• Doctors of BC Health and Dental Plan Plan Tier Change Application

    2027 Plan Year

  • This application will take approximately 5 minutes to complete.

    In this application, "you" and "your" refer to the Sponsoring Physician or Designated Authorized Person for the Health and Dental account.

    Before you begin, please having the following information ready:

    1. Name of the Sponsoring Physician
    Only the Sponsoring Physician or their Designated Authorized Person may request a plan tier change. A Designated Authorized Person must be formally authroized using the designation form.

    2. Your preferred coverage tiers
    Be prepared to select your preferred coverage tier for 2027: Essential, Enhanced, or Premier. You can review details about each tier on the Doctors of BC website.

     

    PLEASE NOTE: Doctors of BC endeavours to prefill the Account name, Business ID, Sponsoring Physician Name, and current plan tiers when you access your personalized application via the link included in your options email. If you require assistance, please contact 604-736-551 or insurance@doctorsofbc.ca.

  • Sponsoring Physician/Employer

  • Who is currently enrolled on the Doctors of BC Health and Dental Plan? (select all that apply)*

  • Authorized Person Information

  • Only the Sponsoring Physician or the Designated Authorized Person is allowed to make changes to the Plan.


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  • Physician Plan Tier

  • Change Physician Plan Tier to*

  • Changing plan tier: Your selected plan tier applies to all participating physicians and their eligible dependants. You cannot select different tiers for individual physician plan members or individual dependants. All covered family members must be approved to change to a higher plan tier. The effective date of the new tier will be the later of: January 1, 2027 or the 1st of the month following approval by the insurer.

    If you have more than one physician associated with your Business ID: The plan tier selection applies to current and future physician enrollees. If a physician is declined by the insurer, they will remain int heir current tier, which may be lower than the Physician Plan Tier for your clinic.

  • No change to plan tier: You will be able to change your plan tier next year (evidence of insuability may be required).

  • Medical Office Staff Plan Tier

  • Change Medical Office Staff Plan Tier to

  • Changing plan tier: Your selected plan tier applies to all medical staff and their eligible dependants. You cannot select different tiers for individual family members. All covered family members must be approved to change to a higher plan tier. The effective date of the new tier will be the later of: January 1, 2027 or the 1st of the month following approval by the insurer.

    If you have more than one medical office staff employee: The plan tier selection applies to current and future employee enrollees. If an employee is declined by the insurer, they will remain in their current tier, which may be lower than the Medical Office Staff Plan Tier for your clinic.

  • No change to plan tier: You will be able to change your plan tier next year (evidence of insuability may be required).

  • Physician - Evidence of Insurability Requirements

  • Evidence of insurability is required for this request. Our insurance administrators will send you (and any other participating physicians) a written health questionnaire after you submit this plan tier change request.

    You, your spouse, and dependants will need to provide health information and submit to Manulife no later than November 30, 2026. All family members must be approved in order for the plan tier change to be approved. Approval is not guaranteed.

  • This request does not require evidence of insurability. Our insurance administrators will send you confirmation of your plan tier change. The effective date of the change will be January 1, 2027.

    Evidence of insurability will be required if you request a higher plan tier in the future, including returning to your current plan tier. Approval is not guaranteed.

  • Medical Office Staff - Evidence of Insurability Requirements

  • Evidence of insurability is required for this request. Our insurance administrators will send all participating medical office staff a written health questionnaire after you submit this plan tier change request.

    The medical office staff member, their spouse, and dependants will need to provide health information to Manulife no later than November 30, 2026. All family members must be approved in order for the plan tier change to be approved. Approval is not guaranteed.

  • This request does not require evidence of insurability. Our insurance administrators will send you confirmation of your plan tier change. The effective date of the change will be January 1, 2027.

    Evidence of insurability will be required if you request a higher medical office staff plan tier in the future, including returning to the current plan tier. Approval is not guaranteed.

  • Physician Plan Tier Change Acknowledgement

  • By submitting this application, you acknowledge and agree that:

    • You have reviewed the available Health and Dental plan tiers and understand the coverage associated with your selection(s).
    • The plan tier selection applies to all participating Physicians and all eligible dependants covered under your Account.
    • The plan tier selected in this application becomes the default plan tier for new Physician enrolees.
    • Changes to this application are not permitted after November 15.
    • The plan tier selection is binding for the next plan year
    • You may only apply for future plan tier changes during an Annual Options Period
    • The information provided in this application is complete and accurate.
    • If approved, this document replaces the plan tiers specified in the member agreement Schedule A, or a previously-submitted Plan Tier Change Application.

    If you are moving to a lower plan tier, you acknowledge and agree that:

    • Evidence of insurability will be required for each Physician and their dependants if they apply for a higher plan tier in the future, including a return to the previous plan tier. Approval is not guaranteed.
    • The new plan tier will take effect January 1, 2027.

    If you are moving to a higher plan tier, you acknowledge and agree that:

    • Evidence of insurability is required for each Physician and all eligible dependants covered under your Account. The plan tier change is subject to Manulife's approval.
    • If a Physician or any of their covered dependants is declined, the Physician and their covered dependants will remain at their current plan tier.
    • If multiple Physicians are enrolled under the same Account, only Physicians who are approved will change to the higher plan tier.
    • If a Physician does not complete the required evidence of insurability by November 30, 2026, their application for the higher plan tier will be closed and they will remain at their current plan tier.
    • An approved higher plan tier will take effect on the later of:
      • January 1 of the following year; or
      • the first day of the month following the approval by the insurer of an application where evidence of insurability was required.

     

  • Medical Office Staff Plan Tier Change Acknowledgement

  • By submitting this application, you acknowledge and agree that:

    • You have reviewed the available Health and Dental plan tiers and understand the coverage associated with your selection.
    • The plan tier selection applies to all participating Medical Office Staff ("Staff") and their eligible dependants covered under your Account
    • The plan tier selected in this application becomes the default plan tier for new Staff enrolees.
    • Changes to this application are not permitted after November 15, 2026.
    • The plan tier selection is binding for the next plan year.
    • You may only apply for future plan tier changes during an Annual Options Period.
    • The information provided in this application is complete and accurate.
    • If approved, this application replaces the plan tier selection specified in Schedule A of the Member Agreement or in any previously-submitted Plan Tier Change Application.

    If Staff are changing to a lower plan tier, you acknowledge and agree that:

    • Evidence of insurability will be required for all Staff and their dependants if you offer a higher plan tier in the future, including a return to the current plan tier. Approval is not guaranteed.
    • The new plan tier will take effect January 1, 2027.

    If Staff are changing to a higher plan tier, you acknowledge and agree that:

    • Evidence of insurability is required for all Staff and their eligible dependants covered under your Account. The plan tier change is subject to Manulife's approval.
    • If any Staff or covered dependant is declined, the plan tier will not be changed that Staff certificate and the Staff and their covered dependants will remain at their current plan tier.
    • If multiple Staff are enrolled under the same Account, only Staff who are approved will change to the higher plan tier.
    • If Staff does not complete the required evidence of insurability by November 30, their application for the higher plan tier will be closed and they will remain at their current plan tier
    • An approved higher plan tier will take effect the later of:
      • January 1, 2027; or
      • the first day of the month following approval by the insurer of an application where evidence of insurability is required.

  • Signature

  • Please sign and click submit. An Insurance Administrator will contact you with next steps.

  • Submission Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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