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 of group plan)
	Ontario Blue Cross	Ontario 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

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


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? 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 Natalia

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

August 31, 2011