 months

Eye exams

1 every 24 months – combined with vision care maximum

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

No limit per person per calendar year.

Physiotherapy

No limit per person per calendar year.

Chiropractor

No limit per person per calendar year.

Psychology

$100 maximum per person per calendar year.

Naturopath

$500 maximum per person per calendar year.

Podiatry

$200 maximum per person per calendar year.

Acupuncture

$300 maximum per person per calendar year.

Speech therapy

$300 maximum per person per calendar year.

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20039

Annual deductible

N/A

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 55: 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