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This form is for extended health care, dental and hospital coverage. If you are interested in the standalone travel coverage, please follow the application information for the travel plan.

  • Your PGA membership number
  • Your health card and the health card for your spouse and any dependents, if applicable
  • Current insurance information, if applicable
  • A cheque for reference for bank deductions and direct deposit for claim payments

If you have questions or need help completing the form, please contact our team.