SD75 – Exempt Staff
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20075
Reimbursement
80% until $1,000 paid per person per calendar year, 100% thereafter
Annual deductible
$50
Lifetime maximum
N/A
Termination Age
Coverage will terminate on June 30th following the date the Member attains age 75, or earlier retirement.
Medical referral travel benefit
N/A
Survivor extension
Yes, to a maximum of 24 months
Prescription Drugs
Drug formulary
Blue Rx
Pay-direct drug card
Yes
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)
$20,000 per calendar year
Hearing aids
$3,500 every 48 months
Other services and supplies (subject to reasonable and customary limits as defined by insurer)
Covered
Orthopedic shoes
$500 per calendar year
Orthotics
$500 per calendar year
Vision Care
Maximum
$650 every 24 months
Eye exams
1 every 24 months – separate from vision care maximum
Prescription sunglasses
Covered
Paramedical Services
Massage therapist
$1,000 per calendar year
Physiotherapy
$1,000 per calendar year
Chiropractor
$1,000 per calendar year
Psychological Counselling Services
$1,500 per calendar year
Naturopath
$1,000 per calendar year
Podiatry
$800 per calendar year
Acupuncture
$1,000 per calendar year
Speech therapy
$800 per calendar year
Osteopath
N/A
Christian Science
N/A
DENTAL CARE
Insurer: Pacific Blue Cross
Policy Number: 20075
Annual deductible
N/A
Dental fee guide
PBC Schedule 2
Specialist fee guide
Fee Guide +10%
Termination Age
The earlier of: the last day of the month in which the Member reaches age 70 or if employment terminates prior to age 70 or if the Member retires between September 1st and May 1st, coverage terminates at the end of the month following the month of termination;
or if employment terminates or a Member retires in the month of June, or if the Member attains age 70 between September 1st and June 30th, coverage terminates on September 30th.
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
75%
Maximum
$5,000/Lifetime
Age limit
Covers adults and children
GROUP LIFE
Insurer: Pacific Blue Cross
Policy Number: 79520
Schedule
Under age 35: 3 x annual earnings;
Age 35 to 44: 2.5 x annual earnings;
Age 45 to 54: 2 x annual earnings;
Age 55 and over: 1.5 x annual earnings
Maximum
$300,000
Termination age
– If employment terminates prior to age 70 or if the Member retires between September 1st and May 31st, coverage terminates at the end of the month following the month of termination or retirement;
– If employment terminates or a Member retires in the month of June, or if the Member attains age 70 between September 1st and June 30th, coverage terminates on September 30th.
Age reduction
See above schedule
Waiver of premium definition
Matches LTD
Optional life
N/A
GROUP ACCIDENT
Insurer: AIG Insurance Company of Canada
Policy Number: Basic – 9428791 | Optional – N/A
Principal sum
Under age 35: 3 x annual earnings;
Age 35 to 44: 2.5 x annual earnings;
Age 45 to 54: 2 x annual earnings;
Age 55 and over: 1.5 x annual earnings
Maximum
$300,000
Optional Accident
N/A