Build Your Own Plan (BYOP)

Sample Gold Plan

Here’s a sample gold plan, you can make changes if needed with higher or lower coverage by using our proprietary Build Your Own Plan (BYOP) template below. If you require assistance please BOOK A CONSULT or call 403-903-2898

Life and AD&D*

Dependent Life*

Optional Life and AD&D

Dental Care*

Maximum Benefit

Spouse Coverage

Maximum Benefit

Maximum Benefit (Basic)

Termination Age

Child Coverage

If Other, Please Specify

Major Restorative Coninsurance

Termination Age

Maximum Benefit (Major)

Units of Scaling

Extended Health Care(EHC)

Prescription Drugs*

Paramedical Practitioner

Emergency Out of Country Medical*

Vision Care

Coinsurance

Emergency Medical Require

Coinsurance

Maximum Benefit

Glasses, Contacts, Etc

Plan Type

If other, Please Specify

Eye Exam

Drug Type

Long Term Disability(LTD)

Critical Illness (CI)

Waiting Period

Amount

Benefit Period

Critical Conditions Covered

Maximum Benefit Amount

If other, Please Specify

Qualifying Benefit Amount

Please Specify X

Please Specify Plus X

Life and AD&D

Maximum Benefit:

Termination Age:

Dependent Life

Spouse Coverage:

Child Coverage:

Termination Age:

Optional Life and AD&D

Maximum Benefit:

Dental Care

Maximum Benefit (Basic):

Major Restorative Coninsurance:

Maximum Benefit (Major):

Units of Scaling:

Extended Health Care(EHC)

Prescription Drugs

Coinsurance:

Maximum:

Plan Type:

Paramedical Practitioner

Coinsurance:

Maximum Benefit:

Emergency Out of Country Medical*

Emergency Medical Require:

Vision Care

Coinsurance:

Glasses, Contacts, Etc:

Eye Exam:

Long Term Disability (LTD)

Waiting Time:

Benefit Period:

Maximum Benefit Amount:

Qualifying Benefit Amount:

Critical Illness

Amount:

Critical Conditions Covered:

Company

Date

Contact Person

Phone Number

Life and AD&D*

Maximum Benefit

Termination Age

Dependent Life*

Spouse Coverage

Child Coverage

Termination Age

Optional Life and AD&D

Maximum Benefit

Dental Care*

Maximum Benefit (Basic)

Major Restorative Coninsurance

Maximum Benefit (Major)

Units of Scaling

Extended Health Care(EHC)

Prescription Drugs*

Coinsurance

Maximum Benefit

Plan Type

Drug Type

Paramedical Practitioner

Coinsurance

Maximum Benefit

Emergency Out of Country Medical*

Emergency Medical Require

Vision Care

Coinsurance

Glasses, Contacts, Etc

Eye Exam

Long Term Disability(LTD)

Benefit Amount

Waiting Period

Critical Illness (CI)

Amount

Critical Conditions Covered

Benefit Period

Maximum Benefit Amount

Life and AD&D

Maximum Benefit:

Termination Age:

Dependent Life

Spouse Coverage:

Child Coverage:

Termination Age:

Optional Life and AD&D

Maximum Benefit:

Dental Care

Maximum Benefit (Basic):

Major Restorative Coninsurance:

Maximum Benefit (Major):

Units of Scaling:

Extended Health Care(EHC)

Prescription Drugs

Coinsurance:

Maximum:

Plan Type:

Paramedical Practitioner

Coinsurance:

Maximum Benefit:

Emergency Out of Country Medical*

Emergency Medical Require:

Vision Care

Coinsurance:

Glasses, Contacts, Etc:

Eye Exam:

Long Term Disability

Benefit Amount:

Waiting Time:

Benefit Period:

Maximum Benefit Amount:

Critical Illness

Amount:

Critical Conditions Covered:

Company

Date

Contact Person

Phone Number

Build Your Own Plan (BYOP)

Sample Gold Plan