You are eligible to apply for Office Overhead Expense Insurance if you are a physician who is:

1. under age 65,
2. a resident in Manitoba,
3. actively at work,
4. personally responsible for the payment of eligible office expenses, and
5. a member or affiliate of Doctors Manitoba.

Benefit Coverage

Coverage is available in units of $100 from a minimum of $300 per month to a maximum of $10,000 per month.

Effective dates

• Coverage takes effect on the 1^st of the month following the date the insurance company approves your application.
• Increases in coverage take effect on the first of the month after the insurance company approves your application.
• Age-related changes in coveragetake effect on the policy anniversary date (June 1) following the change in age.
• Changes in smoking status take effect on the first of the month following the date the insurance company approves your application for a change in smoking status.
• You may cancel coverage at any time by providing written notice to Doctors Manitoba.

Conditions of Payment

The payment of the office overhead benefit will be conditional on:

1. You having paid all premiums that became due for payment prior to becoming disabled,
2. Your disability not resulting directly or indirectly from any risks covered under Exclusions,
3. You having given due notice and having provided the required proof of your disability and loss, as and when required by the claims provisions, and
4. You being under the regular care and attendance of a physician.

Total Disability Benefit

If you are Totally Disabled, the insurance company will pay you 100% of your eligible office expenses, up to a maximum payment for any one month not exceeding the lesser of your coverage and the average of your eligible office expenses for the 12 months immediately preceding your total disability.

Should the benefit be payable for a period, or a final period, of less than one month, the amount payable for each day in that period will be 1/​30th of the monthly amount.

The benefit payment begins on the 15^th or end of the month.

• For benefit in excess of $5,500 per month, only the 30-day Elimination Period is available.
• The maximum benefit period is either 12 months or 18 months depending on your election.

Period for which Total Disability Benefits Payable

The Total Disability benefit will only be payable while you are Totally Disabled but will not be payable for:

1. the Elimination Period,
2. any period for which you fail to provide satisfactory evidence that you are Totally Disabled,
3. more than one disability for the same period, or
4. any period beyond the maximum benefit period.

Recurring Total Disability

If, after a period of Total Disability, you return to work for fewer than 180 days and are subsequently Totally Disabled due to the same or related causes, your Total Disability is treated as a continuation of the previous disability.

If you suffer from a Total Disability, unrelated to the previous disability, after being actively at work and the value of your billable services was at least equal to the monthly benefit insured, the Total Disability is considered a new disability.

Partial Disability Benefit

If you are Partially Disabled, the insurance company will pay you 50% of the selected benefit for a maximum benefit period of 3 months.

Waiver of Premium Benefit

During your disability, you are not required to pay premiums which become due provided you have been continuously disabled for at least 90 days and are receiving benefits from the plan.

While you are eligible for or receiving waiver of premium benefits, you will not be eligible to apply for new benefits, non-smoker rates or any increases in coverage.

The insurance company will not waive premiums for more than 1 year for the period of disability preceding the date the insurance company receives proof of claim for such disability.

Survivor Benefit

If you die while receiving benefits or satisfying the elimination period, any eligible office expenses incurred by your executor or administrator will be paid for up to 3 months following the date of death. Monthly benefits will be paid in full and the balance of the elimination period is waived. However, no benefits will be paid beyond the maximum benefit period.

Organ Donor

If, after your insurance is in force for at least six months, you donate an organ to another person, any resulting disability is deemed to be caused by sickness and you are entitled to benefits.

HIV/​Hepatitis B and C Benefit

If for the first time ever you test positive for Human Immunodeficiency Virus (HIV) or are determined to be a carrier of the Hepatitis B or Hepatitis C Virus (acute viral hepatitis) and are in an asymptomatic infectious state, you are eligible for Partial Disability benefits, notwithstanding the fact that you are neither Totally Disabled nor Partially Disabled.

You are considered eligible if, prior to age 65, you meet either or both of the following conditions:

1. the condition is required to be disclosed to your patients by regulations approved by an appropriate government authority or hospital board or an applicable medical regulatory body or licensing authority, and/​or
2. the condition results in a limitation of your practice of medicine as a consequence of regulations approved by an appropriate governmental authority or hospital board or an applicable medical regulatory body or licensing authority, and

as a consequence of either or both of the situations described in paragraphs (a) or (b), you suffer a loss of 20% or more of your Pre-Disability Average Net Monthly Earned Income for the period before: the date the condition was disclosed as provided in paragraph (a) and/​or your practice of medicine was limited as provided in paragraph (b).

If these circumstances apply, the insurance company will pay benefits in accordance with the terms governing the calculation of the Partial Disability benefit.

Your benefits terminate on the earliest of any of the following occurrences:

1. the date you are determined to have recovered from the infectious state,
2. the date you no longer suffer a loss of Pre-Disability Average Net Monthly Earned Income of at least 20%,
3. the date you become entitled to Total Disability or Partial Disability benefits,
4. the date you reach Age 65,
5. the date you fail to furnish satisfactory medical or financial evidence as requested by the insurance company, or
6. the date of your death.

