Croix Bleue

Québec Blue Cross

 

Personal information

Select your coverage

Application

Payment

Confirmation

Personal information

Province of residence: Québec Modify my province of residence

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Type of coverage

Single  
Couple  
Single parent  
Family  

Provincial Health Coverage

Do you and all individuals seeking coverage, hold valid Quebec Health Insurance Plan (Medicare) Cards? Yes No

Details of the individuals to insure
Primary Insured
Sex Age Height Smoker 
M
F
 m or  ft  in
Smoker
Weight
Non-smoker
 kg or  lb

Employment Status of the primary insured
Student
Self-employed
Working without access to group insurance coverage
Retired (early or otherwise)
Other - specify   
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For more information or help, contact one of our agents at 1-877-909-7686