SD69 – Retirees

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20069

Reimbursement

70% until $1,000 paid, 100% thereafter.

Annual deductible

$50

Lifetime maximum

$25,000/lifetime

Termination Age

Earlier of 5 years of coverage for age 65.

Medical referral travel benefit

N/A

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

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)

Eligible to a maximum of 720 hours per calendar year

Hearing aids

$500/60 months (adult), $500/30 months (child)

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

Covered

Othopedic shoes

$400 per adult/calendar year, $200 per dependent child/calendar year

Orthotics

N/A

Vision Care

Maximum

$100/24 months

Eye exams

N/A

Prescription sunglasses

Not covered

Paramedical Services

Physiotherapy

$250 maximum per person per calendar year, combined with Physiotherapist.

Massage therapist

$250 maximum per person per calendar year, combined with Massage Therapist.

Naturopath

$200 maximum per person per calendar year, combined with Naturopath.

Psychology

$100 per calendar year

Chiropractor

$200 maximum per person per calendar year, combined with Chiropractor.

Podiatry

$100 per calendar year

Acupuncture

$100 per calendar year

Speech therapy

$100 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20069

Annual deductible

N/A

Dental fee guide

PBC Schedule 1

Specialist fee guide

Fee Guide +10%

Termination Age

N/A

Survivor extension

Yes, to a maximum of 24 months

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

60%

Maximum

N/A

Orthodontic Services

Reimbursement

60%

Maximum

$3,000/Lifetime

Age limit

Covers adults and children

GROUP LIFE

Insurer: N/A

Policy Number: N/A

Schedule

N/A

Maximum

N/A

Termination age

N/A

Age reduction

N/A

Waiver of premium definition

N/A

Optional life

N/A

GROUP ACCIDENT

Insurer: N/A

Policy Number: N/A

Principal sum

N/A

Maximum

N/A

Optional Accident

N/A