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      Your Health & Dental Insurance Quotes

  Manulife Financial
  Ontario Blue Cross
  Desjardins Financial Security
  Group Medical Services


Benefits Requested
Extended Health   Minimum Medium Enhanced Coverage
Prescription Drugs None Minimum Medium* Enhanced*  Unlimited*
Dental Care None Minimum Medium Enhanced Coverage
Vision Care Yes No Not Important
Hospital (private or semi-private) Yes No  Not Important
Travel Insurance Yes No  Not Important
Critical  Illness Insurance Yes No    

* Note: These plans do not cover pre-existing medical conditions and medications (that is medical conditions and medications, which exist at the time of application). If you have pre-existing medical conditions and medications, you can apply for guaranteed issue plans: please click here to get a quote.


Gender Male      Female
Is Applicant a smoker ?

Yes    No

Phone Number (if you want a broker to call you)
Co-Applicant (Spouse) -

Plan for Family or Couple

 Gender Male      Female
 Is Co-Applicant a smoker ? Yes  No

Dependent Children -                                Plan for Family or Single Parents

 Number of dependent children*
 Age of dependent children  
 Child 1   Child 2   Child 3   Child 4  
 Child 5   Child 6   Child 7   Child 8  
 *Children of 21-25 years of age must be full time students
When does your group plan expire?  (if applicable)     dd/mmm/yyyy


Notes and Questions

Please contact me to follow up with my quotes:   by phone        by E-mail  

Please confirm your E-mail   

Your quotes will be sent to your e-mail address within one business day.

If you have any questions or need help to complete the form please call at

416-493-0101, 1-877-443-0101


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October 15, 2018