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
Orthopedic 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