Student Application for Membership & Insurance (2025-08)

  • Application for Student Membership and Insurance

    For students enrolled in the Faculty of Medicine at the University of British Columbia. In this application "you" and "your" refer to the person applying for membership with Doctors of BC and for insurance underwritten by Manufacturers Life Insurance company (Manulife)
  • Do you want to complete a shorter version of this form that includes only no-cost student coverage?
  • What are you applying for today?

  • We welcome you to medical school and offer you some OPTIONAL and NO-COST benefits during medical school. There is no obligation to register and you may cancel at any time without penalty.

  • Do you want to apply for complimentary Doctors of BC membership as a student?

  • An active membership is required to obtain the insurance offers available through Doctors of BC.

  • Do you want to apply for complimentary Doctors of BC no-cost Student Disability and Life Insurance? (you must sign up for a Doctors of BC membership in order to apply for the complimentary Doctors of BC insurance)
  • What additional insurance products are you applying for?*

  • You indicated you want no-cost insurance. You must select "Yes" to Complimentary Doctors of BC membership above.

  • Insurance Opt-Out

  • Member - Personal Information

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  • Format: (000) 000-0000.

  • Medical School Information

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  • Are you in the MD/PhD program?*

  • Your medical student membership is provided complimentary when you join Doctors of BC. Membership gives you access to special benefits and covers you for all consecutive years you are enrolled as a medical student. You may cancel at any time.

    I hereby apply for membership with Doctors of BC. By applying for membership you agree to abide by the By-laws, Rules and Regulations of Doctors of BC.

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  • Spouse - Personal Information

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  • Is your spouse's address different from member's address?

  • Format: (000) 000-0000.
  • What is your smoking status?*
  • What is your sex?*

  • Spouse - Occupational Information

    For spouse life or spouse critical illness insurance

  • Doctors of BC Student Insurance Application

  • No-Cost Insurance Coverage available to Doctors of BC student members

    For full coverage details, see the Student Insurance Brochure.

    Disability Income Benefits

    Monthly tax-free income if you are unable to attend medical school, train or work due to accident or illness. Coverage automatically adjusts based on your year of medical school) and can be extended into residency and practice.

    • $1500 monthly tax-free benefit (year 1 & 2)
    • $2500 monthly tax-free Benefit (year 3 & 4)
    • 90 day elimination period
    • maximum 5 year benefit (as a student)

    In Year 4, you can purchase optional coverage to increase your coverage to $4000/month

    Elimination period: The period a claimant must wait after the date of disability before benefits are payable

     

    Life Insurance Benefits

    $100,000 tax-free payout to your loved ones upon your death to help with debt repayment, family support, or funeral expenses.

  • Do you want to apply for $100,000 student life insurance at no-cost to you? (No evidence of insurability is required)*
  • Do you want to apply for student disability benefits at no-cost to you?*
  • What year of medical school are you in currently?*
  • Do you want to purchase $1,500 of optional additional coverage for your 4th year of medical school?*
  • What is your smoking status?*
  • What is your sex?*

  • INCOMEprotect disability insurance - pre-qualification questions

  • Applying for life or disability insurance usually requires you to provide a full health and lifestyle history to the insurer providing the coverage. As a Doctors of BC member, you have access to 'simplified' underwriting for disability insurance and a no-underwriting offer for life insurance.

    As a medical student, you have access to a few insurance offers and our Doctors of BC insurance advisors want to ensure you enrol in the best one for your situation. We'll ask six prescreening yes/no questions, and then that will help us determine whether you should continue in your application.

  • 1. During the past 12 months, have you missed more than 15 consecutive days of work or school because of illness or injury?*
  • 2. 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, schizophrenia or psychosis?*
  • 3. 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?*
  • 4. Have you ever had an application for life, disability, or critical illness insurance declined, rated, postponed, cancelled or modified in any way?*
  • 5. In the last 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.*
  • 6. Do you have any ongoing symptoms for which you have not consulted a physician or health care practitioner or received treatment?*

  • Thanks for answering the pre-screening questions. We recommend you proceed with this application as coverage will be issued immediately.

