SD60 – Principals & VPs
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: $30 per day for 7 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
Orthopedic 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
Available
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)