SD60 – Exempt Satff

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20060

Reimbursement

Choice 1 & 2 – 80% of the first $1,000 and 100% thereafter;
Choice 3, 4, 5 – 100%

Annual deductible

Option 1 – $100 per person/family per year;
Option 2 – $25 per person/family per year;
Options 3, 4, 5 – Nil

Lifetime maximum

$100,000 per lifetime

Termination Age

August 31st following attainment of age 70 or retirement, whichever is earlier

Medical referral travel benefit

Included;
Maximum for Meals: N/A
Maximum for Mileage: $0.20 per KM
Maximum for Accommodation: $40 per day for 3 days

Survivor extension

N/A

Prescription Drugs

Drug formulary

Prescription Required

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

N/A

Oral Contraceptives

Covered

Fertility

Not covered

Smoking cessation

Covered up to $300 lifetime max

Medical Services & Supplies

Medi-assist

Included

Emergency out-of-province reimbursement

100%

Emergency out-of-province maximum

Combined with overall maximum

Hospital

Private

Private duty nursing (including in-home)

$10,000 per calendar year

Hearing aids

Option 1 – Not covered;
Option 2 – $400 per 5 calendar years for Dependent Children only;
Option 3 – $300 per 5 calendar years;
Option 4 – $400 per 5 calendar years;
Option 5 – $500 per 5 calendar years

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

Covered

Othopedic shoes

Charges for the following expenses, when recommended by a Physician or podiatrist/chiropodist: a) stock-item orthopedic shoes which are attached to and form part of a brace; or b) if shoes do not form part of a brace, shoes will be limited to 2 pairs per calendar year to the greater of the actual cost of the specific adjustment or 50% of the total cost of the shoe. c) custom-made shoes which are: i) constructed by a Certified Orthopaedic Footwear Specialist; and ii) required because of a medical abnormality that, based on medical evidence, cannot be accommodated in a stock-item orthopaedic shoe or a modified stock-item orthopaedic shoe.

Orthotics

2 pairs per 3 calendar years to a maximum of $400 per pair

Vision Care

Maximum

Prescription Glasses:
Option 1-Not covered;
Option 2- $125 per 2 calendar years; Option 3- $200 per 2 calendar years;
Option 4- $300 per 2 calendar years;
Option 5- $300 per calendar year;

Contact Lenses (where medically necessary):
Option 1-Not covered;
Option 2, 3, 4, 5 – $200 per 2 calendar years;

Visual Training:
Option 1-Not covered;
Option 2, 3, 4, 5 – $200 per lifetime

Eye exams

Option 1-Not covered;
Option 2, 3, 4, 5- 1 exam per calendar year for Dependent Children, and 1 exam per 2 calendar years for Member and Spouse

Prescription sunglasses

Not covered

Paramedical Services

Massage therapist

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Physiotherapy

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Chiropractor

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Psychology

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Naturopath

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Podiatry

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Acupuncture

$100 per calendar year

Speech therapy

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Osteopath

Option 1 – $500 per calendar year combined for services of a chiropractor, osteopath, podiatrist/chiropodist, massage therapist, naturopath, speech therapist, physiotherapist, and psychologist;
Options 2, 3, 4 and 5 – $1,000 per calendar year combined for services of the above listed

Christian Science

$100 per calendar year

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20060

Annual deductible

N/A

Dental fee guide

PBC Schedule 2

Specialist fee guide

Fee Guide +10%

Termination Age

August 31st following attainment of age 70 or retirement, whichever is earlier

Survivor extension

N/A

Basic Services

Reimbursement

Flex Option 1 – 70%;
Flex Option 2 – 80%;
Flex Option 3, 4, 5 – 100%

Maximum

Flex Option 1 – $1,000 combined with Major services;
Flex Option 2, 3, 4, 5 – Unlimited

Adult check-up

As indicated in the Fee schedule/Fee guide

Child check-up

As indicated in the Fee schedule/Fee guide

Endodontic/Periodontic Services

Reimbursement

Flex Option 1 – 70%;
Flex Option 2 – 80%;
Flex Option 3, 4, 5 – 100%

Maximum

Flex Option 1 – $1,000 combined with Major services;
Flex Option 2, 3, 4, 5 – Unlimited

Major Restorative Services

Reimbursement

Flex Option 1, 2, 3 – 50%;
Flex Option 4 – 60%;
Flex Option 5 – 70%

Maximum

Flex Option 1 – $1,000 combined with Basic services;
Flex Option 2 – $1,000;
Flex Option 3, 4 – Unlimited; Flex Option 5 – $2, 500

Orthodontic Services

Reimbursement

Flex Option 1 – N/A;
Flex Option: 2, 3 – 50%;
Flex Option 4 – 60%;
Flex Option 5 – 70%

Maximum

Flex Option 1 – N/A;
Flex Option 2 – $850 (dependent children only);
Flex Option 3, 4 – $1,800;
Flex Option 5 – $2,500

Age limit

See above

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

Option 1 – 1 x annual earnings;
Option 2 – 2 x annual earnings;
Option 3 – 3 x annual earnings;
Option 4 – 4 x annual earnings;
Option 5 – 5 x annual earnings

Maximum

Options 1, 2 and 3 – $300,000;
Option 4 and 5 – $500,000

Termination age

August 31st following attainment of age 70 or retirement, whichever is earlier

Age reduction

50% at age 65

Waiver of premium definition

Matches LTD

Optional life

N/A

GROUP ACCIDENT

Insurer: AIG Insurance Company of Canada

Policy Number: Basic – 9428792 | Optional – 9428793

Principal sum

Matches Life Benefit

Maximum

$500,000

Optional Accident

Available

OPTIONAL CRITICAL ILLNESS

Insurer: SSQ

Policy Number: 1NS15

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)