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
Orthopedic 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