Resident/Fellow Membership & Insurance Application

Life Coverage

Doctors of BC resident/fellow members may obtain $100,000 life insurance coverage without medical questions if you apply anytime as a resident or fellow member. 

In addition to the Resident offer, you and/or your spouse or common-law partner may apply for up to $5,000,000 of life coverage. Evidence of insurability, typically a telephone interview, is required.

Beneficiary Designation 

This designation supercedes any previous beneficiary designation and will apply to the entire amount of your Doctors of BC Life insurance coverage.

I hereby designate the individual named as beneficiary on this application to receive any death benefit payable with respect to the coverage applied for. If all the
primary beneficiaries are no longer alive, any death benefit payable will become payable to the secondary beneficiary.

If no beneficiary is designated, benefits will be payable to the Estate.

A primary beneficiary is a designated individual(s) who are first in line to receive the proceeds of the life insurance policy. A secondary beneficiary is the individual(s) who would receive the proceeds if something happened to the primary beneficiary.

If your appointed beneficiary is under the age of 19 you must name a trustee. A trustee is ther person who manages a minor’s inheritance under a trust.

If you designate a beneficiary who is a minor when benefits become payable, benefits will be paid into court or to the Public Trustee, unless a trustee is appointed. By appointing a trustee below, you agree that if the beneficiary is a minor on the date that benefits become payable, the benefits will be paid to the trustee to hold in trust for the minor until the minor comes of age.

Critical Illness

New Doctors of BC members may obtain $50,000 in coverage for themselves and/or their spouse or common-law partner without medical questions if you apply within 90 days of becoming a member for the first time or of completing medical school. A pre-existing condition limitation will apply to this coverage.

Disability Insurance

Doctors of BC INCOMEprotect™ for Residents is an enhanced individual disability plan offered at specially discounted residency rates. If you’re unable to work due to accident or illness, you may receive monthly tax-free income until age 65 or until you’re able to return to work. Whether you are totally unable to work or can only work part-time benefits can be claimed. During a claim, INCOMEprotect™ pays in addition to the employer disability insurance plan negotiated through Resident Doctors of BC.

You may apply for INCOMEprotect™ with simplified medical underwriting (3 medical questions) if you meet the following criteria:

• are within 90 days of starting residency training in BC, and
• did not previously have access to a no-medical disability offer through Doctors of BC

You can apply for this benefit in increments of $100, from a minimum of $500 per month to a maximum of:

• Up to $4,000 for Residents in years one through five 
• Up to $6,000 for Residents in years six and seven 
• Up to $7,500 for Residents in a fellowship program

This insurance plan includes Guaranteed Insurability Benefit (GIB), Cost of Living Adjustment (COLA), and an Own Occupation definition of disability.

Any reference to testing, tests, test results, or investigations exclude genetic tests. Genetic test means a test that analyzes DNA, RNA or chromosomes for purposes such as the prediction of disease or vertical transmission risks, or monitoring, diagnosis or prognosis. 

Insurance Authorization and Declaration

I (the Member) hereby apply for insurance to The Manufacturers Life Insurance Company (Manulife). I declare that the statements contained in this application, including my smoker status and health declaration, are true and complete.

I understand that this application, together with any other forms signed by me in connection with this application, forms the basis for any certificate issued hereunder.

I understand that any material misrepresentation, including misstatement of smoker status, shall render the insurance voidable at the discretion of the insurer. I understand that exclusions and limitations apply to the coverage applied for.

Suicide within the first 2 years is a risk not covered.

Relative to the insurance applied for, I hereby authorize any licensed physician, medical practitioner, hospital, pharmacy, clinic or other medically related facility, insurance company, MIB, LLC, the group policy administrator, the insurance plan sponsor, any investigative and security agency, any agent, broker or market intermediary, any government agency or other organization or person that has any records or knowledge of me or my health pursuant to this application to provide to Manulife or its reinsurers any such information for the purpose of this application and contract and any subsequent claim. I authorize Manulife to consult its existing files for this purpose.

I authorize Manulife, its subsidiaries, affiliates, and agents to use the information in this application and its existing files to offer me their products or services. I understand that my consent to the use of such information to offer me products or services is optional and that, if I wish to discontinue such use, I may write to Manulife’s Privacy Officer at the address shown on this document.

An electronic copy, a photocopy, or a faxed copy of this authorization shall be as valid as the original.

I acknowledge receipt of and confirm my agreement with the Personal Information Statement and Information about MIB, LLC.

I declare that I have been made aware of the reasons why the health information is needed and the risks and benefits to me of consenting or refusing to consent. I understand that this consent may be revoked at any time and that, if as a result of such revocation the insurer is unable to obtain proof of claim, this may result in claims not being paid.

