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
Orthopedic 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.
Psychological Counselling Services
$1,500 per calendar year
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