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

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 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