Are you looking for:

All insurers will be solicited

*We will solicit all insurers so you benefit from the best rates on the market.

Enter your active and inactive employees:

Please enter the list of active employees

*Confidentiality: The information submitted is processed so your data remains confidential at all times.

Last name

First name

DOB

Sex

Coverage

Annual salary

Occupation

Delete

---

Select Male Female

Select Individual Single parent Couple Family Waive

Name

First name

DOB DOB

Sexe Select Male Female

Coverage Select Individual Single parent Couple Family Waive

Salary/year Annual salary

Occupation

---

Please enter the list of inactive employees

Last name

First name

Reason for absence

Waiver of premiums

Disability start date

Anticipated return date

Delete

---

Select SAAQ CNESST Accident Illness Leave without pay Temporary layoff Paternity leave Maternity leave Family caregiver

Select Yes No

Last name

First name

Waiver of premiums Select Yes No

Reason for absence Select SAAQ CNESST Accident Illness Leave without pay Temporary layoff Paternity leave Maternity leave Family caregiver

Disability start date

Anticipated return date

General information

• Company name
• Employer’s contribution
• Select25%50%75%100%Other
• Employer’s contribution (%)
• Pay period
• Select12 weeks24 weeks26 weeks48 weeks52 weeks
• Name of contact person
• Are you a member of a chamber of commerce?
• SelectYesNo
• Have you ever been insured by or received a quote from the Chamber?
• SelectYesNo
• Is your company a non-profit organization?
• Choose Yes No
• Do you have seasonal / self-employed / contract employees?
• Choose Yes No
• Do you have employees who do not have their RAMQ card (health card)?
• Choose Yes No
• Do you currently have employees on disability?
• Choose Yes No
• Telephone and extension
• Email address