I acknowledge that the insurer may request a medical examination, urinalysis, or tests such as a general blood profile (including blood test for HIV), which will be made at no expense to me.

I further acknowledge that results of any positive infectious disease tests will be reported to the appropriate provincial or territorial health department if required by law and that, based on my health information, Manulife may offer insurance on an alternative basis or may decline to offer coverage.

I understand that if my application is approved, I will receive a certificate specifying the coverage provided and the main certificate provisions.

Information about MIB, LLC

We consider the information contained in your application to be confidential. However, Manulife or reinsurers involved with your policy may make a report to MIB, LLC based on your application, or to other insurance companies to which you apply for life, health, or critical illness insurance, or to which a claim for benefits has been made. MIB, LLC is a not-for-profit organization set up by life insurance companies to share information among its members. If you apply for insurance or submit a claim to a member company, MIB, LLC will share any information it has on file.

You may review the information in your file, and request a correction if necessary, by contacting MIB, LLC at:

MIB, LLC
330 University Avenue, Suite 501
Toronto, Ontario M5G 1R7
Telephone: (416) 597-0590
Fax: (416) 597-1193
Email: canada_disclosure@mib.com

Personal Information Statement

At Manulife, protecting your personal information and respecting your privacy is important to us.

We, us and our refer to The Manufacturers Life Insurance Company (Manulife) and our affiliated companies and subsidiaries.

Why do we collect, use, and disclose your personal information?

For the purposes of establishing and managing our relationship with you, providing you with products and services, administering our business, and complying with legal and regulatory requirements.

What personal information do we collect?

Depending on the product or service, we collect specific personal information about you such as:

• Identifying information such as your name, address, telephone number(s), email address, date of birth, driver’s license, passport number, or Social Insurance Number (SIN)
• Financial information, investigative reports, credit bureau report, and/or a consumer report
• Information about how you use our products and services, and information about your preferences, demographics, and interests
• Banking and employment information
• Medical information that any organization or person has about you
• Any test that may be necessary for underwriting purposes
• Other personal information that we may require to administer your products or services and manage our relationship with you

We use fair and lawful means to collect your personal information.

Where do we collect your personal information from?

Depending on the product or service, we collect personal information from:

• Your completed applications and forms
• Other interactions between you and us
• Other sources, such as:
  • Your advisor or authorized representative(s)
  • Third parties with whom we deal with in issuing and administering your products or services now and in the future
  • Public sources, such as government agencies, credit bureaus, and internet sites
  • Financial institutions
  • Your employer or plan sponsor, and their authorized agents, consultants, and plan service providers
  • The MIB, LLC (formerly known as the Medical Information Bureau)
  • Health care professionals, including medical practitioners, health care institutions, pharmacy, and any other medically‑related facility

What do we use your personal information for?

Depending on the product or service, we will use your personal information to:

• Administer the products and services that we provide and to manage our relationship with you
• Confirm your identity and the accuracy of the information you provide
• Evaluate your application
• Comply with legal and regulatory requirements
• Understand more about you and how you like to do business with us
• Analyze data to help us make decisions and understand our customers better so we can improve the products and services we provide
• Perform audits and investigations, and protect you from fraud
• Determine your eligibility for, and provide you with details of, other products and services that may be of interest to you
• Automate processing to help us make decisions about your interactions with us, such as applications, approvals, or declines

Who do we disclose your personal information to?

Depending on the product or service, we disclose your personal information to:

• Persons, financial institutions, reinsurers, and other parties with whom we deal with in issuing and administering your product or service now and in the future
• Authorized employees, agents, and representatives
• Your advisor and any agency that has entered into an agreement with us and has supervisory authority, directly or indirectly, over your advisor and their employees
• Your plan sponsor and their authorized agents, consultants, and plan service providers
• Any person or organization to whom you gave consent
• People who are legally authorized to view your personal information
• Service providers who require this information to perform their services for us (for example data processing, programming, data storage, market research, printing and distribution services, paramedical and investigative agencies)
• Your doctor
• Public health authorities as required or the MIB, LLC

Except where there are contractual restrictions, these people, organizations, and service providers are both within Canada and outside of Canada. Therefore, your personal information may be subject to interprovincial or cross-border transfers in order to provide services to you and subject to the laws of those jurisdictions.

Where personal information is provided to our service providers, we require them to protect the information in a manner that is consistent with our privacy policies and practices.

Insurance policies are underwritten by The Manufacturers Life Insurance Company (Manulife).

Manulife, Manulife & Stylized M Design, and Stylized M Design are trademarks of The Manufacturers Life Insurance Company and are used by it, and by its affiliates under license.

Manulife, P.O. Box 670, Stn Waterloo, ON N2J 4B8. Accessible formats and communication supports are available upon request. Visit www.manulife.ca/accessibility for more information.