1-877-443-0101   

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Get Your Health & Dental Insurance Quotes

Manulife Financial

Desjardins Financial Security

Group Medical Services

 Ontario Blue Cross

 

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.

 

Applicant

Name

Gender

Male      Female

Age

Is Applicant a smoker ?

Yes    No

 

E-mail

Phone Number

(if you want a broker to call you)

City

Province

Co-Applicant (Spouse) -

Plan for Family or Couple

 Name

 Gender

Male      Female

 Age

 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 questions or need help to complete the form, please call at

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

 

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March 27, 2019