Application Instructions

Attached you will find the Medavie Blue Cross application form for their “Options Health and Dental” Plan. The first thing you should do is to review the various plan designs and coverages offered by Blue Cross. Please click on the main “Blue Cross” tab above or click on the page in “OPTIONS BENEFITS COMPARISON” order compare the two main plans … Options Plus and Options. (Note that there is a second version of “Options” that is exactly the same as the plan shown – but it is less costly as it provides for a deductible ($500 for single coverage and a combined total of $750 for family coverage). 

Once you decide which plan is best for you, you will want to know the cost of the plan. You can determine the cost of all benefits by doing the following.

Once again locate and click on the “Blue Cross” tab at the top and middle of the page, or Click Here to view the Blue Cross Options Calculator. So go ahead and click …..

The “Options Rate Calculator” page will then be displayed. You will see 4 drop down arrows requesting certain information such as your age range, Province of Residence etc. Simply select the appropriate answers for your situation.

Wait a moment or two .. and the box will automatically open up showing all prices for each benefit item. Note that the “Principal Benefits” box is already checked and print is in dark black. This is because the Principal Benefits are a required benefit that you must include in your package. All other benefit items (shown in light grey) are optional and may be included as to your preference.

Next, under the “SELECT TAB” click each benefit you would like to include in you plan and you will then see the TOTAL Monthly costs automatically calculated. If you decide to delete a benefit item from your plan … simply uncheck that particular box.

Also, note that opposite the Prescription Drug Tab you may select “NO DEDUCTIBLE” or click on the drop down box and select “DEDUCTIBLE” and you will notice a price reduction for the Prescription Drug portion of the OPTIONS PLAN (NOT AVAILABLE FOR OPTIONS PLUS).

We strongly recommend you print out at least 2 copies of the calculations page – keep one page for your records and include the other page with your application – and PLEASE CIRCLE the plan for which you wish to apply.

Please note that you cannot apply for certain benefits under Options Plus and other benefits under Options. All benefits must come from either Options Plus or Options … with no mixing the two. Also, if you are applying for more than one person (i.e. Family Plan) all members of the family must take the same benefits as all other members of the family. Blue Cross, however, may allow an exception in some cases to exempt a family member from a certain benefit – such as your child who may be covered under the Provincial Government Children’s Dental plan. Please contact Mendleson Financial to discuss this and we can possibly arrange to get you special reduced pricing in such situations.

Completing The Application Form

Now that you have the basic information on the Blue Cross Health & Dental plans – it’s time to go ahead and complete the 4 page application. The application is really quite simple as it only requires the following general information:

(Click on “Application Form” To View and print out the .pdf form).

  • Your address plus names & dates of birth of all proposed individuals
  • Check-box of which coverages you want included in your plan
  • A brief medical history of each of the proposed insureds
  • Payment details
  • Please fill in prices on back page of your requested plan

PLEASE PRINT LEGIBLY & CLEARLY

It is important that you read and understand each question very carefully and answer all questions accurately. (The above is only a general summary of what the application asks) Missing information will cause a delay in getting the plan approved.

SIGNATURE PAGE – Page 3 is the “Signature” page. If more than one adult is to be insured, then both spouses must SIGN and DATE the “AGREEMENT & CONSENT” Section by the “X’s. If you are single – or a single parent you only have to sign the line that says “Signature of Applicant

PAYMENT DETAILS – You may pay the plan on an annual basis in which case you do not have to complete the “Pre-Authorized Debit” section. However, if you wish to pay monthly please complete the PAD Section and all persons who are required to sign your cheques must sign by the “X” opposite the words “Authorized Signature(s)”

PLEASE INCLUDE A “VOID” CHEQUE or your application will NOT BE PROCESSED!

If space on the form does permit full information, please add any additional information on a blank sheet of paper.

If you need any clarification or assistance completing the application please contact Gerry Mendleson at Mendleson Financial Inc.

Telephone (902) 479-7000 (Leave message if unavailable when you call) or
e-Mail: gerry@mefine.ca

You may return the application by mailing or if you happen to be in the neighbourhood drop it off (Give To Clerk in a sealed envelope) to…

Mendleson Financial Inc.
c/o: Kwik-Way
7 Dentith Road, Halifax, Nova Scotia B3R 2K8


Thank You … Gerry Mendleson …. Your Local Blue Cross Agent