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.

Hearing aids

$500/5 calendar years

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

Covered

Othopedic 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 maximum per person per calendar year.

Physiotherapy

$1,000 maximum per person per calendar year.

Chiropractor

$1,000 maximum per person per calendar year.

Psychology

$1,000 maximum per person per calendar year; provided by Registered Psychologist.

Naturopath

$1,000 maximum per person per calendar year.

Podiatry

$1,000 maximum per person per calendar year.

Acupuncture

$100 maximum per person per calendar year.

Speech therapy

$1,000 maximum per person per calendar year.

Osteopath

$1,000 maximum per person per calendar year.

Christian Science

$100 maximum per person 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