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
Orthopedic 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
Psychological Counselling Services
$1,500 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