SD83 – Teachers
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20083
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: 20083
Annual deductible
N/A
Dental fee guide
PBC Schedule 2
Specialist fee guide
Fee Guide +10%
Termination Age
The last day of the month in which the Member’s employer terminate or ceases to be eligible for coverage under the benefit, or the last day of the month in which the Member retires
Survivor extension
Yes, to a maximum of 3 months
Basic Services
Reimbursement
85%
Maximum
N/A
Adult check-up
As indicated in the Fee schedule/Fee guide
Child check-up
As indicated in the Fee schedule/Fee guide
Endodontic/Periodontic Services
Reimbursement
85%
Maximum
N/A
Major Restorative Services
Reimbursement
60%
Maximum
N/A
Orthodontic Services
Reimbursement
75%
Maximum
N/A
Age limit
N/A
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