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
Orthopedic 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