SD43 – Non-Teaching
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 90043
Reimbursement
80%
Annual deductible
$100 per family per year
Lifetime maximum
$25,000. This maximum may be reinstated after each 2 Calendar year period of continuous membership. If PBC has paid $25,000 for any one illness or injury in any 2 Calendar year period, reinstatement and entitlement to Benefits will be considered only when the Member provides PBC with satisfactory evidence of complete recovery and return to good health.
Termination Age
N/A
Medical referral travel benefit
N/A
Survivor extension
N/A
Prescription Drugs
Drug formulary
Prescription Required
Pay-direct drug card
No
Per prescription deductible
$0
Sexual dysfunction
N/A
Oral Contraceptives
Not 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
Included in lifetime maximum
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
$400/60 months
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 every 3 years
Eye exams
N/A
Prescription sunglasses
Covered
Paramedical Services
Massage therapist
$500 per calendar year
Physiotherapy
$500 per calendar year
Chiropractor
$200 per calendar year
Psychology
$100 per calendar year
Naturopath
$200 per calendar year
Podiatry
$200 per calendar year
Acupuncture
$100 per calendar year
Speech therapy
$100 per calendar year
Osteopath
N/A
Christian Science
N/A
DENTAL CARE
Insurer: Pacific Blue Cross
Policy Number: 90043
Annual deductible
N/A
Dental fee guide
PBC Schedule 2
Specialist fee guide
Fee Guide +10%
Termination Age
N/A
Survivor extension
N/A
Basic Services
Reimbursement
70%
Maximum
N/A
Adult check-up
2 per year
Child check-up
2 per year
Endodontic/Periodontic Services
Reimbursement
70%
Maximum
N/A
Major Restorative Services
Reimbursement
60%
Maximum
$2,000 maximum per person per calendar year
Orthodontic Services
Reimbursement
60%
Maximum
$2,500 maximum per person per calendar year
Age limit
Covers adults and children
GROUP LIFE
Insurer: N/A
Policy Number: N/A
Schedule
N/A
Maximum
N/A
Termination age
N/A
Age reduction
N/A
Waiver of premium definition
N/A
Optional life
N/A
GROUP ACCIDENT
Insurer: N/A
Policy Number: N/A
Principal sum
N/A
Maximum
N/A
Optional Accident
N/A