School District 43

Coquitlam |

CUPE Local 561

ELIGIBILITY

Minimum hours per week

Core LTD: 15 hours per week

All Other Benefits: 20 hours per week

Extended Health Care

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53760

Waiting period

1st day of the month following date of appointment

Claim deadline

December 31 of the following year

Calendar year deductible

$100 (Single/Family)

Reimbursement

100%

Lifetime maximum

$500,000 per lifetime

Survivor extension

Dependent coverage will continue without further payment of contributions until the earliest of the following occurs:

1. 100 days after the date of the Member’s death.

2. the date the person ceases to be a Dependent other than as a result of the Member’s death.

3. the date the Contract is terminated.

4. the date the Dependent becomes eligible for coverage under a similar group plan.

Termination age

Retirement

Dependent Child definition

Up to age 21, or 25 if in full time attendance at school, or to any age if disabled.

Spouse definition

The person legally married to the Member or a person who has been residing with the Member in a common-law relationship for at least 1 year and who is publicly represented as the Member’s spouse. Only one spouse is eligible for coverage at any one time.

Medical referral travel benefit

n/a

Prescription Drugs

Drug formulary

Blue Rx

Pay-direct drug card

Yes

Per prescription deductible

n/a

Sexual dysfunction

Not Covered

Oral contraceptives

Covered

Fertility drugs

$3,000 per lifetime

Smoking cessation drugs

Not Covered

Medical Services & Supplies

Medi-assist

Included

Emergency out-of-province reimbursement

100%

Emergency out-of-province maximum

Combined with In-Province Maximum

Hospital room

Not Covered

Private duty nursing

Not Covered

Hearing aids – Adults

$3,000 per 48 month

Hearing aids – Children

$1,500 per 24 months

Ambulance

Covered

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

Covered

All Medical Equipment must be purchased from an Authorized Medical Supplier to be considered under your plan. Reasonable and Customary pricing will apply. Authorization by the Benefit Provider is required for equipment that costs more than $5,000.

Orthopedic shoes

$400 per calendar year for Adults, $200 per Calendar year for Children.

Orthotics

$400 per 2 calendar years for (Adults & Children)

Accidental dental

Covered

Vision Care

Maximum – Adults

$650 per 2 calendar year

Maximum – Children

$650 per 2 calendar year

Eye exams

$100 per 2 calendar years (Employee Only)

Paramedical Services

Acupuncture

$200 maximum per person per calendar year

Chiropractor

$500 maximum per person per calendar year

Massage therapy

$3,500 maximum per person per calendar year

Naturopathy

$500 maximum per person per calendar year

Osteopathy

Not Covered

Physiotherapy

$3,500 maximum per person per calendar year

Podiatry

$300 maximum per person per calendar year

Counselling Services

$850 maximum per person per calendar year (Psychologist only)

Speech therapy

$100 maximum per person per calendar year

Dental Coverage

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53760

Waiting period

1st day of the month following date of appointment

Claim deadline

12 months from date of service

Calendar year deductible

$25 Single/$50 Family

Dental fee guide

PBC Schedule 2

Specialist coverage

Fee guide plus 10%

Survivor extension

Dependent coverage will continue with further payment of contributions until the earliest of the following occurs:

1. 100 days after the date of the Member’s death.

2. the date the person ceases to be a Dependent other than as a result of the Member’s death.

3. the date the Contract is terminated.

4. the date the Dependent becomes eligible for coverage under a similar group plan.

Termination age

Retirement

Dependent Child definition

Up to age 21, or any age if in full time attendance at school or if disabled.

Spouse definition

The person legally married to the Member or a person who has been residing with the Member in a common-law relationship for at least 1 year and who is publicly represented as the Member’s spouse. Only one spouse is eligible for coverage at any one time.

Basic Services

Reimbursement

85%

Maximum

n/a

Adult check-up

1 every 9 months

Child check-up

2 per calendar year

Adult fluoride

Covered

Major restorative services

Reimbursement

60%

Maximum

n/a

Orthodontic services

Reimbursement

60%

Maximum

$5,000 per lifetime

Age limit

Covers adults and children

Joint Early Intervention Services

BENEFIT PROVIDER: Desjardins Insurance

Services

The Joint Early Intervention Service (JEIS) is a mandatory program providing proactive service to members to facilitate their return to work in a caring, safe, and timely manner. Members are contacted within six (6) working days of the start of their absence from work by a Healthcare Management Specialist (HCMS). The HCMS makes sure members receive the best possible care and, if appropriate, a coordinated rehabilitation plan. If members are unable to return to work after the LTD qualifying period, the HCMS helps them transfer to the LTD program. A primary factor for the success of the JEIS program is the collaboration and joint support of both union and employers.

