SD46 – Exempt

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20046

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

Orthopedic shoes

$500 per calendar year

Orthotics

$500 per calendar year

Vision Care

Maximum

$650 every 24 months

Eye exams

1 every 24 months – separate from vision care maximum

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

$1,000 per calendar year

Physiotherapy

$1,000 per calendar year

Chiropractor

$1,000 per calendar year

Psychological Counselling Services

$1,500 per calendar year

Naturopath

$1,000 per calendar year

Podiatry

$800 per calendar year

Acupuncture

$1,000 per calendar year

Speech therapy

$800 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20046

Annual deductible

N/A

Dental fee guide

PBC Schedule 3

Specialist fee guide

Fee Guide +10%

Termination Age

Retirement

Survivor extension

N/A

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

80%

Maximum

N/A

Orthodontic Services

Reimbursement

60%

Maximum

$2,000/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

Retirement

Age reduction

N/A

Waiver of premium definition

Matches LTD

Optional life

Available

GROUP ACCIDENT

Insurer: N/A

Policy Number: Basic – N/A | Optional – N/A

Principal sum

N/A

Maximum

N/A

Optional Accident

N/A