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Equote Form for Group Benefits

For Quotes for Group Benefits, please either use our Equote Form below on the right side of this page, or print off the PDF’s below and email or fax to them to us directly. Our fax # is 403-716-2589.

A-Group-Plan-Design-May-Include.pdf 164.97 KB
Employee_Data_Sheet_20.pdf 122.6 KB
Employee_Data_Sheet_100.pdf 287.02 KB
Request_for_Quotation.pdf 125.04 KB

Fill out this form below for a Group Quote:

Name of Business*
Operating Business Name
Number of years in business:*
Number of years your company has been in business.
Has your Business ever had an Employee Benefits Plan?*
If yes, which Insurance Company?*
Renewal Date*
Date when coverage is needed*
First & Last name*
Job Title*
Business Address*
Email
Phone
Website
Number of Full Time Employees*
24+ hours worked per week
Benefits you are most interested in*
- Select All
- Extended Health Care
- Dental Care
- Vision Care
- Short Term Disability
- Long Term Disability
- Critical Illness Insurance
Life Insurance & AD&D are mandatory in a group plan
Preferred coverage option*
- Select All
- 80% coverage for Dental
- 100% coverage for Dental
- 80% coverage for Health Benefits (ie. prescriptions, etc.)
- 100% coverage for Health Benefits (ie. prescriptions, etc.)
- with deductible
- without deductible
Are any Employees seasonal or part time?*
Are eligible Employees participating in plan?*
If no, please explain
Are any Employees absent from work due to maternity, a disability or a certain leave?*
If yes, please explain*
Are your Employees covered by WCB*
How many Employees are related by blood or marriage?*
Other coverages you are interested in*
- Select All
- Buy / Sell Insurance (partnership)
- Key Person Insurance
- Health Spending Account
- Life Insurance
- Group Critial Illness
- Group Pension / RRSP's
- None at this time
Comments
Privacy Policy*
- Yes, I agree to Integrity Insurance & Financial Services Inc. the use of our submitted information to obtain a quote for my/our Business or Practice
Integrity Insurance & Financial Services Inc. values your business and we thank you for your confidence in us to negotiate your Group Employee Benefits on your behalf. All information is held in strict confidence and only shared with the Insurance Companies that we are obtaining a quote from.
Employee Information*
- Yes, I agree to complete the below Employee Data Sheet (or if your company form holds the same employee information as our data sheet, we will accept it). If a current group plan is in place, please attach PLAN DESIGN, RATE HISTORY AND CLAIMS EXPERIENCE. This can be completed and uploaded below with this eQuote. Thank you. You will be sent an authorization letter upon receipt of this eQuote.
File Upload
Max. file size: 100 MB.
Upload your current PLAN DESIGN, EMPLOYEE INFORMATION, CLAIMS EXPERIENCE & RATE HISTORY. If you have chosen a big file, it may take several minutes to upload. Please be patient. Hit the SUBMIT button only once, as hitting it a second time will cause serious delays in transmitting your file.

All asterisk * fields must be completed or you will not be able to submit this request. This is submitted confidentially.

About Us

At Integrity Insurance & Financial Services Inc. we are Independent Brokers. We are not tied to any one company to make you fit the insurance or investment product. We deal with many different companies to ensure you get the best product to suit you. We are a locally owned and operated company in Elk Point, Alberta.

Contact Us

Mailing and courier address only:

PO Box 128
Elk Point, AB
T0A 1A0

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