Health&Dental Quick Insurance quotes

Your Guaranteed Issue Health&Dental Insurance Quotes

No medical Questionnaire Required

	Manulife Financial	FlexCare ComboPlus Starter
		FlexCare Dental
		FlexCare Select
		FollowMe (conversion from group plan)*
	Ontario Blue Cross	Blue Vision Express Plan

		* represents mandatory fields
Applicant
Name*
Gender*		Male Female
Age*
Is Applicant a smoker ?*		Yes No

City*
Province*
E-mail*
Phone Number

Co-Applicant (Spouse)		- Plan for Family or Couple
Name *
Gender *		Male Female
Age *
Is Co-Applicant a smoker ?*		Yes No

Number of Children -		Family Plan
0-4 years old
5-9 years old
10 years old
11 years old
12 years old
13-16 years old
17-20 years old

* 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. When does your group plan expire? mm/dd/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 Natalia

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

July 18, 2010