Termination Surrender Request

REQUEST FOR TERMINATION OR REDUCTION IN BENEFITS

Use this form to instruct Doctors of BC to cancel or reduce your insurance coverage.
Insurance coverage is an important aspect of your financial plan and terminating or reducing coverage may have consequences. Please consider your situation carefully before proceeding with reduction or cancellation as this decision is typically irreversible.

Please note: any spousal insurance cancellations must be signed by the Doctors of BC member.
Please indicate which product(s) this request pertains to:

Accidental Death & Dismemberment InsuranceCritical Illness Insurance - MemberCritical Illness Insurance - SpouseDisability Insurance (INCOMEprotect)Life insurance - MemberLife Insurance - SpousePhysicians' Disability Insurance (PDI)Professional Expense Insurance
This online form cannot accommodate HBTF (Health and Dental) surrender requests. If you want to cancel coverage, please use this form and return to insurance@doctorsofbc.ca

NOTES: ALL Terminations will take place as of the first of the month following receipt of this form. Premium must be paid up to effective date of the termination.
- Member Name*
  
  First NameMiddle Name(s)Last Name
- Member's Date of Birth*
  
  YearMonthDay
  Date
- Email of Doctors of BC Member*
  
  Confirmation Emailexample@example.com
- Phone Number*
  Format: (000) 000-0000.
- Doctors of BC Member ID:
  (If known)
- Spouse Name
  First Name Middle Name(s) Last Name
- What do you want to do with your AD&D coverage?*
  
  I wish to reduce my coverage effective immediatelyI wish to terminate coverage effective immediately
- Desired AD&D insurance amount*
- What is the primary reason behind your decision?*
  
  My needs have changed / No longer need this insuranceCoverage is too expensiveI purchased / am already covered by similar insurance through a different providerOther
- Name of your alternate insurance company
- What do you want to do with your member critical illness coverage?
  
  I wish to reduce coverage effective immediatelyI wish to remove a rider from my coverageI wish to terminate coverage effective immediately
- Desired Member CII insurance amount*
- What rider(s) do you want to remove from your member critical illness coverage
  
  Waiver of PremiumChild Critical Illness insurance
- What do you want to do with your spouse's critical illness coverage?
  
  I wish to reduce coverage effective immediatelyI wish to remove a rider from their coverageI wish to terminate coverage effective immediately
- Desired Spouse CII insurance amount*
- What rider(s) do you want to remove from your spouse's critical illness insurance?
  
  Waiver of PremiumChild Critical Illness insurance
- What is the primary reason behind your decision?*
  
  My needs have changed / No longer need this insuranceCoverage is too expensiveI purchased / am already covered by similar insurance through a different providerOther
- Name of your alternate insurance company
- What best describes you?*
  
  I am a practicing physicianI am a medical studentI am a medical resident or fellow
- What do you want to do with your disability insurance?*
  
  Reduce coverageChange the elimination period to a longer durationChange rider to a lower benefit optionRemove a rider from coverageTerminate coverage effective immediately
- What year of medical school are you in?*
  
  Year 1-3Year 4 +
- Desired Disability insurance amount after reduction*
- OPTIONAL: Additional comments or specific requests
  Use this field if you have multiple certificates and need to specify which coverage is being terminated or changed.
- What elimination period do you wish to change to?*
  
  60 days90 days120 days
- What rider(s) do you want to remove from your disability insurance?*
  
  Not applicableCost of Living Adjustment RiderGuaranteed InsurabilityOwn Occupation RiderRetirement Protection Rider
- What rider(s) do you wish to adjust?*
  
  Cost of Living Adjustment Rider - reduce to 3%Retirement Protection Rider - reduce to $500Retirement Protection Rider - reduce to $1000
- This option does not apply to student disability insurance. Please choose again.
- Student disability insurance only has the option to reduce to $2500 if you are in 4th year. Please choose $2500.
- This option does not apply to resident disability insurance. Please choose again.
- NOTE: If you have more than one elimination period on your disability insurance coverage, we will contact you to confirm which layer this reduction request applies to.
- PRACTISING: I am aware of the following (please tick all bullets)*
  
  While on a disability claim, under Doctors of BC INCOMEprotect for Practicing Physicians Disability coverage, benefits are payable as long as you are unable to work in your regular occupation or until age 65. This is different from group employer plans which commonly change to a more restrictive definition of disability after 24 months on claim.Doctors of BC INCOMEprotect for Practicing Physicians Disability coverage can cover you anywhere in the world you practice medicineI understand I will need to provide proof of health in order to rejoin a Doctors of BC disability planOnce this form is submitted I cannot reverse my request to terminate coverage.
- STUDENT I am aware of the following (please tick all bullets):*
  
  I will not be eligible to transition my coverage to Doctors of BC INCOMEprotect for Residents Disability plan without providing proof of good healthThe Doctors of BC INCOMEprotect for Residents Disability is a program separate from the group employer long-term disability benefits offered under the Resident Doctors of BC Collective AgreementThe Doctors of BC INCOMEprotect for Residents Disability is coordinated with a government-funded Physicians' Disability Insurance (PDI) available to practising physicians in BC. Cancelling my student coverage means I will need to apply with proof of good health to join the PDI plan when I start practiceIn BC, there is no offer for newly-practising physicians to join any Disability Insurance plan without proof of health, unless they have maintained Doctors of BC INCOMEprotect for Residents Disability throughout residency. If Residents only rely on long-term disability benefits provided by their employer during residency, they may face challenges getting coverage once they start practiceI understand I will need to provide proof of health in order to rejoin a Doctors of BC disability plan
- RESIDENT I am aware of the following (please tick all bullets):*
  
