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For agencies with 1-75 employees
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Agency Name:
Street:
Unit number:
City:
Province:
Postal Code:
Agency contact:
Contact e-mail:
Contact phone #:
Fax:
Is your agency currently a member of the following associations?

Capacity Builders
In Kind Canada
OACAO
OCSA
Volunteer Alberta
None
How did you find out about OASSIS?


Choose a Health & Dental plan for quotation (click to review our plans)
Would you like a drug card with your plan?
For the included Life Insurance and Accidental Death/Dismemberment Coverage Amounts
Choose coverage of 1x or
2x annual salary
Select an OPTIONAL Disability Insurance module (click to review our disability modules)
Short Term Disability – Choose INTEGRATED or NON-INTEGRATED with Employment Insurance (EI)
Long Term Disability - Choose Employer Paid LTD Premium (LTD income will be Taxable) OR Choose Employee Paid Premium (LTD income will be Non-Taxable)
Select OPTIONAL Employee Assistance Plan (EAP) Benefit (Counseling & work-life programs for enrolled employees and their families)
Does your agency currently have a benefits plan?
Yes
No
Employee position
Annual Income
Health & Dental Single, Family or Waived
Part-time/ Full-time Status?
Add Dependant Life Insurance?
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