Income Replacement

Long Term Disability

BENEFIT PROVIDER: Desjardins Insurance

POLICY NUMBER: 64090L

Waiting period

3 months of continuous Active Employment with the Employer

Benefit amount

70% of monthly earnings from the Employer

Minimum benefit

$50 per month

Maximum benefit

$10,000 per month

Non-evidence maximum

n/a

Elimination period

120 calendar days

Taxability status

Taxable

Termination age

A Member, who is not receiving LTD Benefits shall cease to be entitled to coverage for LTD Benefits one hundred twenty days prior to the last day of the month during which the Member attains age 65 or thirty-five (35) years of pensionable service and a minimum age of fifty-five (55) pursuant to the terms of the Municipal Pension Plan or other school district pension arrangement.

For Members receiving LTD Benefits, the Maximum Benefit Period ends the earliest of normal retirement age as defined under the Municipal Pension Plan (currently 65 years of age), or 35 years of service and a minimum age of 55.

Earnings definition

A Member’s basic rate of pay, including premiums/allowances paid for Regular Duties performed during a regular work year and vacation pay, but excluding overtime.

Extended health and/or dental coverage continuation

The Core LTD Program shall fund the Member’s portion of premiums for EHC (including medical referral travel benefits, if applicable) and dental while in receipt of Core LTD Benefits for the period starting the first of the month following completion of the Elimination Period, and ending on the earlier of the last day of the month in which the Member is no longer eligible for Core LTD Benefits or the last day of the final month of the Member’s twenty-four-month Regular Duties period outlined in the definition of Disabled.

Group Life

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53760

Waiting period

1st of the month following date of employment

Benefit amount

$50,000

Maximum

$50,000

Non-evidence maximum

n/a

Age reduction

n/a

Waiver of premium definition

Matches Core LTD

Coverage during disability

Life coverage for a disabled employee will terminate at the earlier of age 65 or 35 years of pensionable service under the Municipal Pension Plan or any other registered pension plan arising out of employment with an Employer and a minimum age of 55, whichever is earlier.

Living benefit

Up to 50% of your Basic Life benefit to a maximum of $50,000 for members under age 65

Termination age

Earlier of age 70 or retirement

Earnings definition

n/a

Conversion privilege

Available

Optional Life

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53760

Eligibility

Employee and Spouse

Waiting period

1st of the month following the month of employment

Benefit amount

Units of $10,000

Maximum

$300,000

Age reduction

Reduces by 50% at age 65

Waiver of premium definition

Matches Core LTD

Coverage during disability

Optional Life coverage (employee and spouse, if applicable) for a disabled employee will terminate at the earlier of age 65 or 35 years of pensionable service under the Municipal Pension Plan or any other registered pension plan arising out of employment with an Employer and a minimum age of 55, whichever is earlier.

Termination age

Earlier of age 70 or retirement

Spouse definition

Legal spouse or common-law spouse (Opposite or same sex. Must be continuously cohabitating for a minimum of 12 months.) Only one spouse can be covered as a dependent at any given time.

Conversion privilege

Employee: Available
Spouse: Not Available

Application deadline

Applicant must apply and be accepted prior to their 65th birthday

Child Optional Life

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53760

Waiting period

1st of the month following the month of employment

Benefit amount

Units of $2,500

Maximum

$10,000

Waiver of premium definition

Matches Core LTD

Coverage during disability

n/a

Waiver of premium definition

Matches Core LTD

Coverage during disability

Child Optional Life coverage for a disabled employee will terminate at the earlier of age 65 or 35 years of pensionable service under the Municipal Pension Plan or any other registered pension plan arising out of employment with an Employer and a minimum age of 55, whichever is earlier.

Termination age

Earlier of age 70 or retirement

Child definition

Up to age 21, or 25 if in full time attendance at school, or any age, if disabled. A child is effective from birth. If the child is institutionalized the benefit will not be effective until the child ceases to be confined.

Conversion privilege

Not available

Disclaimer:

This summary contains information about your group benefits plan. This summary provides only brief descriptions of the coverage available. Full coverage details are contained within the Plan documents, including limitations, exclusions, definitions and termination provisions. If there are any conflicts between the summary and the official Plan documents, the official Plan documents shall govern.

The information contained on this website is provided for general information purposes only. Every effort has been made to ensure that this information is accurate, but this site is not a substitute for the official Plan documents, nor is it an employment contract. In the event there is a discrepancy between this website and the official Plan documents, the official Plan documents will prevail. For more information, or if you have questions about the information provided on this website please contact your School District Benefits Administrator.