Extended Health and Dental benefits

Transcription

1 Extended Health and Dental benefits To find out about our District benefits go to: Surrey School District website >Top green bar > Staff icon > Benefits > BCPSEAwebsite> Employees > Select School District 36 Surrey > Select employee group > teachers >Site Map > Choose icon (eg. extended health) > choose( general, or details or exclusions) There is lots of information at this site. If you have any questions look under FAQ. Please refer to the Collective Agreement - Article 52 (STA website) for eligibility, Group life, benefits during medical leave of absence or during leave of absences, benefits for retirees, conditions of employment, waiting period, choice deadlines, adding dependents, dependent children, return to active service or refusal or cancellation

2 Extended Health Page 1 of 3 S.D. #36 Teachers (10 month) HOME CONTACTS SITE MAP LOG OFF MY PLAN Extended Health Dental Optional AD&D PEBT COMMUNICATIONS FAQ WHAT HAPPENS WHEN... MAKING CLAIMS POLICY NUMBERS FORMS RELATED SITES GLOSSARY Extended Health Below is a summary of the benefits you are eligible to receive under the plan. For an overall description of this benefit, click the General link. print version This information does not create or confer any rights. The exact terms of the plan are described in the more detailed provisions of the group benefits agreement or contract. In the event of a discrepancy between this information and the group contract, the terms of the contract will be applicable. General Details Exclusions Benefit provisions Eligibility Minimum Work Week Waiting Period As per collective agreement. As per collective agreement. Effective Date of Coverage Termination Age Dependent Child Definition Spouse Definition General Insurer Policy Number Deductible (single / family) Overall Maximum Survivor Extension Drug Coverage Drug card available Drug definition Reimbursement Fertility drugs covered Oral Contraceptives Hospital Reimbursement Private/Semi- Private Room TBA None Up to age 21, or 25 if in full time attendance at school, or any age, if handicapped. Legal, common-law or same sex partner. Pacific Blue Cross E $25/$25 N/A No As prescribed and dispensed by a licensed pharmacist or Physician. 80% until $1,000 paid, 100% thereafter Not covered Not covered 80% until $1,000 paid, 100% thereafter Semi Private or Private

3 Extended Health Page 2 of 3 Vision Care Reimbursement 80% till $1,000 paid, then 100% Vision Discount Not applicable Card Maximum ($ / $150/2 years period) Prescription Not covered Sunglasses Services and Supplies Reimbursement 80% until $1,000 paid, 100% thereafter. Hearing Aids Convalescent Care Private Duty Nursing Orthopedic Shoes Orthotics Smoking Cessation Supplies Miscellaneous Paramedicals Speech Therapy Acupuncture Chiropractor Christian Science Massage Therapy Naturopath Osteopath Physiotherapy Podiatry Psychology Out Of Province Reimbursement Maximum ($) Maximum days OOC Submit to provincial plan first $400/4 years N/A Fees for a registered nurse for special duty nursing in an acute case when ordered by the attending physician, up to 720 hours per year. $400/year (adult), $200/year (child) Yes, up to $200/year. N/A $100 maximum per person per calendar year. $100 maximum per person per calendar year. $200 maximum per person per calendar year combined with Naturopath. Not covered $250 maximum per person per calendar year combined with Physiotherapy. $200 maximum per person per calendar year combined with Chiropractor. Not covered $250 maximum per person per calendar year combined with Massage Therapy. $100 maximum per person per calendar year. $100 maximum per person per calendar year. 100% for Emergency, 80% for Non-Emergency No limit provided MSP coverage is maintained. Yes. Pacific Blue Cross will not reimburse any expenses payable or provided under a Government plan. Pregnancy 2 months limitation Emergency Travel Assistance Travel Assist Worldwide emergency medical assistance is available. Please see your plan administrator for an ID card and brochure. Deluxe Features

4 Extended Health Page 3 of 3 Medical Referral Travel Benefit N/A Continuation of Coverage Maternity/Parental Coverage may be continued during maternity/parental leave, but not leave more than the period required under the relevant legislation. Please contact your Benefits Administrator for details. Strike or Lock out Lay-off Secondments, Elections, Appointments or Leaves for Public Office Unpaid leave of absence Coverage may be continued during strike or lock out, but not for a period longer than that required under the relevant legislation or by School Board policy. Please contact your Benefits Administrator for details. Coverage may or may not be continued during lay off as described in the School Board policy. Please contact your Benefits Administrator for details. Coverage may or may not be continued during secondments, elections, appointments or leaves for public office as described in the School Board policy. Please contact your Benefits Administrator for details. Coverage may or may not be continued during an unpaid leave of absence as described in the School Board policy. Please contact your Benefits Administrator for details. Costs Cost Sharing Deduction Frequency 2007, Morneau Sobeco.

5 Dental Page 1 of 2 S.D. #36 Teachers (10 month) HOME CONTACTS SITE MAP LOG OFF MY PLAN Extended Health Dental Optional AD&D PEBT COMMUNICATIONS FAQ WHAT HAPPENS WHEN... MAKING CLAIMS POLICY NUMBERS FORMS RELATED SITES GLOSSARY Dental Below is a summary of the benefits you are eligible to receive under the plan. For an overall description of this benefit, click the General link. print version This information does not create or confer any rights. The exact terms of the plan are described in the more detailed provisions of the group benefits agreement or contract. In the event of a discrepancy between this information and the group contract, the terms of the contract will be applicable. General Details Exclusions Benefit provisions Eligibility Minimum Work Week Waiting Period As per collective agreement. As per collective agreement Effective Date of Coverage Termination Age Dependent Child Definition Spouse Definition General Insurer Policy Number TBA None Up to age 21. Legal, common-law or same sex partner. Pacific Blue Cross D Deductible $0/$0 (single / family) Dental Fee Guide PBC Schedule 3 Specialist Fee Guide Adult fluoride Fee Guide plus 10% Covered Inlays/onlays Covered under Basic Services. Please refer to the general plan description for more information. Survivor None Extension Basic Services Reimbursement 85% Maximum Adult check up 2 per year frequency Child check up 2 per year frequency Endodontics / Periodontics Reimbursement 85%

