SD58 – Teachers

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20058

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: 20058

Annual deductible

N/A

Dental fee guide

PBC Schedule 1

Specialist fee guide

Fee Guide +10%

Termination Age

The last day of the month in which the member retires or attains age 65.

Survivor extension

Yes, to the last day of the month in which the member died.

Basic Services

Reimbursement

90%

Maximum

N/A

Adult check-up

2 per year

Child check-up

2 per year

Endodontic/Periodontic Services

Reimbursement

90%

Maximum

N/A

Major Restorative Services

Reimbursement

80%

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

Under age 35: 3 x annual earnings;
Age 35 to 44: 2.5 x annual earnings;
Age 45 to 54: 2 x annual earnings;
Age 55 and over: 1.5 x annual earnings; Minimum benefit of $15,000.

Maximum

$100,000

Termination age

Earlier of age 65 or retirement.

Age reduction

N/A

Waiver of premium definition

Matches LTD

Optional life

N/A

GROUP ACCIDENT

Insurer: AIG Insurance Company of Canada

Policy Number: Basic – 9428791 | Optional – 9428793

Principal sum

Matches Life Benefit

Maximum

$1,000,000

Optional Accident

N/A