Health Care Providers Group Insurance Plan

The following information is optional and will allow us to contact you with important information in the future:

Do you plan on retiring at age 65?
If "No", please fill out month / year directly below.

Date your present hospital benefit coverage will stop:
(if applicable)

Date your present spousal benefit coverage will stop:
(if applicable)

Date you plan to move to part-time/casual from full-time:
(if applicable)

Date you plan to return to work from...
(if applicable)

Thank you for registering with the Health Care Providers, Canada's unique program of group benefits specifically designed for part-time and casual hospital employees, and, since 2004, all hospital retirees.

Your registration will entitle you to product updates, newsletters, special offers, retirement notices and more.

Register now to receive your FREE trial of MyFilesRX - Personal Medical Records Manager!

Your Contact Details:

First Name:

Date of Birth:

Last Name:

Sex:

Female Male

Email Address:

Phone:

()

Address:

Province:

City:

Postal Code:

How would you prefer to receive the HCP newsletter:

Your Hospital Site:

Please select your hospital site:

Is your hospital not listed?
Click here if you are currently employed at a non-endorsing hospital.