Application for Membership and/or Insurance (Residents and Fellows)

  • Application for Membership and/or Insurance (Residents and Fellows)

  • Introduction

  •  - -

  • Complete this form to apply for Doctors of BC Membership and/or Doctors of BC Insurance products.

    This application must be completed and submitted in one sitting. However, you may edit your submission after submissions 

    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.

    New Doctors of BC members may obtain $50,000 in Critical Illness 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.

    You may apply for the INCOMEprotect for Residents disability plan with simplified medical underwriting (6 medical questions).


     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.

  • What are you applying for today?*
  • Are you completing this during Resident Orientation and wish to complete a shorter version of the insurance form?*
  • I am a:*
  • I am applying for coverage for:*
  • I want to apply for:*
  • Spouse Only: I want to apply for:*
  • Member & Spouse: I want to apply for:*
  • Did you attend medical school in BC?*
  • Are you currently covered by Doctors of BC INCOMEprotect disability insurance for medical students? (select "No" if you had student coverage in the past but it is not currently active)*

  • ***WARNING - You are completing the wrong form***

    You indicated that you attended medical school in BC and held disability insurance during medical school. You should be completing the Medical Graduates Option Form, using this link

  • 1. Member - Personal Information

  •  / /

  •
  • Format: (000) 000-0000.
  • Smoking status:*
  • Sex:*

  • Member - Medical School Information

    Residents only
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  • 2. Member - Residency or Fellowship program information

  • Have you ever been a Doctors of BC member?*
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  • Year of residency:*
  • Are you actively working as a medical resident at least 25 hours per week in your occupation?*

  • 3. Spouse - Personal information

    for Spouse Critical Illness or Life Insurance
  •  / /
  • Does your spouse have the same address as you?*

  • Format: (000) 000-0000.
  • Spouse's Smoking status:*
  • Spouse's Sex:*

  • 4. Spouse - Occupational information

    For Spouse Critical Illness or Life Insurance

  • 5. Child information (for critical illness insurance)

    If you are applying for the Child Critical Illness Rider, please enter your children's information below.

  • Insurance applications require the consent of the insured if the insured is 16 or older. If any of your children are over 16, we will ask for an email address as they must sign the DocuSign application as well. We keep the email on file solely for the purpose of completing the insurance application, or administering a claim.

  • Child 1

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  • Child 1 - Sex
  • Is Child 1 age 16 or older?*

  • Child 2

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  • Sex
  • Is Child 2 age 16 or older?*

  • Child 3

  •  - -
  • Child 3 Sex
  • Is Child 3 age 16 or older?*

  • Child 4

  •  - -
  • Child 4 - Sex
  • Is Child 4 age 16 or older?*

  • Child 5

  •  - -
  • Child 5 - Sex
  • Is Child 5 age 16 or older?*

  • Child 6

  •  - -
  • Child 6 - Sex
  • Is Child 6 age 16 or older?*

  • 6. Member - Life insurance

  • Resident term life insurance offer
    As a resident, you may apply to purchase $100,000 term life insurance with no evidence of insurability ($100,000 lifetime maximum). 

  • Do you want this $100,000 of term life insurance?*
  • Optional riders - select the riders you want to purchase:*
  • Do you want to apply for additional life insurance beyond the $100,000 offer? Medical evidence will be required*

  • Additional term life insurance
    You may apply to purchase a combined total of up to $5,000,000 term life insurance in units of $50,000 to a maximum of 100 units.

    Evidence of insurability is required. 

    Indicate the amount of coverage you are applying for at this time excluding existing Doctors of BC coverage.

  • Optional life insurance riders - select the riders you want to purchase:*

  • Medical evidence
    Additional information may be required so that we can assess your application.


    Additional requirements may include, but not be limited to, a telephone interview by a carefully screened and trained interviewer who will ask you a series of questions about your medical history, your doctor’s name, and any medications taken. The interview will take approximately 30 minutes.


    The information you provide will be sent to Manulife promptly and will be used only for insurance purposes.

  • 7. Member - Life insurance beneficiary designation

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


    You hereby designate the individual(s) named as beneficiary on this application to receive any death benefit payable with respect to the coverage applied for.


    If none of the primary beneficiaries are alive, any death benefit payable will be payable to the secondary beneficiary. If no beneficiary is designated, benefits will be payable to your Estate.


    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.

  • Rows
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  • Are any of the beneficiaries named under the age of 19?*
  • Rows

  • 8. Spouse - Life insurance

    You may apply to purchase a combined total of up to $5,000,000 term life insurance in units of $50,000 to a maximum of 100 units. Evidence of Insurability is required
  • Optional riders - select the riders you want to purchase:*

  • Medical evidence
    Additional information may be required so that we can assess your application.


