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Enrollment – Basic Information * Required Fields
Please select at least one product that you are interested in:


Health & Dental Insurance
(+ Annual Travel Option)






ENCON Health & Dental
Insurance is underwritten by:

The Manufacturers Life Insurance Company

ENCON Annual Travel Insurance is underwritten by:

Royal & Sun Alliance Insurance Company

ENCON Health & Dental
Insurance is underwritten by:

The Manufacturers Life Insurance Company

ENCON Annual Travel Insurance is underwritten by:

Royal & Sun Alliance Insurance Company

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Convalescent Care
Insurance




ENCON Convalescent Care
Insurance is underwritten by:

Industrial Alliance

ENCON Convalescent Care
Insurance is underwritten by:

Industrial Alliance

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Life
Insurance




ENCON Life Insurance
is underwritten by:

The Manufacturers Life Insurance Company


ENCON Life Insurance
is underwritten by:

The Manufacturers Life Insurance Company


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Your Information
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Spouse Information
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Retiree Benefits Enrollment - Quote

 
 
Total Premium: $0.00/month

(applicable taxes included)
 
 

Getting Started
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We have a few questions before we proceed with your application.

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Please read and accept ENCON’s terms and conditions:
Terms of Use | eDelivery of Documentation | Privacy and Confidentiality Statements

Reminder Service
Please note that we cannot accept an application for an effective date more than 6 months in the future. If you'd like, you can set up a reminder with us and we will contact you closer to your requested effective date.

Please provide your contact information below.

Your first name must be at least 2 letters.
Your last name must be at least 2 letters.
We'll need your email in order to send you a reminder.
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Profile
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Policyholder Information:
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Contact Information:
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You must enter a valid Email Address in order to enroll online.
If you do not have an Email Address, please contact us
for assistance.

Address:

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Province Error: Please edit your address above, or click here to return
to Basic Information and correct your Province of Residence.












Enter address manually
Street address
City
State Zip code
Country
Coverage Details
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New Coverage Effective Dates
 
 
 
Medical Questionnaire
Because you have not applied for the Health & Dental plan within 90 days of losing your prior coverage,
both you and your spouse must be medically underwritten and approved before this plan can become effective.
A Medical Questionnaire will be emailed to you upon submission of your application.
Additional details will be provided on the Summary of Coverage page.
Please proceed to the next step.
Payment
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Please provide your banking information below to set up payment of your plan via pre-authorized monthly debit.
 

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Summary of Coverage
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Your Plan (please Scroll to right)
Coverage Insured Monthly Premium Tax
Total Monthly Premium: $0
Effective Dates (please Scroll to right)
Payment Details
Declaration
  • I/We acknowledge that the statements contained herein are true and together with any other forms signed by me/us in connection with this enrollment form the basis for my/our coverage. I/We understand that my/our coverage will begin on the effective date(s) indicated above, provided ENCON has received my/our banking information for pre-authorized debit.