You are eligible to apply for Office Overhead Expense Insurance if you are a physician who is:
- under age 65,
- a resident in Manitoba,
- actively at work,
- personally responsible for the payment of eligible office expenses, and
- a member or affiliate of Doctors Manitoba.
Coverage is available in units of $100 from a minimum of $300 per month to a maximum of $10,000 per month.
- Coverage takes effect on the 1st 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:
- You having paid all premiums that became due for payment prior to becoming disabled,
- Your disability not resulting directly or indirectly from any risks covered under Exclusions,
- 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
- 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 15th 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:
- the Elimination Period,
- any period for which you fail to provide satisfactory evidence that you are Totally Disabled,
- more than one disability for the same period, or
- 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.
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.
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:
- 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
- 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:
- the date you are determined to have recovered from the infectious state,
- the date you no longer suffer a loss of Pre-Disability Average Net Monthly Earned Income of at least 20%,
- the date you become entitled to Total Disability or Partial Disability benefits,
- the date you reach Age 65,
- the date you fail to furnish satisfactory medical or financial evidence as requested by the insurance company, or
- the date of your death.