SD75 – Trustees

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

$25 annual deductible. Deductible does not apply to vision care.

Lifetime maximum

N/A

Termination Age

The earlier of:
– the last day of the month in which the Member retires or reaches age 65;
– if employment terminates prior to age 65 or if the Member retires between September 1st and May 1st, coverage terminates at the end of the month following the month of termination;
– if employment terminates or a Member retires in the month of June, or if the Member attains age 65 between September 1st and June 30th, coverage terminates on September 30th.

Medical referral travel benefit

N/A

Survivor extension

Yes, to a maximum of 24 months

Prescription Drugs

Drug formulary

Prescription Required

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

N/A

Oral Contraceptives

Covered

Fertility

$2,500 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)

$25,000 per 12 months

Hearing aids

$400 per 60 months (adults)
$800 per 60 months (dependent children)

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

Covered

Othopedic shoes

One pair of orthopaedic shoes to a maximum of $100 per year.

Orthotics

$500 per calendar year

Vision Care

Maximum

$250 every 24 months

Eye exams

N/A

Prescription sunglasses

Not covered

Paramedical Services

Massage therapist

$350 per calendar year

Physiotherapy

$350 per calendar year

Chiropractor

$350 per calendar year

Psychology

$350 per calendar year

Naturopath

$350 per calendar year

Podiatry

$350 per calendar year

Acupuncture

$350 per calendar year

Speech therapy

$350 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 retires or reaches age 65;
– if employment terminates prior to age 65 or if the Member retires between September 1st and May 1st, coverage terminates at the end of the month following the month of termination;
– if employment terminates or a Member retires in the month of June, or if the Member attains age 65 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

80%

Maximum

N/A

Orthodontic Services

Reimbursement

50%

Maximum

$1,500/Lifetime

Age limit

Covers adults and children

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

Flat $10,000

Maximum

$10,000

Termination age

– If employment terminates prior to age 65 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 65 between September 1st and June 30th, coverage terminates on September 30th.

Age reduction

N/A

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

Flat $10,000

Maximum

$10,000

Optional Accident

N/A