SD45 – Principals & VPs

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20045

Reimbursement

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

Annual deductible

$50

Lifetime maximum

N/A

Termination Age

Coverage will terminate on June 30th following the date the Member attains age 75, or earlier retirement.

Medical referral travel benefit

N/A

Survivor extension

Yes, to a maximum of 24 months

Prescription Drugs

Drug formulary

Blue Rx

Pay-direct drug card

Yes

Per prescription deductible

$0

Sexual dysfunction

Covered

Oral Contraceptives

Covered

Fertility

$20,000 per lifetime

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)

$20,000 per calendar year

Hearing aids

$3,500 every 48 months

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

Covered

Othopedic shoes

$500 per calendar year

Orthotics

$500 per calendar year

Vision Care

Maximum

$550 every 24 months

Eye exams

1 every 24 months – separate from vision care maximum

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

$900 per calendar year

Physiotherapy

$900 per calendar year

Chiropractor

$900 per calendar year

Psychology

$900 per calendar year

Naturopath

$900 per calendar year

Podiatry

$800 per calendar year

Acupuncture

$900 per calendar year

Speech therapy

$800 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20045

Annual deductible

N/A

Dental fee guide

PBC Schedule 3

Specialist fee guide

Fee Guide +10%

Termination Age

The last date of the month following the month in which You retire, or the last day of the month in which You become no longer eligible for coverage.

Survivor extension

Yes, to a maximum of 24 months

Basic Services

Reimbursement

85%

Maximum

N/A

Adult check-up

2 per Calendar year

Child check-up

2 per Calendar year

Endodontic/Periodontic Services

Reimbursement

85%

Maximum

N/A

Major Restorative Services

Reimbursement

60%

Maximum

N/A

Orthodontic Services

Reimbursement

75%

Maximum

$5,000/Lifetime

Age limit

Covers adults and children

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: AIG Insurance Company of Canada

Policy Number: Basic – 9428791 | Optional – 9428793

Principal sum

3X annual earnings

Maximum

$400,000

Optional Accident

Available

OPTIONAL CRITICAL ILLNESS

Insurer: SSQ

Policy Number: 1L420

Principal sum

$10,000 minimum, in units of $5,000, to a maximum of $150,000. (Guaranteed Issue Amount: $50,000)

Maximum

$150,000 (Active Employees & Spouses); $3,000 (Dependent Children)