SD39 – Teachers
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20039
Reimbursement
80% reimbursement up to $1,000 claims paid per person or family per calendar year, 100% reimbursement 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
$3,000 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)
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
Orthopedic 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
N/A
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 per calendar year
Naturopath
$500 per calendar year
Podiatry
$200 per calendar year
Acupuncture
$300 per calendar year
Speech therapy
$300 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 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