Benefits will not be paid for Office Overhead Expense Insurance for any disability resulting directly or indirectly from any one of the following:

1. terrorism, war or insurrection, whether or not declared, or any conduct, act or thing incidental thereto,
2. intentionally self-inflicted injury,
3. attempt, provocation or commission of a criminal offense or assault, or participation in a riot or civil commotion, or incarceration,
4. service in the armed forces of any country,
5. any period of imprisonment or confinement in a similar institution, unless as the result of psychiatric or psychological conditions,
6. any period of loss of standing to practice medicine as a result of disciplinary proceedings, whether such disability occurred prior to or during such period, unless loss of standing is due to psychiatric or psychological conditions,
7. any period of disability, including throughout the Elimination Period, during which you are not under the Regular Care and Attendance of a Physician considered satisfactory to the insurance company, when required,
8. any period of disability while you are outside of Canada, United States of America, Australia, New Zealand or a country belonging to the European Economic Community, for a period of more than 6 months, unless you can establish to the satisfaction of the insurance company that evidence of your continued disability can and will be supplied to the insurance company whenever reasonably so required,
9. alcoholism, drug addiction, substance abuse, or other condition, unless participating in a therapeutic program, recognized as such by the insurance company, and under continuous medical supervision by a specialist in the field, or
10. a psychiatric or psychological condition, unless under the care of a psychiatrist or clinical psychologist.

If you must hold a government permit or license to perform your regular duties, you will not be considered disabled solely because such permit or license has been withdrawn or not renewed.

Riders may be issued for individuals that exclude coverage for specific conditions.

Cessation of Benefit Payments

Your benefits terminate on the earliest of any of the following:

1. the date you are no longer disabled,
2. the date you do not comply, or fail to comply with the proof of claim provision,
3. the date the you fail to undergo, when requested by the insurance company, medical, psychiatric, psychological examinations and evaluation selected by the insurance company,
4. the date you refuse or fail to undergo medical, psychiatric or psychological treatment or participate in a rehabilitation program considered beneficial to you as recommended by the insurance company,
5. the date you fail to furnish satisfactory evidence of continuance of disability or the date you are no longer receiving Regular Care and Attendance of a Physician satisfactory to the insurance
6. company,
7. the date you reach your maximum benefit period,
8. the date you return to your Regular Occupation,
9. the date you retire,
10. any period of incarceration in a prison or mental institution following conviction by a criminal court, or
11. the date of your death (with the exception of the survivor benefit, if applicable).

Cost of Coverage

Like all of our insurance plans, our Office Overhead Expense Insurance plan is not-for-profit. This means if there is a surplus in any year – where the income from premiums after operating expenses exceeds the amount paid out in claims in any year – the savings are returned to plan members as a credit on the next year’s premiums.

Premium Calculation

The annual premium is calculated by multiplying the applicable rate, according to your age, sex and smoking status, by the number of units for which you are insured at the beginning of each Policy Year. If coverage becomes effective in the midst of a Policy Year, a prorated premium will be determined based on your age at the beginning of the Policy Year in which application for such insurance was made.

For cost information, please contact: Mark Venton, Insurance Coordinator at 204−985−5846, or Gord Brennan, Marketing Representative, at 204−985−1140.

The premiums are age-banded rather than level premiums. This means you pay in today’s dollars for today’s risk. With level premiums, the cost of premiums for older participants is transferred to younger participants. Rather than have younger participants ​‘overpay’, premiums are based on a more cost-effective banding method whereby participants pay premiums for risk based on their actual age. Retail sales taxes are calculated based on the premiums applicable to those members of Doctors Manitoba who reside in Manitoba, Ontario and Quebec.

Changes to Premium

The insurance company may adjust the premium rates on any Policy Anniversary Date by giving 90 days’ notice in writing to Doctors Manitoba, unless the insurance company and Doctors Manitoba mutually agree to the contrary, but not more often than once in any 12 month period. Insured Members will be given 30 days’ written notice of changes to premium by Doctors Manitoba.

Refund of Premiums

If you should die during a Policy Year for which premiums have been paid, a prorated refund of premiums will be paid to your estate.

Grace Period

On each premium due date, you will pay a premium calculated on the basis of the premium rates in effect at the time for your insurance, including any applicable riders.

• A period of 30 days is allowed for the payment of each premium due after the first, during which the insurance continues in force.
• If any premium is not paid within the grace period, the insurance will terminate immediately.
• If a benefit becomes payable during the grace period, any premium that is due but unpaid will be deducted from the benefit.

Premium Payment Not Honoured

If any cheque, draft, money order or other instrument tendered in payment or part payment of a premium is not paid when presented for payment in due course of business, the premium or such part will be considered to be unpaid and Doctors Manitoba’s official receipt, if issued, will be null and void.

Method and Frequency of Premium Payments

You may pay premiums:

1. annually by cheque (made payable to ​“Doctors Manitoba”), or
2. by any other frequency or payment method made available by Doctors Manitoba and approved by the insurance company.

