SD42 – Principals & VPs

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20042

Reimbursement

Choice 1- 20% until $1,000 paid, 100% thereafter;
Choice 2 – 80% until $1,000 paid, 100% thereafter;
Choice 3 – 100%

Annual deductible

N/A

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

Choice 1 – Pharmacare;
Choice 2 & 3 – Blue RX

Pay-direct drug card

Yes

Per prescription deductible

$0

Sexual dysfunction

Choice 1 – Not covered;
Choice 2& 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)

Fees for a registered nurse for special duty nursing in an acute case when ordered by the attending physician, based on reasonable and customary charges.

Hearing aids

Choice 1 & 2 – $500/60 months (adult), $900/60 months (child); Choice 3 – $3,500 per 48 months

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

Covered

Othopedic shoes

Choice 1 – $300 per calendar year (combined with orthotics);
Choice 2 – $500 per calendar year (combined with orthotics);
Choice 3 – $600 per calendar year (combined with orthotics)

Orthotics

Included with Orthopedic shoes

Vision Care

Maximum

Choice 1 – Nil;
Choice 2 – $550 for vision care every 2 calendar year;
Choice 3 – $700 for vision care every 2 calendar year

Eye exams

Choice 1- Nil;
Choice 2 – $75 for eye exams every 2 calendar years;
Choice 3 -$100 for eye exams every 2 calendar years

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Physiotherapy

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Chiropractor

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Psychology

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Naturopath

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Podiatry

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Acupuncture

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Speech therapy

Choice 1 – $250 per person per calendar year;
Choice 2 – $900 per person per calendar year;
Choice 3 – $1,200 per person per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20042

Annual deductible

$0

Dental fee guide

PBC Schedule 2

Specialist fee guide

Specialist fees no longer capped at the General Fee Guide + 10%

Termination Age

Last day of the month in which Member’s employment terminates or member becomes ineligible for coverage, or August 31st coincident with or next following the date the plan member attains age 70, or the end of the month following the month in which the plan member retires, whichever is earlier.

Survivor extension

N/A

Basic Services

Reimbursement

Choice 1 – 80%;
Choice 2 & 3 – 100%

Maximum

Unlimited

Adult check-up

Choice 1 – Every 9 months;
Choice 2 & 3 – Every 6 months

Child check-up

Choice 1, 2 & 3 – Every 6 months

Endodontic/Periodontic Services

Reimbursement

Choice 1 – 80%;
Choices 2, & 3 – 100%

Maximum

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

Major Restorative Services

Reimbursement

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

Maximum

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

Orthodontic Services

Reimbursement

Choice 1 – Nil;
Choice 2 – 50%;
Choice 3 – 75%

Maximum

Choice 1 – Nil;
Choice 2 – $2,000/calendar year;
Choice 3 – $5,000/lifetime

Age limit

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

$600,000

Termination age

August 31st coincident with or next following the date you attain age 65 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 Accident

Available

GROUP ACCIDENT

Insurer: AIG Insurance Company of Canada

Policy Number: Basic – 9428791 | Optional – 9428793

Principal sum

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

$500,000

Optional Accident

Available