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
Orthopedic 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