PART 1 — EMPLOYER/PLAN ADMINISTRATOR: Members must input their annual income in the ‘Member salary’ field of this section. If you require more time to gather the information needed to report your income, input $0 (zero) for now to avoid delay in coverage for all the other non-disability benefits.

Please refer to the Reporting Midwifery-Related Income for Long-Term and Short-Term Disability Coverage section below for more information.

PART 2 — MEMBER/DEPENDENTS INFORMATION: Members must provide PBC with their true family composition - even when waiving EHC&D coverage; this helps ensure that eligible EHC&D claims can reimbursed promptly, preventing not listed dependents to be considered “late applicants” and be required to provide the insurer with evidence of insurability, where coverage may be denied.    

Q: Who qualifies as my dependent?

1. Your spouse
2. Your Common-law spouse if you have cohabited as spousal partners for one year
3. Your financially dependent unmarried children (biological child, your stepchild, your adopted child, or a foster child you are taking care of) are eligible to age 21 or to age 25 if they are in full-time attendance at a school, college or university that is recognized by Pacific Blue Cross or have a disability.

Q: Do I need to disclose a dependent with disabilities on the Enrollment form?

If your dependent is under age 21, you do not need to declare disabled status. If your dependent is over age 21, this will be required to determine eligibility.

PART 4 — CO-ORDINATION OF BENEFITS: Members may use coordination of benefits in situations where themselves and/or their eligible dependents have EHC&D coverage under more than one EHC&D Plan. The combined payment from all Group Plans for a particular item cannot exceed 100% of the eligible medical/dental expense.

*Members using coordination of EHC&D benefits must not complete PART 6 (Section A) of the application*  

When using co-ordination of EHC&D Benefits, members must provide the following EHC&D alternate plan information:

1. Name of insurance company
2. Group Policy number 
3. ID or certificate number 

PART 5 — BENEFICIARY DESIGNATION: Members must designate at least one beneficiary. If a beneficiary is not nominated, these benefits will be paid to your estate in the event of your death.  A trustee must be named if the beneficiary is under age 18.

PART 6 — WAIVER OF GROUP BENEFITS (Section A):  Members may waive the EHC&D benefits under this plan for themselves and/or their dependents due to coverage under another EHC&D plan. 

*Members waiving EHC&D benefits must not complete PART 4 of the application*

PART 7 - MEMBER SIGNATURE: A typed signature is not acceptable. Members must complete this section by selecting the Draw option.

It is important that members report their gross midwifery-related income accurately to avoid any impact on the processing of a disability claim as proof of income will be requested by the insurer in the event of a claim.

Gross midwifery-related income is considered income generated from paid positions that require a Midwifery designation and/or to be a Registered Midwife in the province of British Columbia.

What types of income sources are considered midwifery related?

• MSP billings
• T4A income from MABC Programs (parental leave, MESP Instructor, Engagement Fund, Leadership Bursary, etc.)
• Locum work (including Rural Locum Program)
• University Faculty positions / contracts
• Health Authority contracts, including midwifery service contracts and leadership positions
• Vaccination Clinics
• Affiliate organizations funding (Rural Coordination Centre of BC, Doctors of BC, etc.)
• BCCNM staff positions / contracts / committee work
• Overhead payments *New 2022-2025 MMA clause

To assist members in calculating and accurately reporting their income for disability coverage purposes, the MABC Reporting Midwifery Income Worksheet has been developed to allow input income from the types of income sources that are considered as midwifery related income.

To unveil the Annual Midwifery Income Q&A - Click HERE