Add members to a policy…

To add a new member to your health insurance policy or cash plan please complete and submit the form below.

We will then contact you to discuss benefit levels and underwriting for the new member(s).



Company information:


Employee information:



Does the employee already have a health insurance policy in place? If so, 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? If so, 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? If so, 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? If so, 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? If so, 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.