    Additional requirements may include, but not be limited to, a telephone interview by a carefully screened and trained interviewer who will ask you a series of questions about your medical history, your doctor’s name, and any medications taken. The interview will take approximately 30 minutes.


    The information you provide will be sent to Manulife promptly and will be used only for insurance purposes.

  • 9. Spouse - Life insurance beneficiary designation

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


    You hereby designate the individual(s) named as beneficiary on this application to receive any death benefit payable with respect to the coverage applied for.


    If none of the primary beneficiaries are alive, any death benefit payable will be payable to the secondary beneficiary. If no beneficiary is designated, benefits will be payable to your Estate.


    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.

  • Rows
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  • Are any of the beneficiaries named under the age of 19?*
  • Rows

  • 10. Critical Illness insurance

  • Member critical illness insurance
    Minimum $50,000, Maximum $500,000, in units of $10,000

  • Critical Illness Insurance Offer - No evidence of insurability
    $50,000 critical illness insurance is available at certain life events, including 90 days after graduating medical school or joining Doctors of BC for the first time.

  • Do you want to apply for $50,000 critical illness insurance?*
  • Do you want to apply for additional critical illness insurance beyond the $50,000 offer? Medical evidence will be required.*
  • Optional rider - Waiver of Premium*

  • Medical evidence
    Additional information may be required so that we can assess your application.


    Additional requirements may include, but not be limited to, a telephone interview by a carefully screened and trained interviewer who will ask you a series of questions about your medical history, your doctor’s name, and any medications taken. The interview will take approximately 30 minutes.


    The information you provide will be sent to Manulife promptly and will be used only for insurance purposes.

  • Spouse critical illness insurance
    Minimum $50,000, Maximum $500,000, in units of $10,000

  • Optional rider - Waiver of Premium*

  • Dependent child critical illness (CI) insurance rider

  • Amount of new insurance applied for at this time, excluding existing Doctors of BC coverage, if any:*
  •  - -

  • 11. Member - INCOMEprotect disability insurance

  • INCOMEprotect disability insurance
    You may apply for disability insurance in increments of $100, for a benefit between $500/month and the maximum, based on your program year:

    Residency year Monthly benefit minimum* Monthly benefit maximum
    1-5 $500 $4,000
    6-7 $500 $6,000
    Fellowship $500 $7,500

    *The minimum recommended monthly benefit is $2,000 to meet eligibility requirements for the PDI plan offer. If you maintain monthly benefits of at least $2,000 for at least 12 months immediately prior to your program completion, you will not be required to provide evidence of insurability when you apply for the government-funded Physicians' Disability Insurance (PDI) plan within 90 days of completing residency or fellowship.

  • Do you wish to apply for Resident Disability Insurance?*
  • Optional riders - select the riders you want to purchase. If selected, medical evidence will be required.*

  • 12. Member - Medical questionnaire (for INCOMEprotect disability insurance ONLY)

  • During the past 12 months, have you missed more than 15 consecutive days of work or school because of illness or injury?*
  • In the last 3 years, have you experienced symptoms of, been diagnosed with, received treatment or medication for, or consulted a physician or health care practitioner about any mental health condition or psychological disorder,including, but not limited to, anxiety, burnout, depression, schizophrenia or psychosis?*
  • Do you currently have the loss of your power of speech, hearing in both ears, or sight in both eyes, or the loss of the use of both hands, both feet, or one hand and one foot?*
  • Have you ever had an application for life, disability, or critical illness insurance declined, rated, postponed, cancelled, or modified in any way?*
  • In the past 3 years, have you undergone any investigations, received any treatment or medication, or been referred to a specialist by a physician or health care practitioner? This question does not refer to routine tests with normal results, or the common cold, flu, strep throat, ear infection, or pink eye, or birth control.*
  • Do you have any ongoing symptoms for which you have not consulted a physician or health care practitioner or received treatment?*

  • Medical evidence

    Additional information is required so that we can assess your application. This is because you selected an optional rider, or answered "yes" to the medical history questions above.


    Additional requirements are, but not be limited to, a telephone interview by a carefully screened and trained interviewer who will ask you a series of questions about your medical history, your doctor’s name, and any medications taken. The interview will take approximately 30 minutes.


    The information you provide will be sent to Manulife promptly and will be used only for insurance purposes.

  • 13. Member - Other Insurance Information

  • Note: If you intend to replace coverage, do not cancel your existing coverage until you receive
    your new insurance certificate.


    If you have indicated replacement, DoBC may require a replacement form or declaration form from you before we can provide an insurance certificate.

