Plan design 6 overview

The information below is intended to be a descriptive outline only. All provisions of the Plan are subject to the terms and conditions of the contract issued to the University by Pacific Blue Cross (PBC). It is recommended that you request pre-authorization from PBC for all major purchases.

Dental coverage

Some dentists may charge fees in excess of that provided by the fee guide. Any such excess is not an eligible expense under the dental plan.

Dental policy 40704 plan design 6
Category	Amount
Basic preventative and restorative expenses (Plan A)	90%
Crowns, bridges and prosthetic appliances (Plan B)	70%
Orthodontics (Plan C)	85% to a lifetime maximum benefit of $4000 per person
Dental implants lifetime max per tooth	$1000
Annual deductible	$0

Extended health coverage

Extended health policy 40704 plan design 6

$100

$1,000,000

100%

$750 per person per 2 calendar years

$125 per person per 2 calendar years

$400 per calendar year

$1,200 per calendar year

$1,500 per person, per calendar year

$500 per person, per calendar year

$900 per person, per 5 calendar years

50% of cost

$2,000 per calendar year

$50 per visit for first 12 visits in a calendar year, to a maximum of $1,200 per person per calendar year

$20 per visit for first 12 visits in a calendar year, to a maximum of $500 per person in any calendar year

$50 per visit for the first 12 visits in a calendar year, to a maximum of $1,200 per person per calendar year

$50 per visit for the first 12 visits in a calendar year, to a maximum of $12,000 per person per calendar year

$50 per visit for the first 12 visits in a calendar year, to a maximum of $250 per person per calendar year

$500 per person per calendar year

Lifetime maximum of $3,000 per person

Emergencies

Emergency means a sudden or unexpected injury or an acute episode of disease that requires immediate treatment or surgery.

Emergency out of province benefits

While travelling or on vacation outside British Columbia, benefits are payable for the expenses incurred IN AN EMERGENCY ONLY and when ordered by the attending physician.

Emergency travel assistance

In emergencies which occur while you (and your eligible dependents) are travelling, Medi-Assist will coordinate assistance.

Dental emergency

In an emergency if you require dental care while travelling or on vacation outside British Columbia, you are entitled to the services of a dentist and will be reimbursed up to the amount that would have been paid had the services been rendered in British Columbia.

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