Doctors of BC - Student-Resident Options Form

Medical Graduate Insurance Options Form:
Submission Deadline: September 28, 2024

Need help completing this form? Call 604-638-2904 or 1-800 665 2272 ext 2904, or email insurance@doctorsofbc.ca. Read about the plans here.

This form assumes that you had disability insurance as a medical student. If you did not have disability insurance as a medical student and want to implement disability insurance as a resident, please contact us at insurance@doctorsofbc.ca. Proof of health will be required.
1. Personal Information
Member Name*

First NameMiddle Name(s)Last Name
Where did you attend medical school?*

Vancouver (VFMP)Prince George (NMP)Victoria (IMP)Kelowna (SMP)Outside of BC
Please do not complete this online form

As you completed Medical School outside of British Columbia, you must first complete the below applications to become a Doctors of BC member and enrol in NEW resident Special offers (deadline - within 90 days of starting residency in BC).

To join Doctors of BC as a resident member and apply for life, disability and/or critical illness insurance, please complete this online form: https://doctorsofbc.jotform.com/221644834983869

If you have questions, please email us at insurance@doctorsofbc.ca or call us at 604-638-2904.
Date of Birth (dd-mm-yyyy)*

DayMonthYear
Date
Doctors of BC ID# ⓘ
Email*

Confirmation Email
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number*
Member Smoking Status ⓘ

Non-smokerSmoker
Member Gender ⓘ

MaleFemale
2. Residency Program Details
Type of Residency Program*
Location (Hospital, City)*
Residency Program Start Date (dd-mm-yyyy)*

DayMonthYear
Date
Residency Program Completion Date (dd-mm-yyyy) *

DayMonthYear
Date
3. Life Insurance Options
Did you have life insurance as a student? ⓘ*

YesNo / Unsure
Life Insurance Amount ⓘ*

No change requiredIncrease my Life Insurance by $100,000 for a total of $200,000Cancel my life insurance
Life Insurance Optional Features ⓘ*

Add Future Insurance Option riderAdd Waiver of Premium rider (waives life premiums while you're disabled)Do not add any riders
4. Critical Illness Options

You are eligible for $50,000 of Critical Illness coverage without proof of good health if you apply within 90 days of completing medical school and have not obtained coverage without proof of good health previously. A pre-existing condition limitation will apply to this coverage.
Critical Illness Amount ⓘ*

Add $50,000 of Critical Illness coverageI decline this Critical Illness coverage offer
5. INCOMEprotect™ for Residents Disability Options
In R1-R5, you may have a maximum of $4,500 in monthly disability coverage across all insurers (excluding employer mandatory disability). Select your desired monthly coverage amount.*

$4,000 (recommended)$3,500$3,000$2,500$2,000$1,500$1,000$500Cancel my disability coverage
You have selected a coverage amount below $2,000, which means you may not qualify for the BC government-paid Physicians' Insurance (PDI) without proof of health when you begin practice in BC.*

I understand that I may have to prove good health if I apply for PDI in the future.
INCOMEprotect™ for Residents includes many features such as True Own Occupation, Top-Up Feature, Guaranteed Insurability Benefit and Cost of Living Adjustment. You may add the Retirement Protection Rider that pays an extra monthly tax-free amount into a retirement account to increase your savings if you're disabled.*

Add Retirement Protection $500/month riderDo not add the Retirement Protection rider
5b. Doctors of BC INCOMEprotect™ Disability Surrender Request & Acknowledgement
Please read the follwing information carefully. By ticking each box, you are confirming your understanding of each point as it relates to the cancellation of Doctors of BC INCOMEprotect™ for Residents. If you wish to speak with a Doctors of BC Insurance Advisor, please schedule an appointment here.
I understand my Doctors of BC INCOMEprotect™ Disability insurance coverage is an important aspect of my financial plan and terminating it may have consequences. I wish to terminate coverage effective June 30 of this year (or the first of the month following this request) and am aware of the following (please check ALL bullets):*

Doctors of BC INCOMEprotect™ for Residents is a completely separate program from the group employer long-term disability benefits offered under your resident employer collective agreement. Employer disability coverage ends when you complete residency.While on disability claim, INCOMEprotect™ benefits are payable as long as you're unable to work in your Own Occupation or until age 65. This is different from your employer group plan which commonly changes to a more restrictive definition of disability after 24 months on claim.INCOMEprotect™ covers you in Residency across Canada and the US, and in practice anywhere in the world.INCOMEprotect™ is coordinated with a BC government-funded Physicians' Disability Insurance (PDI) available to physicians practicing in BC. Having at least $2,000 of INCOMEprotect™ in residency/fellowship allows you to enroll in PDI without proof of health. All other applicants require proof of health and may be declined. Students leaving for residency in another province should consider retaining Doctors of BC coverage if they are expecting to return to BC to practice.In BC, Doctors of BC is the only organization offering coverage to medical students, residents and practicing physicians with no medical questions. Once you cancel Doctors of BC coverage, this offer will no longer be available to you. If you rely on your employer long-term disability plan during residency, you may have difficulty getting disability insurance coverage once in practice.I understand that I will need to provide proof of good health in order to rejoin a Doctors of BC disability plan or to enroll in BC government-paid Physicians' Disability Insurance (PDI).I understand the information provided above, and am making an informed decision.
6. Other Disability Coverage
Do you have any pending or existing insurance with Manulife or any other company (excluding employer mandatory disability and Doctors of BC coverage)? ⓘ*

YesNo
Name of other insurer
Monthly coverage that is in effect or is pending approval with other insurer (excluding employer mandatory disability) ⓘ
Upon approval of Doctors of BC INCOMEprotect™, I will: ⓘ*

terminate all my other disability coveragereduce my other disability coveragekeep all my other disability coverage in effect
I will reduce my other monthly disability coverage to:
7. Request for Insurance Appointment
Would you like a free insurance review with a Doctors of BC non-commissioned, licensed Insurance Advisor?

YesNoI have already met or scheduled a meeting with an Advisor
8. Authorization
I understand that Doctors of BC will use this form to make changes to my existing Life and Disability Insurance and that changes will be effective July 1, or the 1st of the month following my successful completion of medical school.

I understand that if I cancel any of my insurance programs and re-apply at a later date, I will be required to provide medical evidence of my health at that time.

Electronic Signature Authorization

By signing below, you are confirming that you are the member named in this form and you acknowledge that you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document.
Signature*

Clear
Date of Signature*

YearMonthDay
Date
Should be Empty:

Medical Graduate Insurance Options Form:

1. Personal Information

2. Residency Program Details

3. Life Insurance Options

4. Critical Illness Options

5. INCOMEprotect™ for Residents Disability Options

5b. Doctors of BC INCOMEprotect™ Disability Surrender Request & Acknowledgement

6. Other Disability Coverage

7. Request for Insurance Appointment

8. Authorization