  • Do you have any pending or existing life, critical illness, disability*, or professional expense insurance coverage with Manulife, Doctors of BC, or any other company?*
  • Rows
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  • Is Coverage #1 Pending?*
  • Do you intend to replace Coverage #1?*
  • Do you intend to reduce Coverage #1?*

  • Indicate how much of the insurance listed above will be reduced if the coverage you have applied for is issued:

  • Do you have any other pending or existing life, critical illness, disability, or professional expense insurance with Manulife, Doctors of BC, or any other company (beyond coverage #1)?*
  • Rows
  • Rows
  • Is Coverage #2 Pending?*
  • Do you intend to replace Coverage #2?*
  • Do you intend to reduce Coverage #2?*
  • Do you have any other pending or existing life, critical illness, disability, or professional expense insurance with Manulife, Doctors of BC, or any other company (beyond coverage #2)?*
  • Rows
  • Rows
  • Is Coverage #3 Pending?*
  • Do you intend to replace Coverage #3?*
  • Do you intend to reduce Coverage #3?*
  • Do you have any other pending or existing life, critical illness, disability, or professional expense insurance with Manulife, Doctors of BC, or any other company (beyond coverage #3)?*
  • Rows
  • Rows
  • Is Coverage #4 Pending?*
  • Do you intend to replace Coverage #4?*
  • Do you intend to reduce Coverage #4?*
  • Do you have any other pending or existing life, critical illness, disability, or professional expense insurance with Manulife, Doctors of BC, or any other company (beyond coverage #4)?*
  • Rows
  • Rows
  • Is Coverage #5 Pending?*
  • Do you intend to replace Coverage #5?*
  • Do you intend to reduce Coverage #5?*

  • 14. Spouse - Other Insurance Information

  • Do you have any pending or existing life or critical illness insurance coverage with Manulife, Doctors of BC, or any other company?*
  • Rows
  • Is Coverage #1 Pending?*
  • Do you intend to replace Coverage #1?*
  • Do you intend to reduce Coverage #1?*

  • Indicate how much of the insurance listed above will be reduced if the coverage you have applied for is issued:

  • Do you have any other pending or existing life or critical illness with Manulife, Doctors of BC, or any other company (beyond coverage #1)?*
  • Rows
  • Is Coverage #2 Pending?*
  • Do you intend to replace Coverage #2?*
  • Do you intend to reduce Coverage #2?*
  • Do you have any other pending or existing life or critical illness with Manulife, Doctors of BC, or any other company (beyond coverage #2)?*
  • Rows
  • Is Coverage #3 Pending?*
  • Do you intend to replace Coverage #3?*
  • Do you intend to reduce Coverage #3?*
  • Do you have any other pending or existing life or critical illness with Manulife, Doctors of BC, or any other company (beyond coverage #3)?*
  • Rows
  • Is Coverage #4 Pending?*
  • Do you intend to replace Coverage #4?*
  • Do you intend to reduce Coverage #4?*
  • Do you have any other pending or existing life or critical illness insurance with Manulife, Doctors of BC, or any other company (beyond coverage #4)?*
  • Rows
  • Is Coverage #5 Pending?*
  • Do you intend to replace Coverage #5?*
  • Do you intend to reduce Coverage #5?*

  • 15. Member/spouse - Declaration and authorization

  • Please review the Declaration and authorization section form carefully on the Application for Insurance PDF before DocuSigning.

  • 16. Member/spouse - Information about MIB, LLC

  • Please review the statement regarding Medical Information Bureau, LLC on the Application for Insurance PDF carefully before signing via DocuSign. 

  • 17. Member/spouse - Personal information statement

  • Please review the personal information statement on the Application for Insurance PDF carefully before signing via DocuSign. 

  • Signature

  • Applying for Insurance

  • Please press submit. A member of our insurance team will follow-up directly via DocuSign to obtain the required signatures.

  • Joining Doctors of BC

  • As a member of the College of Physicians and Surgeons of British Columbia, I hereby apply for membership in the Association of Doctors of BC, and agree to abide by the Constitution and By-Laws of the Association. I will pay online by direct debit or credit card. (Instructions will be emailed one applicaiton is processed.)

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  • Clear

  • Doctors of BC respects the privacy of members and is committed to protecting your personal infomation. For information related to privacy of the information collected, please see Doctors of BC Privacy Policy.  

    Contact and demographic information provided on the Doctors of BC Membership Application will be shared with CMA only if you choose to join CMA and used in accordance with the CMA's Corporate Privacy Policy. 

    T 604 736 5551 115 - 1665 West Broadway
    TF 1 800 655 2262 Vancouver, BC V6J 5A4

       





     

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