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 higher (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.