Apply Online

Health Assist LINK

New Applicant

If you are a new customer and wish to apply online, please get a quote or click the New Application button.

Returning Applicant

If you have already completed a quote or partially completed an application within the last 30 days, your original application or quote information has been saved. To access this, please enter your Confirmation Number and click the Continue Application button.

Your confirmation number:*

Apply Manually

If you would prefer to fill out a paper form and submit it through the mail, download and print the PDF below. You will need Adobe^® Acrobat^® Reader^® to view the file.

Advisor Information

The attached form is designed to automatically populate the information about your advisor.If it does not populate properly, please use the information below to complete the advisor fields. That way we'll know who sent you to us.

In case the file you downloaded does not have below fields automatically populated, please fill them in accordingly.

ADVISOR CODE: PB2101
OFFICE CODE: GPB21
MGA CODE: 8915

ADVISOR NAME: Prosum Health Benefits Inc.
OFFICE NAME: Unifor Community Chapters
MGA NAME: Prosum Health Benefits Inc.

PDF icon Download application form