SD84 – Exempt Staff
EXTENDED HEALTH CARE
Insurer: Pacific Blue Cross
Policy Number: 20084
Reimbursement
100%
Annual deductible
$0
Lifetime maximum
N/A
Termination Age
Earlier of age 70 or retirement
Medical referral travel benefit
N/A
Survivor extension
To be determined.
Prescription Drugs
Drug formulary
Prescription Required
Pay-direct drug card
No
Per prescription deductible
$0
Sexual dysfunction
N/A
Oral Contraceptives
Covered
Fertility
Covered
Smoking cessation
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)
Fees for a registered nurse for special duty nursing in an acute case when ordered by the attending physician to a maximum of $10,000 per calendar year.
Hearing aids
$500/5 calendar years
Other services and supplies (subject to reasonable and customary limits as defined by insurer)
Covered
Orthopedic shoes
$200/calendar year
Orthotics
$400/3 calendar years
Vision Care
Maximum
$250 every 24 months
Eye exams
1 visit per person every 2 calendar years (adults)
1 visit per person every calendar year (children)
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
$1,000 per calendar year.
Acupuncture
$100 per calendar year.
Speech therapy
$1,000 per calendar year.
Osteopath
$1,000 per calendar year.
Christian Science
$100 per calendar year.
DENTAL CARE
Insurer: Pacific Blue Cross
Policy Number: 20084
Annual deductible
N/A
Dental fee guide
PBC Schedule 1
Specialist fee guide
Fee Guide +10%
Termination Age
Earlier of age 70 or retirement
Survivor extension
To be determined
Basic Services
Reimbursement
100%
Maximum
$2,000/calendar year. Maximum combined with Endodontic/Periodontic services and Major Services.
Adult check-up
2 per year
Child check-up
2 per year
Endodontic/Periodontic Services
Reimbursement
100%
Maximum
$2,000/calendar year. Maximum combined with Basic and Major Services.
Major Restorative Services
Reimbursement
80%
Maximum
$2,000/calendar year. Maximum combined with Basic and Endodontic/Periodontic services.
Orthodontic Services
Reimbursement
50%
Maximum
$2,000/Lifetime
Age limit
Covers adults and children
GROUP LIFE
Insurer: Pacific Blue Cross
Policy Number: 79520
Schedule
3 x annual earnings
Maximum
$500,000
Termination age
Earlier of retirement or age 70.
Age reduction
50% at age 65
Waiver of premium definition
Matches LTD
Optional life
Available
GROUP ACCIDENT
Insurer: AIG Insurance Company of Canada
Policy Number: Basic – 9428791 | Optional – 9428793
Principal sum
Matches Life Benefit
Maximum
$400,000
Optional Accident
Available