enrolment.canadalife.com
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34.149.129.205
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Submitted URL: https://click.mail.canadalife.com/?qs=7c486b54e2b4921906885bcbf519ca741e30b557d965c150eb0d258c0570c8d188d6e3000cb02048bf55b6fe5cae...
Effective URL: https://enrolment.canadalife.com/publicMember/auth/800b7da7-fb23-43c6-bdd7-20ad8ee0549d-fX1xK3s%3D
Submission: On June 02 via manual from CA — Scanned from CA
Effective URL: https://enrolment.canadalife.com/publicMember/auth/800b7da7-fb23-43c6-bdd7-20ad8ee0549d-fX1xK3s%3D
Submission: On June 02 via manual from CA — Scanned from CA
Form analysis 1 forms found in the DOM
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<div _ngcontent-sgm-c104="" class="input-group"><label _ngcontent-sgm-c104="" id="authentication-last-name-field-label" class="col-form-label">Last name</label>
<div _ngcontent-sgm-c104="" class="input-wrapper"><input _ngcontent-sgm-c104="" id="authentication-last-name-field" formcontrolname="lastName" aria-required="true" aria-labelledby="authentication-last-name-field-label"
class="input msse-form-input ng-untouched ng-pristine ng-valid" aria-invalid="false" maxlength="20"></div>
</div><app-member-field-error _ngcontent-sgm-c104="" _nghost-sgm-c77=""><!----></app-member-field-error>
<div _ngcontent-sgm-c104="" class="input-group">
<div _ngcontent-sgm-c104=""><label _ngcontent-sgm-c104="" id="dateOfBirthLabel" class="col-form-label">Birthday</label></div>
<div _ngcontent-sgm-c104="" class="w-100"><app-date-picker _ngcontent-sgm-c104="" _nghost-sgm-c78="">
<div _ngcontent-sgm-c78="" class="d-flex align-items-end w-100 ng-untouched ng-pristine ng-valid">
<div _ngcontent-sgm-c78="" class="col-6 date-item ng-star-inserted"><app-select-wrapper _nghost-sgm-c75="" class="ng-star-inserted">
<div _ngcontent-sgm-c75="" class="select-wrapper full-width"><select _ngcontent-sgm-c78="" formcontrolname="monthOfDate" aria-required="true" class="msse-form-select item-month-select ng-untouched ng-pristine ng-valid ng-star-inserted"
id="undefined-month" aria-labelledby="dateOfBirthLabel undefined-month-label" aria-invalid="false" style="font-size: 18px;">
<option _ngcontent-sgm-c78="" value="" selected="">select</option>
<option _ngcontent-sgm-c78="" value="01" class="ng-star-inserted"> January </option>
<option _ngcontent-sgm-c78="" value="02" class="ng-star-inserted"> February </option>
<option _ngcontent-sgm-c78="" value="03" class="ng-star-inserted"> March </option>
<option _ngcontent-sgm-c78="" value="04" class="ng-star-inserted"> April </option>
<option _ngcontent-sgm-c78="" value="05" class="ng-star-inserted"> May </option>
<option _ngcontent-sgm-c78="" value="06" class="ng-star-inserted"> June </option>
<option _ngcontent-sgm-c78="" value="07" class="ng-star-inserted"> July </option>
<option _ngcontent-sgm-c78="" value="08" class="ng-star-inserted"> August </option>
<option _ngcontent-sgm-c78="" value="09" class="ng-star-inserted"> September </option>
<option _ngcontent-sgm-c78="" value="10" class="ng-star-inserted"> October </option>
<option _ngcontent-sgm-c78="" value="11" class="ng-star-inserted"> November </option>
<option _ngcontent-sgm-c78="" value="12" class="ng-star-inserted"> December </option><!---->
</select><!----></div>
</app-select-wrapper><!----><label _ngcontent-sgm-c78="" class="item-label" id="undefined-month-label">Month</label></div><!---->
<div _ngcontent-sgm-c78="" class="col-3 date-item ng-star-inserted"><input _ngcontent-sgm-c78="" minlength="1" maxlength="2" inputmode="numeric" digitonly="" formcontrolname="dayOfDate" aria-required="true"
class="input msse-form-input ng-untouched ng-pristine ng-valid" id="undefined-day" aria-labelledby="dateOfBirthLabel undefined-day-label" aria-invalid="false" style="font-size: 18px;"><label _ngcontent-sgm-c78="" class="item-label"
