SD85 – Retired Teachers

EXTENDED HEALTH CARE

Insurer: Pacific Blue Cross

Policy Number: 20085

Reimbursement

80% until $1,000 paid per person per calendar year, 100% thereafter

Annual deductible

$25

Lifetime maximum

N/A

Termination Age

Death

Medical referral travel benefit

N/A

Survivor extension

Yes, coverage will continue to the last day of the month in which the Member dies.

Prescription Drugs

Drug formulary

Prescription Required

Pay-direct drug card

No

Per prescription deductible

$0

Sexual dysfunction

N/A

Oral Contraceptives

Not covered

Fertility

Not covered

Smoking cessation

Not covered

Medical Services & Supplies

Medi-assist

Included

Emergency out-of-province reimbursement

100%

Emergency out-of-province maximum

Included in lifetime maximum

Hospital

Semi-private or private if semi-private is not available.

Private duty nursing (including in-home)

For a person with an acute condition in the person’s home or in a hospital in the patient’s province of residence.

Hearing aids

$400 for adults, $800 for dependent children / 60 Months.

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

Covered

Othopedic shoes

$500 max for adults, $300 for dependent children, combined with orthotics.

Orthotics

$500 max for adults, $300 for dependent children, combined with orthopedic shoes.

Vision Care

Maximum

$200 every 24 months

Eye exams

1 visit per person per 24 months

Prescription sunglasses

Covered

Paramedical Services

Massage therapist

$250 per calendar year

Physiotherapy

$250 per calendar year

Chiropractor

$250 per calendar year

Psychology

$250 per calendar year

Naturopath

$250 per calendar year

Podiatry

$250 per calendar year

Acupuncture

$250 per calendar year

Speech therapy

$250 per calendar year

Osteopath

N/A

Christian Science

N/A

DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20085

Annual deductible

N/A

Dental fee guide

PBC Schedule 2

Specialist fee guide

Fee Guide +10%

Termination Age

Death

Survivor extension

Yes, coverage will continue to the last day of the month in which the Member dies.

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

60%

Maximum

N/A

Orthodontic Services

Reimbursement

75%

Maximum

$5,000/Lifetime

Age limit

Covers adults and children

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

3 x annual earnings

Maximum

$300,000

Termination age

June 30th following age 65, September 30th if terminated June 30th or retirement.

Age reduction

N/A

Waiver of premium definition

Matches LTD

Optional life

Available

GROUP ACCIDENT

Insurer: N/A

Policy Number: N/A

Principal sum

N/A

Maximum

N/A

Optional Accident

N/A