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Group Benefit Plan Quotes
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Name
*
First
Last
Email
*
Phone
*
Business Name
Business Legal Structure
Corporation
Personal Enterprise
Non-Profit
Other
Details
Number of Employees (Including Yourself)
Do You Have Any Existing Prescription Medication that Require Coverage?
No
Yes
Approximate Annual Cost of Existing Prescription Medication
Would You Like to Also Cover the Family Members of Your Employees?
No
Yes
Employee Survey
List the ages of all employees (including yourself) with the ages of their proposed insured family member (if you are choosing to cover them)
Are All Your Employees Covered by Government Health Insurance?
Yes
No
What Kind of Benefits Would You Like Your Plan?
Basic Dental
Enhanced Dental
Basic Prescription Drugs
Enhanced Prescription Drugs
Basic Vison Care
Enhanced Vison Care
Basic Paramedical Services
Enhanced Paramedical Services
Home Care
Medical Devices
Travel Insurance
Short Term Disability
Long Term Disability
Life Insurance
Critical Illness Insurance
Health Spending Account
Group RRSP / Pension
Deferred Profit Sharing Plan
Does Your Business Currently Have a Group Benefits Plan in Place?
No
Yes
Submit
