Health and Dental Annual Options Period

Moving to a higher plan tier

Applications to move from Essential to Enhanced or Premier, or from Enhanced to Premier, require evidence of insurability for you and your insured dependants. Manulife reviews the medical information and decides whether to approve the application.

Evidence of insurability

If evidence of insurability is required, you will be emailed a written health questionnaire for you and your dependants. Manulife will review your responses and may request additional information. Manulife will then approve or decline the application.

Approval is not guaranteed. If Manulife declines you or one of your dependants, you and all of your dependants will remain on your current plan tier. Manulife generally takes 4–6 weeks from the date evidence of insurability is submitted to make a decision.

Moving to a lower plan tier

Evidence of insurability is not required to move from Premier to Enhanced or Essential, or from Enhanced to Essential. The plan tier change takes effect January 1 of the next year.

Changes to your submitted application are accepted until November 15. After that date, your decision is binding for the next calendar year. You can apply to upgrade to a higher plan tier during a future Annual Health and Dental Options period. Each time you apply for a higher tier, evidence of insurability will be required, even if returning to your previous plan tier. Approval is not guaranteed.

When your new plan tier takes effect

Your new plan tier takes effect on the later of January 1 of the next year, or the first day of the month coincident with or immediately following approval of any medical evidence, if required. Make sure your new plan tier is effective before incurring claims that you expect to be covered under the new tier.

If you do not submit evidence of insurability by November 30, your application will be closed, and you will remain at your current plan tier for the next year.

How claims and benefit maximums carry forward

Claims incurred after January 1 of the year of the plan tier change, and before your new plan tier takes effect,  will count toward the benefit maximums under your new tier.

Example

You move from the Enhanced Plan, with a $2,000 annual dental maximum, to the Premier Plan, with a $3,000 annual dental maximum. You claim $2,000 in dental benefits under the Enhanced Plan in January 2027, and your Premier Plan tier takes effect February 1, 2027. The $2,000 already claimed counts toward the Premier Plan’s annual dental maximum, leaving $1,000 available for the remainder of the calendar year.

Claim history for benefits with multi-year or lifetime maximums, such as lifetime prescription drug maximums or custom orthotic inserts, will also carry forward to your new plan tier.

A physician and their Medical Office Staff may be enrolled in different plan tiers. However, all Medical Office Staff must have the same designated staff plan tier.

A Sponsoring Physician may apply to change plan tiers for themselves and/or their Medical Office Staff.

Moving staff to a higher plan tier

If the Sponsoring Physician selects a higher plan tier for their Medical Office Staff, each staff member must provide evidence of insurability for themselves and their insured dependants.

If a staff member or any of their dependants are not approved for the higher tier, the staff member and all their dependants will remain on their current tier. Staff members who are approved will move to the higher tier.

Moving staff to a lower plan tier

If the Sponsoring Physician selects a lower plan tier for their Medical Office Staff, all staff members and their insured dependants will be moved to the lower tier. Evidence of insurability is not required.

If the Sponsoring Physician later requests a higher plan tier for Medical Office Staff, including a return to a previous tier, each staff member will need to apply and provide evidence of insurability for themselves and their insured dependants. Approval is not guaranteed.

No action is required if you choose to remain on your current plan tier. Your plan will automatically continue to the next year.

If you submit a plan tier change application:

1. During the Annual Options Period between September 1–October 31, the Sponsoring Physician or Designated Authorized Person must submit a plan tier change application.
2. If you are applying for a lower tier
   • You will receive confirmation of your new plan tier, which will take effect on January 1 of the next year.
   • If you are moving your Medical Office Staff to a lower tier, their new plan tier will take effect on January 1 of the next year.
3. If you are applying for a higher tier
   • Complete the required evidence of insurability for yourself and any applicable dependants by November 30 of the current year.
   • If you are requesting a higher tier for your Medical Office Staff, each staff member must provide evidence of insurability for themselves and their insured dependants by November 30 of the current year.
   • Manulife will review the medical information provided and make an underwriting decision.
   • Doctors of BC and Manulife will notify you of the outcome of your application.
   • If approved, your new plan tier will take effect on the later of January 1 of the next year, or the first day of the month that coincides with or immediately follows the date of approval.