School District 5

Southeast Kootenay |

CUPE Local 4165

Eligibility

Minimum hours per week

Core LTD: 15 hours per week

All Other Benefits: 18 hours per week or more

Extended Health Care

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53701

Waiting period

3 months following date of employment

Claim deadline

December 31 of the following year

Calendar year deductible

$100 (Single/Family)

Reimbursement

80% until $1,000 paid per family per calendar year, then 100%

Lifetime maximum

Unlimited

Survivor extension

Dependent coverage following the member’s death will continue until the earliest of the following occurs:

a. 24 months without further payment of premium contributions;

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

c. the date the contract is terminated;

d. 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 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

$7,500 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

Private or Semi-private Room

Private duty nursing

In-home nursing care covered

Hearing aids – Adults

$4,000 per 5 calendar years

Hearing aids – Children

$4,000 per 2 calendar years

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

Accidental dental

Covered

Vision Care

Maximum – Adults

$625 per 24 months – prescription sun glasses included in vision maximum

Maximum – Children

$625 per 24 months – prescription sun glasses included in vision maximum

Eye exams

$125 per 24 months

Paramedical Services

Acupuncture

$600 per calendar year

Chiropractor

$600 per calendar year (Chiropractic x-rays are included in this maximum)

Massage therapy

$1,200 per calendar year

Naturopathy

$600 per calendar year

Osteopathy

Not Covered

Physiotherapy

$1,000 per calendar year

Podiatry

$600 per calendar year

Counselling Services

$1,500 per calendar year combined for Psychologists, Clinical Counsellors and Social Workers

Speech therapy

$600 per calendar year

Dental Coverage

BENEFIT PROVIDER: Pacific Blue Cross

POLICY NUMBER: 53701

Waiting period

3 months following date of employment

Claim deadline

12 months from date of service

Calendar year deductible

n/a

Dental fee guide

PBC Schedule 3

Specialist coverage

N/A

Survivor extension

End of following month in which employee died

Termination age

Last day of the month following the month in which you retire

Dependent Child definition

Up to age 21, or any age 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.

Basic Services

Reimbursement

100%

Maximum

n/a

Adult check-up

2 per calendar year

Child check-up

2 per calendar year

Adult fluoride

2 per calendar year

Major restorative services

Reimbursement

60%

Maximum

n/a

Orthodontic services

Reimbursement

60%

Maximum

$3,500 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

Weekly Indemnity (Short Term Disability)

BENEFIT PROVIDER: Desjardins Insurance

POLICY NUMBER: 64090S-5

Waiting period

3 months following date of employment

Benefit amount

70% of weekly earnings

Maximum benefit

n/a

Elimination period

Accident and Hospitalization: Nil; Illness: 3 days

Maximum benefit period

17 weeks

Benefit pro-rating

5 days (working)

Payment schedule

If a 10 month or 11 month employee becomes Totally Disabled during the months they are Not Actively At Work, the Elimination Period will commence on the initial date of Total Disability and payment of Weekly Indemnity Benefits will begin on the later of the end of the Elimination period or September 1st, so long as the Member remains Totally Disabled. If a 10 month Member is Totally Disabled and in receipt of Weekly Indemnity Benefits as of June 30th, Weekly Indemnity will cease and the employee will not be entitled to Weekly Indemnity benefits payments from July 1st through August 31st, inclusive. If still Totally Disabled on the September 1st following, Weekly Indemnity benefit payments will resume. If an 11 month employee is Totally Disabled and in receipt of Weekly Indemnity as of July 31st, Weekly Indemnity benefit payments will cease and the employee will not be entitled to Weekly Indemnity payments from August 1st through August 31st, inclusive. If still Totally Disabled on September 1st following, Weekly Indemnity benefit payments will resume.

Taxability status

Taxable

Waiver of premium definition

Included

Termination age

Retirement

Earnings definition

Employee’s basic rate of pay, including premiums/allowances paid for the regular duties performed during a regular work year (including bus drivers field trips), as well as vacation pay, but excluding occasional overtime.

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:53701

Waiting period

3 months following date of employment

Benefit amount

2.5 times Annual Earnings rounded to next higher $1,000 with a minimum benefit of $50,000

Maximum

$100,000

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

Employee’s regular rate of pay from the employer (prior to deductions), excluding commissions and bonus payments. Earnings may include other sources of income as agreed to in writing by the employer and the insurance company.

Conversion privilege

Available

Basic Accidental Death & Dismemberment

BENEFIT PROVIDER: AIG

POLICY NUMBER: BSC 9104906

Waiting period

3 months following date of employment

Benefit amount

Matches Basic Life

Maximum

$100,000

Non-evidence maximum

N/A

Age reduction

N/A

Waiver of premium definition

Matches Core LTD

Coverage during disability

Basic Accident 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

Conversion privilege

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.