SD44 – Trustees

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20044

Reimbursement

80% until $1,000 paid per person per calendar year, 100% thereafter

Annual deductible

$25

Lifetime maximum

$100,000/lifetime

Termination Age

Retirement

Medical referral travel benefit

N/A

Survivor extension

Yes, to a maximum of 6 months

Prescription Drugs

Drug formulary

Prescription Required

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

N/A

Oral Contraceptives

Not covered

Fertility

Not covered

Smoking cessation

Not covered

Medical Services & Supplies

Medi-assist

Included

Emergency out-of-province reimbursement

100%

Emergency out-of-province maximum

N/A

Hospital

Private or Semi-Private

Private duty nursing (including in-home)

Eligible to a maximum of 30 days each calendar year for each member or dependent.

Hearing aids

$500/5 calendar year period for a member or dependent. Payment will not be made for maintenance, batteries, recharging devices or other such accessories.

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

Covered

Othopedic shoes

$400/calendar year per member of dependent for custom orthopedic shoes (including repairs) and modifications to stock item footwear, when prescribed by a podiatrist or a physician and surgeon.

Orthotics

$500/2 calendar years per member or dependent.

Vision Care

Maximum

$150/2 calendar years.

Eye exams

Not Covered

Prescription sunglasses

Not Covered

Paramedical Services

Massage therapist

$250 maximum per person per calendar year. Also subject to a maximum of $10 per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Physiotherapy

$250 maximum per person per calendar year. Also subject to a maximum of $10 per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Chiropractor

$200 maximum per person per calendar year, combined with Naturopath. Also subject to a maximum of $10 coverage per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Psychology

$100 maximum per person per calendar year. Also subject to a maximum of $10 per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Naturopath

$200 maximum per person per calendar year, combined with Chiropractor. Also subject to a maximum of $10 coverage per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Podiatry

$100 maximum per person per calendar year. Also subject to a maximum of $10 per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Acupuncture

$100 maximum per person per calendar year. Also subject to a maximum of $10 coverage per visit for the first 12 visits under age 65 or first 15 visits (age 65 and over).

Speech therapy

$100 per person per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20044

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 6 months

Basic Services

Reimbursement

80%

Maximum

N/A

Adult check-up

2 per year

Child check-up

2 per year

Endodontic/Periodontic Services

Reimbursement

80%

Maximum

N/A

Major Restorative Services

Reimbursement

50%

Maximum

N/A

Orthodontic Services

Reimbursement

50%

Maximum

N/A

Age limit

Covers adults and children; however, individuals must be covered for 12 consecutive months before they are eligible to receive orthodontic benefits.

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

3 x annual earnings

Maximum

$400,000

Termination age

Earlier of age 70 or retirement

Age reduction

N/A

Waiver of premium definition

Matches LTD

Optional life

Available

GROUP ACCIDENT

Insurer: N/A

Policy Number: N/A

Principal sum

N/A

Maximum

N/A

Optional Accident

N/A