6 Dental Page 2 of 2 Maximum Major Restorative Services Reimbursement 70% Maximum Orthodontics Reimbursement 70% Maximum Age Limit $2,000/lifetime Covers adults and children Continuation of Coverage Maternity/Parental Coverage may be continued during maternity/parental leave, but not Leave more than the period required under the relevant legislation. Please contact your Benefits Administrator for details. Strike or Lock out Lay-off Secondments, Elections, Appointments or Leaves for Public Office Unpaid leave of absence Coverage may be continued during strike or lock out, but not for a period longer than that required under the relevant legislation or by School Board policy. Please contact your Benefits Administrator for details. Coverage may or may not be continued during lay off as described in the School Board policy. Please contact your Benefits Administrator for details. Coverage may or may not be continued during secondments, elections, appointments or leaves for public office as described in the School Board policy. Please contact your Benefits Administrator for details. Coverage may or may not be continued during an unpaid leave of absence as described in the School Board policy. Please contact your Benefits Administrator for details. Costs Cost Sharing Deduction Frequency 12 months 2007, Morneau Sobeco.

7 FAQ Page 1 of 3 03/03/2010 S.D. #36 Teachers (10 month) HOME CONTACTS SITE MAP LOG OFF MY PLAN PEBT COMMUNICATIONS FAQ WHAT HAPPENS WHEN... Frequently Asked Questions print version MAKING CLAIMS POLICY NUMBERS FORMS RELATED SITES GLOSSARY This section of the site provides answers to a variety of frequently asked questions. Should I purchase additional out-of-country travel insurance when traveling outside of Canada? Am I required to register for PharmaCare? If I become disabled, are the premiums for my benefits continued? I have optional life insurance for myself and/or my Spouse. Is it necessary to periodically complete a form to ensure that my smoking habits, or that of my Spouse, have not changed? If I am presently being charged a smoker rate for Optional Life or Optional Spouse Life insurance, can this rate be changed to a non-smoker rate at a later date? What happens if I make a false statement concerning my or my Spouse's smoking habits? Should I purchase additional out-of-country travel insurance when traveling outside of Canada? You are strongly encouraged to check into additional out-of-country emergency medical insurance when traveling outside of Canada. Your benefits program may have Out-of- Country emergency medical insurance but this may not be sufficient in some cases. Am I required to register for PharmaCare? If you are a BC resident and enrolled with the Medical Services Plan (MSP), you can register your family to receive your maximum financial assistance under Fair PharmaCare. Your family includes you, your spouse and any dependent children whose Medical Services Plan coverage is on the same contract as you or your spouse. Your extended health coverage (EHC) through Pacific Blue Cross requires that you take advantage of other plans that are available to you, such as the Fair PharmaCare program. As a result, the EHC plan will only pay for eligible drugs up to your deductible and amounts that exceed the 70% PharmaCare co-payment. In other words, your EHC plan does not provide coverage for drug expenses that are eligible under the Fair PharmacCare program. After you reach a certain threshold of drug expenses, PBC will contact you to request proof that you have registered with the Fair PhamaCare program. You can still register for PharmaCare. As part of the registration process, you will be asked for your family's annual net income based on your previous year's income tax returns. You will also be asked to provide authorization for the Canada Revenue Agency (CRA) to send information from your tax return to Fair PharmaCare. You will be advised of your annual Fair PharmaCare deductible at time of registration, and will receive notice each year for the following year's annual deductible.

8 FAQ Page 2 of 3 03/03/2010 You can still register for PharmaCare. As part of the registration process, you will be asked for your family's annual net income based on your previous year's income tax returns. You will also be asked to provide authorization for the Canada Revenue Agency (CRA) to send information from your tax return to Fair PharmaCare. You will be advised of your annual Fair PharmaCare deductible at time of registration, and will receive notice each year for the following year's annual deductible. You can contact PharmaCare at (8:00 AM to 8:00 PM weekdays, 8:00 AM to 4:00 PM weekends). You can also register on-line at If I become disabled, are the premiums for my benefits continued? If you become disabled, you may be eligible for long term disability (LTD), Workers' Compensation and/or other disability insurance benefits. If you are approved for LTD benefits by the insurer, your premiums for LTD will be waived as long as you meet the definition of disability. You may also be eligible for waiver of life insurance, optional life insurance, and/or accidental death & dismemberment premiums. The insurers have strict application timelines, so you should contact your Benefits Administrator as soon as possible after you become disabled for more information. I have optional life insurance for myself and/or my Spouse. Is it necessary to periodically complete a form to ensure that my smoking habits, or that of my Spouse, have not changed? No. The only time that you or your Spouse must again attest to your smoking habits is when there is a change in the amount of optional life insurance. If an increase is requested, the Smoker Declaration form must be completed on the Application, indicating the smoking status at the time of the requested increase. If I am presently being charged a smoker rate for Optional Life or Optional Spouse Life insurance, can this rate be changed to a non-smoker rate at a later date? Yes. If the Insured has abstained from the use of tobacco products for at least the past 12 consecutive months, he or she may apply for the preferred non-smoking rate by completing the Smoker Declaration form. What happens if I make a false statement concerning my or my Spouse's smoking habits? If an Optional Life or Optional Spouse Life insurance claim is filed and the smoking habits have been misrepresented, the claim will be denied. Any premiums which have been paid will be refunded.