ENROLLMENT FORM

    CAIP enrollment form for "In Canada" and "Travel Medical" insurance.

    In Canada Insurance - 12 Month Enrollment
    (Please enclose a list of names and province of provincial medical insurance for each person)




    Ontario Premium Tax: 8%




    Quebec Premium Tax: 9%




    TRAVEL MEDICAL INSURANCE

    (Please enclose a list of names and dates of travel)

    • Members should carry the Emergency Travel Assistance card when travelling outside of Canada/Province.

    • There are 3 options for travel medical insurance:

      • Per Trip - $35 per week of travel per eligible member. We need the dates of travel before the trip.

      • Individual Annual Plan (IAP) - $210 per year for 30 day IAP/$350 per year for 60 day IAP

      • Group Annual Plan (GAP) - Can be arranged for the Sport Body for their respective members. Please contact us for further details.

    • We will send an invoice to the Association noted above

    • Payment of the invoice must be remitted by the Association and made payable to "M. Kirsch Financial Services"

    IN-CANADA INSURANCE - 12 MONTH ENROLLMENT

    TRAVEL MEDICAL INSURANCE ENROLLMENT

    HOW TO ENROLL IN CAIP

    • All enrollments must be submitted through a sport body such as a National or Provincial sport organization, Canadian Sport Centre, Sport Team, league, club, etc.
    • Full name of the person to be enrolled (Please no nicknames)
    • Province of provincial medical insurance of the person to be enrolled (premium tax may apply)
    • Effective date of coverage
    • Level of insurance – Bronze, Silver, Gold or 500 Plus