  The Doctors of BC INCOMEprotect for Residents Disability is a program separate from the group employer long-term disability benefits offered under the Resident Doctors of BC Collective AgreementWhile on a disability claim, under Doctors of BC INCOMEprotect Disability coverage, benefits are payable as long as you are unable to work in your regular occupation or until age 65. This is different from group employer plans which commonly change to a more restrictive definition of disability after 24 months on claim.Doctors of BC INCOMEprotect for Residents Disability coverage can cover you across Canada or the USThe Doctors of BC INCOMEprotect for Residents Disability is coordinated with a government-funded Physicians' Disability Insurance (PDI) available to practising physicians in BC. Having INCOMEprotect for Residents allows you to join the PDI plan without proof of health within 90 days of starting practice. All other applicants require proof of health and may be declined.In BC, there is no offer for newly-practising physicians to join any Disability Insurance plan without proof of health, unless they have maintained Doctors of BC INCOMEprotect for Residents Disability throughout residency. If Residents only rely on long-term disability benefits provided by their employer during residency, they may face challenges getting coverage once they start practiceI understand I will need to provide proof of health in order to rejoin a Doctors of BC disability planOnce this form is submitted, I cannot reverse my request to terminate coverage
- RESIDENT REDUCE - I am aware of the following (please tick all bullets):*
  
  In order to join the government-funded Physicians' Disability Insurance (PDI) available to practising physicians in BC, you must have a minimum of $2000 Doctors of BC INCOMEprotect for Residents Disability coverage for at least 12 months prior to starting practice. If you exercise the GIB (see next bullet) in your final year to increase to $2000 you will not have it in place for 12 monthsDuring residency and/or fellowship, you may increase disability insurance once a year during annual guaranteed insurability benefit (GIB) period. This period runs July 1-July 31st.
- If you would like advice on your situation before cancelling or reducing please book a time with our licensed student and resident insurance advisors using this link.
- If you would like advice on your situation before cancelling or reducing please book a time with one of our licensed insurance advisors using this link.
- What is the primary reason behind your decision?*
  
  My needs have changed / No longer need this insuranceCoverage is too expensiveI purchased / am already covered by similar insurance through a different providerOther
- Name of your alternate insurance company
- What do you want to do with your member life insurance coverage?*
  
  I wish to reduce coverage effective immediatelyRemove a rider from coverageI wish to terminate coverage effective immediately
- Desired Member Life insurance amount*
- What rider(s) do you want to remove from your life insurance?*
  
  Waiver of PremiumFuture Insurance Option
- What do you want to do with your spouse's life insurance coverage?*
  
  I wish to reduce coverage effective immediatelyRemove a rider from coverageI wish to terminate coverage effective immediately
- Desired Spouse Life insurance amount*
- What rider(s) do you want to remove from your spouse's life insurance?
  
  Waiver of PremiumFuture Insurance Option
- OPTIONAL: Additional comments or specific requests
  Use this field if you have multiple certificates and need to specify which coverage is being terminated or changed.
- What is the primary reason behind your decision?*
  
  My needs have changed / No longer need this insuranceCoverage is too expensiveI purchased / am already covered by similar insurance through a different providerOther
- Name of your alternate insurance company
- What is the primary reason behind your decision?*
  
  I have retired from practising medicineI am no longer working in British ColumbiaI am no longer billing MSP or receiving non-salaried service contract or sessional incomeOther
- PDI is a government-funded benefit, but insureds have the right to convert some or all of their current PDI Benefit to the INCOMEprotect for Practicing Physicians disability insurance if they wish to continue disability insurance in some form.
  
  To inquire about a conversion, please email insurance@doctorsofbc.ca - our team can assist you with determining how much you can continue and the cost of premiums. It is typically a one-page application to apply.
- PDI Surrender (skip if planning to convert coverage)
  
  I wish to terminate coverage effective immediately
- Please choose one of the following*
  
  I wish to reduce my coverage effective immediatelyI wish to terminate coverage effective immediatelyI wish to change my elimination periodI wish to add or remove the Guaranteed Insurability Benefit rider
- Please confirm whether you wish to add or remove this rider:*
  
  I wish to add the GIB riderI wish to remove the GIB rider from my coverage
- What elimination period do you wish to change to?*
  
  14 days30 days60 days90 days
- Desired Professional Expense insurance amount*
- OPTIONAL: Additional comments or specific requests
  Use this field if you have multiple certificates and need to specify which coverage is being terminated or changed.
- What is the primary reason behind your decision?*
  
  My needs have changed / No longer need this insuranceCoverage is too expensiveI purchased / am already covered by similar insurance through a different providerOther
- Name of your alternate insurance company
- NOTE: If you have more than one elimination period on your professional expense insurance coverage, we will contact you to confirm which layer this reduction request applies to.
- If you would like advice on your situation before cancelling or reducing please book a time with one of our licensed insurance advisors using this link.
  
  I understand the information provided above and am making an informed decision.
- Please confirm:
  
  I have considered my decision and am comfortable proceeding with my request. I understand that I may need to prove good health to reverse my request.
- Signature
  
  Clear
- Should be Empty:

REQUEST FOR TERMINATION OR REDUCTION IN BENEFITS