Add somebody to a company policy

Please select one of the options below;


Company information:


Employee information:



Does the employee already have a health insurance policy in place?

NoYes

Please provide details of their current insurer and renewal date:

Add another employee


Add a second employee:



Does the employee already have a health insurance policy in place?

NoYes

Please provide details of their current insurer and renewal date:

Add another employee


Add a third employee:



Does the employee already have a health insurance policy in place?

NoYes

Please provide details of their current insurer and renewal date:

Add another employee


Add forth employee:



Does the employee already have a health insurance policy in place?

NoYes

Please provide details of their current insurer and renewal date:

Add another employee


Add fifth Employee



Does the employee already have a health insurance policy in place?

NoYes

Please provide details of their current insurer and renewal date:

You may submit a maximum of 5 employees at once using this form. To submit more employees please click submit and then start the process again.


Company information:


Employee information:


Dependant information:




Add another dependant


Add a second dependant:




Add another dependant


Add a third dependant:




Add another dependant


Add a forth dependant:




Add another dependant


Add a fifth dependant:




You may submit a maximum of 5 dependants at once using this form. To submit more dependants please click submit and then start the process again.