1-877-443-0101

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      Your Guaranteed Issue Health&Dental  Insurance Quotes

No medical Questionnaire Required  (pre-existing conditions are covered)

Manulife Financial

FlexCare ComboPlus Starter  

Base Health & Dental Plan

FlexCare Dental

Association Dental Plans

FollowMe * (conversion of group plan)

Ontario Blue Cross

Blue Vision Express Plan

* FollowMe is designed to offer uninterrupted health and dental coverage for you and your family, when your employment and group benefits end. If you apply within 60 days of your loss of group health and dental benefits, you will qualify without having to complete a medical questionnaire.

 

Applicant  
Name  
Gender Male      Female
Age  
   
City
Province  
   
E-mail  
Phone Number   (if you want a broker to call you)
Co-Applicant (Spouse)

 - Plan for Family or Couple

 Name  
 Gender Male      Female
 Age  
 Dependent Children  - Family Plan

 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?                    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 emailed you 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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June 22, 2017