Retiree Benefits
Retiree Benefits
 
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Enrollment – Basic Information

*Required Fields
Please select at least one product that you are interested in:


Health & Dental Insurance
(+ Annual Travel Option)






Victor Health & Dental
Insurance is underwritten by:

The Manufacturers Life Insurance Company

Victor Annual Travel Insurance is underwritten by:

The Manufacturers Life Insurance Company

Victor Health & Dental
Insurance is underwritten by:

The Manufacturers Life Insurance Company

Victor Annual Travel Insurance is underwritten by:

The Manufacturers Life Insurance Company

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RecoverEase
Insurance




Victor RecoverEase
Insurance is underwritten by:

Industrial Alliance

Victor RecoverEase
Insurance is underwritten by:

Industrial Alliance

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Life
Insurance




Victor Life Insurance
is underwritten by:

The Manufacturers Life Insurance Company


Victor Life Insurance
is underwritten by:

The Manufacturers Life Insurance Company


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Your Information

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Spouse Information

The following fields are only required if you wish to receive pricing information for your spouse.
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Retiree Benefits Enrollment - Quote


 
 
Total Premium: $0.00/month

(applicable taxes included)
 
 
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Getting Started

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We have a few questions before we proceed with your application.


 
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Please read and accept Victor’s terms and conditions:
Terms of Use | eDelivery of Documentation | Privacy and Confidentiality Statements

Reminder Service

Please note that we cannot accept an application for an effective date more than 6 months in the future. If you'd like, you can set up a reminder with us and we will contact you closer to your requested effective date.

Please provide your contact information below.

Your first name must be at least 2 letters.
Your last name must be at least 2 letters.
We'll need your email in order to send you a reminder.
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Visit again soon
Please note that we cannot accept an application for an effective date more than 6 months in the future. Please visit again within 6 months of your desired effective date.


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Profile

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Policyholder Information:

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Contact Information:

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You must enter a valid Email Address in order to enroll online.
If you do not have an Email Address, please contact us
for assistance.

Address:

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Province Mismatch. Please edit address above or click
here to correct province under Basic Information.












Enter address manually
Street address
City
State Zip code
Country
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Coverage Details

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New Coverage Effective Dates

 
 
 
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Medical Questionnaire

Because you have not applied for the Health & Dental plan within 90 days of losing your prior coverage,
both you and your spouse must be medically underwritten and approved before this plan can become effective.
A Medical Questionnaire will be emailed to you upon submission of your application.
Additional details will be provided on the Summary of Coverage page.
Please proceed to the next step.
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Payment

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Please provide your banking information below to set up payment of your plan via
pre-authorized monthly debit.
 
 

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Summary of Coverage

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Your Plan

(please Scroll to right)
Your Plan Details
Coverage Insured Monthly Premium Tax
Total Monthly Premium: $0

Effective Dates

(please Scroll to right)
Policy Effective Date Details

Payment Details

Declaration

  • I/We acknowledge that the statements contained herein are true and together with any other forms signed by me/us in connection with this enrollment form the basis for my/our coverage. I/We understand that my/our coverage will begin on the effective date(s) indicated above, provided Victor has received my/our banking information for pre-authorized debit.