SD5 – Exempt Staff

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20005

Reimbursement

100%

Annual deductible

$25 per person or family each calendar year

Lifetime maximum

$1,000,000

Termination Age

Last day of the month in which the member’s employment terminates or the member retires.

Medical referral travel benefit

N/A

Survivor extension

N/A

Prescription Drugs

Drug formulary

Prescription required

Pay-direct drug card

No

Per prescription deductible

N/A

Sexual dysfunction

Not Covered

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

$1,000,000 per lifetime

Hospital

Private or Semi-Private

Private duty nursing (including in-home)

Eligible to a maximum of 720 hours per calendar year

Hearing aids

$500 every 5 years

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

Covered

Othopedic shoes

$400 adults/$200 children

Orthotics

$300 adults every 2 years / $300 children every year

Vision Care

Maximum

$800 every 2 calendar years

Eye exams

Included in maximum

Prescription sunglasses

Not covered

Paramedical Services

Massage therapist

Max 50 visits per calendar year

Physiotherapy

Max 40 visits per calendar year

Chiropractor

$200 subject to $500/family max per year

Psychology

$100 per calendar year

Naturopath

$500/family max per calendar year

Podiatry

$200 subject to $500/family max per year

Acupuncture

$300 per calendar year

Speech therapy

$100 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20005

Annual deductible

None

Dental fee guide

PBC Schedule 3

Specialist fee guide

Fee Guide +10%

Termination Age

Last day of the month in which the member’s employment terminates or the member retires.

Survivor extension

N/A

Basic Services

Reimbursement

100%

Maximum

N/A

Adult check-up

2 per calendar year

Child check-up

2 per calendar year

Endodontic/Periodontic Services

Reimbursement

100%

Maximum

N/A

Major Restorative Services

Reimbursement

80%

Maximum

N/A

Orthodontic Services

Reimbursement

50%

Maximum

$2,500/Lifetime

Age limit

N/A

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

3 x annual earnings (min. $200,000)

Maximum

$500,000

Non-Evidence Maximum

$400,000

Termination age

Age 70 or earlier 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

Matches Basic Life

Maximum

$500,000

Optional Accident

Available