Employee Group Health

Worry about your profits, not your employees’ health.

Employer group health plans provide comprehensive health and dental benefits to your employees at affordable rates. Plans are available for small, medium and large-sized businesses and include benefits such as prescription drugs, ambulance services, semi-private hospital accommodation, major and routine dental services, paramedical practitioners and more. Comprehensive health benefits help you attract and retain staff, and help minimize health-related workplace disruptions.

Just fill out the information below, and one of our group benefit consultants will review your file and contact you to discuss your options.

required field

First Name:
Last Name:
Organization:
Position/Title:
E-mail Address:
Address:
City:
Province:	Select an Option Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario P.E.I. Quebec Saskatchewan Yukon or
Postal Code:
Country:
Phone:
Fax:
Gender:	Select an Option Male Female
Date of Birth:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910
Company Information
Company Name:
Address:
City:
Province:	Select an Option Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario P.E.I. Quebec Saskatchewan Yukon
Postal Code:
Years in business:
Nature of business:
Do all employees work a minimum of 20 hours per week?
	Yes      No
Any employees on commission basis? (Details):
Employee covered by Workers Compensation?
	Yes      No
Any employees involved in hazardous activities such as flying, offshore activities, handling of dangerous chemicals, etc.?
	Yes      No
Has there been a staff turnover more than 30% in the last two years?
	Yes      No
Are all employees residents of Canada?
	Yes      No
Do you have a present group plan?
	Yes      No
If yes, with whom and for how long?
If yes, have any of your employees been declined for group coverage?
	Yes      No
If yes, have any of your employees had any Life or Disability claims in the last 12 months?
	Yes      No
Any employees presently off due to illness?
	Yes      No
If yes, please give dates of birth, duration of absence and nature of illness/injury:
If yes, are any of them receiving CPP/QPP, WSIB or any other disability benefits?
	Yes      No
Any employees currently on Life or Disability Waiver of Premium?
	Yes      No
Outline of current plan design including co-insurance and deductibles (if applicable):
Employee Information
1st Employee (Expand/collapse employee record) Name: Gender: Select an Option Male Female Date of Birth: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 Marital Status: Select an Option Single Married Common-Law Date Employed: Month January February March April May June July August September October November December Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 Province of Residence: Select an Option Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario P.E.I. Quebec Saskatchewan Yukon Annual Earnings: Occupation:
Add another employee
Additional Comments:
The information you submit will be kept and used by Ingle International to respond to your request. For further information on how Ingle International respects your privacy, visit our Privacy Policy. I consent to such use by Ingle International.