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.

Accidental Death & Dismemberment - Surrender
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

Physicians' Disability Insurance - Surrender
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

Sign and Submit
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: