BCMA Insurance Department responds

Dr Frimer has raised an issue relating to the extension of coverage under the Physicians’ Disability Insurance (PDI) Plan to age 70 that took effect on 1 April 2008. 

Prior to this change, coverage under the PDI Plan terminated at age 65. At that point, members who continued to work past age 65 and who wished to maintain disability insurance protection had the option of converting all or part of their PDI coverage to the BCMA Disability Income Insurance (DII) Plan, on a premium paying basis, until age 70. 

Physicians reaching the limiting age were provided with a conversion form by the BCMA Insurance Department and advised that they had 60 days to return the completed form to the BCMA. Many members chose to continue their coverage on this basis.

The PDI Plan is a negotiated benefit and its funding and operation are governed by the Benefits Subsidiary Agreement (BSA) of the Physician Master Agreement (PMA). It is overseen by the Benefits Committee, the members of which are jointly appointed by the BCMA and government. Any changes to the negotiated benefits must be approved by the Benefits Committee and operated within the funding allocated under the BSA.

Disability plans can be extremely volatile and, as such, the Benefits Committee has operated the PDI Plan very prudently in order not to run def­icits, as the government will not provide additional funding unless it is negotiated by the parties to the PMA. 

In 2008 the Benefits Committee determined that the Plan was sufficiently funded to bear the cost of extending the insurance coverage to age 70, on the same basis as is provided under the BCMA DII Plan (i.e., a maximum 1-year benefit for disabilities occurring between age 65 and 70). However, as the PDI Plan is fully insured, it was necessary to obtain the insurer’s (Sun Life) agreement to this change.

Sun Life agreed to the change for physicians covered under the PDI Plan on 31 March 2008 (i.e., those under age 65) and physicians between the ages of 65 and 70 who had converted their coverage to the BCMA DII Plan at age 65. Physicians who chose not to convert their PDI insurance were not offered the option of reinstating their coverage. 

This was an insurance decision, based on the principle that coverage on a person must be in effect in order for a change to apply to that person. Since the BCMA DII Plan is also underwritten by Sun Life, physicians who had converted their PDI coverage to that plan at age 65 were considered to have continuous coverage and therefore continued insurability. 

The insurability of physicians whose coverage had terminated was not a quantifiable risk and therefore Sun Life would not agree to extend coverage to them. This decision was supported by the Benefits Committee.
—Sandie Braid, CEBS, Assistant Director, Insurance, BCMA

Sandie Braid, CEBS. BCMA Insurance Department responds. BCMJ, Vol. 52, No. 1, January, February, 2010, Page(s) 9 - Letters.

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