Apply for a non-smoker rate on your portable benefits coverage
Have you added portable benefits coverage to your workplace plan? You’re in the right place.
Make a change
Use this form to apply for non-smoker rates on your portable benefits coverage.
Download this form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save.
Use this form to apply for non-smoker rates when updating your portable benefits coverage.
When you’ve completed your forms, you can submit them to us by email at email@example.comOpens in a new window or fax to (416) 552-3373.