Benefits lead form

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Name

First

Last

Years in Business

Number of employees

Extended Health

Level 1 - $12,500 prescription (70% co-insurance) + $300/year (total) for health practitioners
Level 2 - $25,000 prescription (80% co-insurance) + $300/year (per) health practitioner
Level 3 - $25,000 prescription (80% co-insurance) + $500/year (per) health practitioner
Level 4 - $50,000 prescription (80% co-insurance) + $500/year (per) health practitioner + $300/24 months orthotics
Level 5 - $50,000 prescription (80% co-insurance) + $500/year (per) health practitioner + $300/24 months orthotics
Level 6 - $50,000 prescription (80% co-insurance)) + $600/year (per) health practitioner

*Each level comes with travel insurance, orthotics, vision and hearing aids