  • Thanks for answering the pre-screening questions. We recommend you talk to a Doctors of BC insurance advisor before submitting a disability insurance application.

  • Backpack day: Thanks for answering the pre-screening questions. A Doctors of BC Insurance Advisor will be in touch with you shortly to finalize your application.

  • Recommendation for disability insurance: Talk to a Doctors of BC Insurance advisor. How would you like to proceed?*

  • 6. Member - Life Insurance

  • 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, if any:

  • Optional rider: Waiver of Premium*
  • Optional rider: Future Insurance Option*

  • 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.

     

  • Is Primary Beneficiary #1 under 19?*
  • Is Primary Beneficiary #2 under 19?*
  • Is Primary Beneficiary #3 under 19?*

  • Secondary Beneficiary

    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.

  • Do you want to name a secondary beneficiary?*
  • Is Secondary Beneficiary #1 under 19?*
  • Is Secondary Beneficiary #2 under 19?*
  • Is Secondary Beneficiary #3 under 19?*

  • Trustee for minor children

    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. 

  • 8. Spouse - Life Insurance

  • 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, if any:

  • Optional rider: Waiver of Premium*
  • Optional rider: Future Insurance Option*

  • 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.

     

  • Is Primary Beneficiary #1 under 19?*
  • Is Primary Beneficiary #2 under 19?*
  • Is Primary Beneficiary #3 under 19?*

  • Secondary Beneficiary

    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.

  • Do you want to name a secondary beneficiary?*
  • Is Secondary Beneficiary #1 under 19?*
  • Is Secondary Beneficiary #2 under 19?*
  • Is Secondary Beneficiary #3 under 19?*

  • Trustee for minor children

    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. 

  • Member - Critical Illness Insurance

  • Minimum $50,000. Maximum $500,000, in units of $10,000.

    For more information about the riders, please visit doctorsofbc.ca

  • Do you want to add Waiver of Premium Rider?

  • Spouse - Critical Illness Insurance

  • Minimum $50,000. Maximum $500,000, in units of $10,000.

    For more information about the riders, please visit doctorsofbc.ca

  • Do you want to add Waiver of Premium Rider?

  • Critical Illness Insurance - Life Event Eligibility

  • Manulife will accept applications for Doctors of BC member and/or spouse critical illness insurance without evidence of insurability for benefit amounts of a one-time maximum of $50,000 within 90 days of eligible life events. Such insurance coverage is subject to the Pre-existing Condition Limitation outlined in the Critical Illness certificate 

  • Are you applying for $50,000 critical illness offer with no evidence of insurability?*
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  • Dependent Child Critical Illness Insurance Rider

  • Amount of Dependent Child Critical Illness insurance applied for at this time, excluding existing Doctors of BC coverage, if any:*

  • Dependent Children - Personal Information

    for Dependent Child Critical Illness Rider

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

  • Child 2

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

  • Child 3

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

  • Child 4

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

  • Child 5

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

  • Child 6

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

  • Member - Other Insurance Information

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

    Disability insurance includes individual, group, association, creditor insurance, salary continuation, accident only, professional/office overhead expense, or any other type of insurance that provides disability benefits

     

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

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

  • Spouse - Other Insurance Information

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

    Disability insurance includes individual, group, association, creditor insurance, salary continuation, accident only, professional/office overhead expense, or any other type of insurance that provides disability benefits

     

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

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

  • Application for Membership Only - Next Steps

  • Upon submitting this application, you will be emailed a copy of your completed membership form.

    Within a few days, one of our membership administrators will reach out via email to provide Doctors of BC website access and provide you with new member information.

  • Application for Insurance - Next Steps

  • Upon submitting this application, you will be emailed a copy of your completed form for your DocuSign signature. Please review the completed application carefully for Member (or Spouse) information on:

    • Applicant Declaration and Authorization
    • Information about the MIB (Medical Information Bureau)
    • Personal Information Statement

     

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

    Your application for insurance cannot be processed without the DocuSignature.

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