id="undefined-day-label">Day</label></div><!---->
<div _ngcontent-sgm-c78="" class="col-3 date-item pr-0 order-3 ng-star-inserted"><input _ngcontent-sgm-c78="" minlength="1" maxlength="4" inputmode="numeric" digitonly="" formcontrolname="yearOfDate" aria-required="true"
class="input msse-form-input ng-untouched ng-pristine ng-valid" id="undefined-year" aria-labelledby="dateOfBirthLabel undefined-year-label" aria-invalid="false" style="font-size: 18px;"><label _ngcontent-sgm-c78="" class="item-label"
id="undefined-year-label">Year</label></div><!----><!----><!----><!----><!----><!----><!---->
</div><app-member-field-error _ngcontent-sgm-c78="" _nghost-sgm-c77="" id="undefined-invalidDate" class="ng-star-inserted"><!----></app-member-field-error><app-member-field-error _ngcontent-sgm-c78="" _nghost-sgm-c77=""
id="undefined-required" class="ng-star-inserted"><!----></app-member-field-error><app-member-field-error _ngcontent-sgm-c78="" _nghost-sgm-c77="" id="undefined-validMinAge" class="ng-star-inserted"><!----></app-member-field-error><!---->
</app-date-picker></div>
</div>
<div _ngcontent-sgm-c104="" class="input-group ng-star-inserted">
<div _ngcontent-sgm-c104=""><label _ngcontent-sgm-c104="" id="authentication-cert-number-field-label" class="col-form-label">Certificate number</label><app-tooltip _ngcontent-sgm-c104="" _nghost-sgm-c103=""
class="ng-tns-c103-2 ng-star-inserted"><button _ngcontent-sgm-c103="" type="button" tabindex="0" containerclass="msse-tooltip" class="tooltip-button ng-tns-c103-2" aria-label="tooltip">
<div _ngcontent-sgm-c103="" aria-hidden="true" class="tooltip-icon ng-tns-c103-2">?</div>
</button><!----><!----></app-tooltip></div>
<div _ngcontent-sgm-c104="" class="input-wrapper"><input _ngcontent-sgm-c104="" id="cert-number-field" formcontrolname="certNumber" aria-required="true" appalphanumberformat="" aria-labelledby="authentication-cert-number-field-label"
class="input msse-form-input ng-untouched ng-pristine ng-valid" aria-invalid="false" maxlength="10"></div>
</div><!----><app-member-field-error _ngcontent-sgm-c104="" _nghost-sgm-c77=""><!----></app-member-field-error><button _ngcontent-sgm-c104="" id="authentication-submit-button" type="submit" appnavtrack=""
class="btn btn-primary begin-button begin-button-pshcp">Continue</button>
</form>Text Content
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PUBLIC SERVICE HEALTH CARE PLAN (PSHCP) POSITIVE ENROLMENT
Positive enrolment must be completed and consent must be provided to have your
claims processed by Canada Life.
Have this information ready to complete your positive enrolment.
* Information about you and your eligible dependants for coordination of
benefits:
* Insurance provider, plan and certificate numbers
Your eligible dependants' information including their birthdates
* Your bank account information to set up direct deposit
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HAVE THIS INFORMATION READY TO COMPLETE YOUR POSITIVE ENROLMENT.
* Information about you and your eligible dependants for coordination of
benefits:
* Insurance provider, plan and certificate numbers
Your eligible dependants' information including their birthdates
* Your bank account information to set up direct deposit
BEFORE WE GET STARTED, LET’S VERIFY YOUR IDENTITY.
Last name
Birthday
select January February March April May June July August September October
November December
Month
Day
Year
Certificate number
?
Continue
If you need technical assistance with the positive enrolment system, contact
Canada Life at 1-855-415-4414, Monday to Friday from 8 am to 5 pm your local
time.
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© The Canada Life Assurance Company 2009 - 2023
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