All payments must be in Canadian or US dollars.

Smoker and Non-Smoker Rates

If you are paying smoker premiums, you may apply to change to Non-Smoker premiums. The insurance company will grant this request provided that:

You qualify as a Non-Smoker,

1. health declaration, on the insurance company’s standard form, is completed, submitted and approved by the insurance company,
2. satisfactory evidence as to your smoking habits is submitted, and
3. at the time the request is submitted to the insurance company, Non-Smoker rates are offered

Non-smoker rates apply to people who have not used any form of tobacco or tobacco cessation products in the last 12 months. Marijuana use is excluded.

If the insurance company approves the change to Non-Smoker premiums, future premiums will be payable on a Non-Smoker basis. The change will take effect on the first of the month coinciding with or following the date the insurance company approves the change to Non-Smoker status.

A misstatement of Non-Smoker status is considered fraud. The insurance company reserves the right to void your insurance if Non-Smoker status has been misstated.

Beneficiary Designations

There is no right to name a beneficiary under your coverage.

Cancellation of Coverage

The insurance company cannot cancel your coverage provided the policy remains in force and premiums are paid when due.

Termination of Coverage

Your coverage terminates on the earliest of any of the following occurrences:

1. the Policy Anniversary Date coinciding with or following the date you have reached age 70,
2. subject to the grace period, the date any premium due has not been paid, unless premiums are being waived,
3. the end of the period for which premiums have been paid, following receipt by Doctors Manitoba of written notice from you that one or more units of your coverage are to be terminated,
4. the Policy Anniversary Date coinciding with or following the date on which you no longer qualify as a duly qualified member of Doctors Manitoba in accordance with the membership requirements,
5. the date on which the policy is terminated,
6. the date of your retirement, or
7. the date of your death.

Extension of Coverage

If on the date your coverage terminates (because the policy terminates) you are disabled and either receiving benefits, eligible to receive benefits or fulfilling a required Elimination Period, the insurance company will pay you the monthly benefit while you remain disabled.

Leave of Absence

The insurance of a duly qualified member of Doctors Manitoba will not terminate due to a leave of absence, sabbatical leave of a maximum duration of 4 years, or solely by reason of such member having moved from the province of Manitoba. However, you may not apply for a subsequent increase in coverage or change of coverage until such time as you again become a member in accordance with the membership requirements.

Portability

If you move outside of Manitoba and maintain your membership with Doctors Manitoba, you may continue the coverage in force as long as the premiums are paid when due. You may also increase or change the coverage, provided you are resident in Canada. Any increase in coverage is subject to evidence of good health and approval by the insurance company.

Tax Issues

Premiums are tax deductible as business expenses, and benefits received are taxable.

Facility of Payment

If for any reason, you are not competent to give a valid release for payments to which you are entitled, the insurance company may in its discretion make payment, to the extent permitted by law, to any person related to you, or to any other individual appearing to the insurance company to be equitably entitled to such payment. Any payment made by the insurance company in good faith pursuant to this provision fully discharges the insurance company to the extent of such payment.

Rights of the Insurance Company

If benefit payments made to you are later determined to be in excess of the amounts you are qualified for, the insurance company and Doctors Manitoba reserve the right to recover the excess. If the excess amount cannot be recovered, the insurance company has the right to reduce benefit payments until the excess amount is fully recovered.

Right of Examination

On request, the insurance company will furnish to you or the claimant a copy of the application and any written document provided to the insurance company as evidence of good health, to the extent required by law.

Assignment

Your rights and interests with respect to the policy may not be assigned.

Governing Law

This contract will be subject to the laws of the province of Manitoba.

Your coverage will be subject to the laws of the Canadian province or territory in which you resided at the time of application.

Incontestability

The insurance company will not contest the validity of your coverage, or any unit of your coverage, after it has been in effect for 2 years from the effective date of insurance, or the date of reinstatement, except for in the case of fraud.

No statement will be used by the insurance company to void your coverage or to deny a claim during this 2‑year period unless the statement is:

1. false
2. part of your application, and
3. material to the insurance.

In issuing each coverage, the insurance company has relied on statements made in the applications of Doctors Manitoba and each applicant. These are representations and not warranties. If your coverage is voided for fraud, the insurance company will not refund the premiums paid under your coverage.

Limitation of Action

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act, or other applicable legislation.

Reinstatement

Your coverage may be reinstated at any time within 6 months from the date coverage lapsed due to non-payment of premiums„ on the following conditions:

receipt by the insurance company of satisfactory evidence of good health and insurability determined on the same basis as when the coverage was issued,

1. receipt by the insurance company of all overdue premiums with interest, and
2. written confirmation by the insurance company of your coverage’s reinstatement.

Definitions

Actively at Work means you work at your Regular Occupation for a minimum of 20 hours per week and perform all of the usual and customary job duties, at the time of application for insurance and during any period you are not disabled.

Age means the age as of the Policy Anniversary Date of each year.