SD61 – Exempt Staff
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20061
Reimbursement
Choice 1: 20%;
Choice 2 & 3: 80%;
Choice 4: 100%
Annual deductible
N/A
Lifetime maximum
Unlimited
Termination Age
Retirement
Medical referral travel benefit
N/A
Survivor extension
Yes, to a maximum of 24 months
Prescription Drugs
Drug formulary
Prescription Required
Pay-direct drug card
No
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)
Fees for a registered nurse for special duty nursing in an acute case when ordered by the attending physician.
Hearing aids
Choice 1 & 2 : $2500 every 4 years;
Choice 3: $3000 every 4 years;
Choice 4: $3500 every 4 years
Other services and supplies (subject to reasonable and customary limits as defined by insurer)
Covered
Orthopedic shoes
Choice 1 & 2: $300 per year;
Choice 3: $400 per year;
Choice 4: $500 per year (All choices cover adults & children)
Orthotics
Choice 1 & 2: $300 per year;
Choice 3: $400 per year;
Choice 4: $500 per year (All choices cover adults & children)
Vision Care
Maximum
Choice 1: Not Covered;
Choice 2: $275/24 months;
Choice 3: $350/24 months;
Choice 4: $550/24 months
Eye exams
Choice 1: Not Covered;
Choice 2: $275/24 months;
Choice 3: $350/24 months;
Choice 4: $550/24 months
Prescription sunglasses
Covered
Paramedical Services
Massage therapist
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Physiotherapy
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Chiropractor
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Psychology
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Naturopath
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Podiatry
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Acupuncture
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Speech therapy
Choice 1, 2 : $450 per year;
Choice 3: $700 per year;
Choice 4: $900 per year
Osteopath
N/A
Christian Science
N/A
DENTAL CARE
Insurer: Pacific Blue Cross
Policy Number: 20061
Annual deductible
N/A
Dental fee guide
PBC Schedule 2
Specialist fee guide
Fee Guide +10%
Termination Age
Retirement
Survivor extension
Yes, to a maximum of 24 months
Basic Services
Reimbursement
Choice 1: 20%;Â Choice 2, 3, 4: 100%
Maximum
Choice 1: $1,000 per calendar year;
Choice 2, 3, 4 : Unlimited
Adult check-up
Once every 9 months
Child check-up
Once every 6 months
Endodontic/Periodontic Services
Reimbursement
Part of Basic Coverage;
Choice 1: 20%;
Choice 2, 3, 4: 100%
Maximum
Choice 1: $1,000 per calendar year; Choice 2, 3, 4 : Unlimited
Major Restorative Services
Reimbursement
Choice 1, 2: 50%;
Choice 3: 80%;
Choice 4: 60%
Maximum
Choice 1, 2 : $1,000 per calendar year;
Choice 3: $3,000 per calendar year;
Choice 4: Unlimited
Orthodontic Services
Reimbursement
Choice 1: 50%;
Choice 2: Not Covered;
Choice 3: 60%;
Choice 4: 75%
Maximum
Choice 1: $2,000 lifetime maximum;
Choice 2: Not Covered;
Choice 3: $3,000 lifetime maximum;
Choice 4: $5,000 lifetime maximum
Age limit
Covers adults and children
GROUP LIFE
Insurer: Pacific Blue Cross
Policy Number: 79520
Schedule
Choice 1: $50,000;
Choice 2: $100,000;
Choice 3: $200,000;
Choice 4: $300,000;
Choice 5: $400,000
Maximum
$400,000
Termination age
Earlier of age 70 or 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
Choice 1: $50,000;
Choice 2: $100,000;
Choice 3: $200,000;
Choice 4: $300,000;
Choice 5: $400,000
Maximum
$400,000
Optional Accident
Available