SD67 – Exempt Staff

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20067

Reimbursement

100%

Annual deductible

$25

Lifetime maximum

N/A

Termination Age

Retirement

Medical referral travel benefit

N/A

Survivor extension

Yes, coverage will continue to the last day of the month in which the Member dies.

Prescription Drugs

Drug formulary

As prescribed and dispensed by a licensed pharmacist or Physician.

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

N/A

Oral Contraceptives

Not covered

Fertility

Not covered

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

$1,000 per ear per person every 60 month period.

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

Covered

Othopedic shoes

1 pair (and replacements when necessitated by normal wear and tear) combined with Orthotics

Orthotics

1 pair (and replacements when necessitated by normal wear and tear) combined with Orthopedic Shoes

Vision Care

Maximum

$200/12 months

Eye exams

N/A

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

No limit

Physiotherapy

No limit

Chiropractor

$200 maximum per person per calendar year.

Psychology

Not covered

Naturopath

$200 maximum per person per calendar year.

Podiatry

$200 maximum per person per calendar year.

Acupuncture

$100 maximum per person per calendar year.

Speech therapy

$100 maximum per person per calendar year.

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20067

Annual deductible

N/A

Dental fee guide

PBC Schedule 2

Specialist fee guide

Fee Guide +10%

Termination Age

Retirement

Survivor extension

Yes, coverage will continue to the last day of the month in which the Member dies.

Basic Services

Reimbursement

100%

Maximum

N/A

Adult check-up

2 per year

Child check-up

2 per year

Endodontic/Periodontic Services

Reimbursement

100%

Maximum

N/A

Major Restorative Services

Reimbursement

80%

Maximum

N/A

Orthodontic Services

Reimbursement

50%

Maximum

$2,500/Lifetime

Age limit

Covers adults and children

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

3 x annual earnings

Maximum

$1,000,000

Termination age

Retirement

Age reduction

Coverage is reduced to 50% at age 65.

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

Matches Life Benefit

Maximum

$400,000

Optional Accident

Available