Online inquiry

User details

* Name This value is required.

Your occupation

* Company name This value is required.

* Number of employees This value is required.

Type of business

Group coverage in place Yes No

Contact information

Company address

Head office address

* Postal code This value is required.

* Business phone This value is required.

Fax

* Email address

Use the list below to indicate the benefits you are most interested in. We'd be pleased to advise you on a plan which will provide maximum value and cost effectiveness for you and your employees — based on YOUR choices!

Benefit options

Extended health benefits Yes No

(includes outside-Canada travel coverage)

Dental Yes No

Drug benefits Direct bill Reimbursement

70% 80% 100%

(dependant life, optional life, accidental death and dismemberment)

Least Cost Alternative (LCA) Yes No

Vision Yes No

Life insurance benefits Yes No

Short or long-term disability Yes No

Spending accounts Yes No

Additional information

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