SD60 – Management
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20060
Reimbursement
80% of the first $1,000 and 100% thereafter
Annual deductible
$50
Lifetime maximum
N/A
Termination Age
June 30th following the attainment of age 75 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: $30 per day for 7 days
Survivor extension
Yes, up 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, up to reasonable and customary amounts
Prescription sunglasses
Covered
Paramedical Services
Massage therapist
$1,000 per calendar year
Physiotherapy
$1,000 per calendar year
Chiropractor
$1,000 per calendar year
Psychology
$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: 20060
Annual deductible
N/A
Dental fee guide
PBC Schedule 2
Specialist fee guide
Fee Guide +10%
Termination Age
The first day of the month or immediately following the earlier of five years from the date of retirement or the attainment of age 66; or, August 31st following attainment of the normal retirement age, currently 65 but never to exceed age 70
Survivor extension
Coverage will continue to the last day of the month in which the Member dies
Basic Services
Reimbursement
100%
Maximum
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
100%
Maximum
Unlimited
Major Restorative Services
Reimbursement
60%
Maximum
Unlimited.
Only 1 major restorative service involving the same tooth will be covered in a 5 year period
Orthodontic Services
Reimbursement
75%
Maximum
$5,000/Lifetime
Age limit
N/A
GROUP LIFE
Insurer: Pacific Blue Cross
Policy Number: 79520
Schedule
3 x Annual Salary
Maximum
$300,000
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
Available
GROUP ACCIDENT
Insurer: AIG Insurance Company of Canada
Policy Number: Basic – 9428792 | Optional – 9428793
Principal sum
Matches Life Benefit
Maximum
$300,000
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)