Plan Sponsor company name

Plan Sponsor contact

Plan Sponsor Email

Plan Sponsor Website

Advisor Name *

Advisor Email *

What size is the group? *

Is there a plan already in place? *

• Yes
• No

If there is a plan in place, tell us what benefit features are included

• Health Spending Account (classic plan held in trust for Members)
• Health Spending account (on cost plus basis)
• Extended Health (insured)
• Extended Health (self-insured/ASO)
• Group Travel
• Excess Medical
• Life
• Long Term Disability
• Short Term Disability
• Dependant Life
• Accidental Death & Dismemberment
• Critical Illness
• Dependant Critical Illness
• Short Term Income Replacement (Wage Preserver)
• Wellness/Lifestyle Spending Account

Any other benefit features not listed above?

If there is a plan in place, what's working and what's not? (Our goal is to match or do better on pooled Peace of Mind benefits and to fix any problems with health and dental.)

If you have an existing plan with extended health and you were surprised by a renewal, we can match what you have in a cost controllable way. Tell us about it.

Tell us about your employee benefit program goals. *

• seeking the best value for money
• cost control
• recruitment
• retention
• treating employees equitably
• cost participation by employees
• options for retirement planning

The BIG question! Do you have a budget in mind that you'd like to stick to? Describe it anyway you like - x amount per person, max total for the group, match existing, surprise me :) or unlimited (kidding!)

What benefit features would you like us to include in a proposal? Note some options require minimums. *

• Health Spending Account (classic plan held in trust for Members)
• Health Spending account (on cost plus basis)
• Enhanced Health Blends (extended health on self-insured/ASO basis)
• Life
• Long Term Disability
• Short Term Disability
• Dependant Life
• Accidental Death & Dismemberment
• Critical Illness
• Dependant Critical Illness
• Short Term Income Replacement (Wage Preserver)
• Wellness/Lifestyle Spending Account

Tell us about your group. You can give us some basic information about the team below and we'll let you know if we have questions. * You can also fill out this worksheet to help us properly prepare your quote. Just email the completed document to hello@blendable.ca after you submit