SD43 – Exempt Staff

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20043

Reimbursement

100%

Annual deductible

$25

Lifetime maximum

N/A

Termination Age

Retirement

Medical referral travel benefit

N/A

Survivor extension

Yes, to a maximum of 24 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% Cdn$ equivalent of reasonable and customary charges (less amount paid by MSP_ for emergency expenses only.

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

$500/5 year period for Adults and Children

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

Covered

Othopedic shoes

One pair of Orthopedic shoes or orthotics per person on prescription by a physician/podiatrist. Replacements due to normal wear and tear only as necessary and pre-approved by PBC.

Orthotics

Yes. See Orthopedic shoes coverage details.

Vision Care

Maximum

$325 claimable per calendar year.

Eye exams

Eye exams for employees only to a maximum of $100 every 2 calendar years.

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

Unlimited

Physiotherapy

Unlimited

Chiropractor

$350 per calendar year

Psychology

$100 per calendar year

Naturopath

$350 per calendar year

Podiatry

$350 per calendar year

Acupuncture

$350 per calendar year

Speech therapy

$350 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20043

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 24 months

Basic Services

Reimbursement

100%

Maximum

N/A

Adult check-up

2 per year

Child check-up

2 per year

Endodontic/Periodontic Services

Reimbursement

100%

Maximum

N/A

Major Restorative Services

Reimbursement

100%

Maximum

N/A

Orthodontic Services

Reimbursement

100%

Maximum

N/A

Age limit

Covers adults and children

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79543

Schedule

3 x annual earnings, rounded to the next higher $1,000

Maximum

$400,000

Termination age

Age 70

Age reduction

Flat $15,000 at age 65 or earlier of retirement with premiums paid by the member

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

$400,000

Optional Accident

Available