All-risks Insurance Brokers - Employee Benefit Plan

Welcome to our online Employee Benefit Plan quote page. Please take a few minutes to fill out the questionnaire below, submit and we will e-mail back your free quotation within 5 business days. If you wish us to contact you by telephone simply complete the "Daytime Phone" box and one of our representatives will contact you with your quotation.

Note: For an accurate quotation all fields should be completed.

Business Name
Owned By
Street
City
Postal Code
E-mail address
Daytime phone
Contact Person

General Information

Type of Business
Type of Products and/or Services Sold
Years in Business?
Current Insurance Carrier.
Is anyone currently receiving a disability benefit?
If yes, describe
Are all employees covered by U.I.C.?
If no, describe
Are all employees covered by Worker's Compensation?
If no, describe

Policy Design Information (select as many as required)

Note that the Deductible or Co-pay selected is to be paid by the employee to aid in cost sharing. You may select one or both where applicable.

Life Insurance

Amount of coverage

Dependent Life

Amount of Coverage

Extended Health

Includes: Private duty nursing, selected paramedicals, chiropractor, podiatrist, hearing aids. Maximums per practitioner / per person / per year vary with company quoting. Details will be provided in your quotation.

Deductible (annual)

Co-Pay

Out of Province Coverage

Hospital Benefit

Prescription Drugs

Deductible per prescription

OR Annual deductible

Co-Pay

Reimburse for over the counter drugs

Dental Benefit

Deductible (annual)
Co-Pay
Major restorative
Orthodontic
Combined Max
Re-Call

Weekly Indemnity

66.67% weekly earnings payable to a max of:
OR flat amount
Benefit commences at:

Benefit period

Long Term Disability

66.67% weekly earnings payable to a max of:
OR flat amount
Benefit commences at:
Benefit period

Employee Data

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Comments

This quotation is based on the information you provide. If information differs from the information stated, policy premium may be affected. Please be accurate.