COHIP APPLICATION FORM
No commitment or payment required. Once you submit this form, a representative will be in touch to assist you with your COHIP application and/or any questions you may have regarding your coverage, fees, or membership options.

Step One - Contact Information

Question Title

* Please provide your contact information:

*Main Contact - Name *

Organization Name

Address

Address 2

City/Town

*Province *

Postal Code

*Country *

*Email Address *

*Phone Number *

Question Title

* Please provide your billing contact information for COHIP invoices:

*Name *

Company

City/Town

Province

Country

*Email Address *

Question Title

* Are you considering applying for COHIP as an individual, or would you like to offer COHIP benefits to your members or team?

Individual - COHIP Application:
1 person
$35 CAD, one-time application fee
I am a Freelancer, Self-Employed, Student, Artist, Part-Time or Indie Worker
I want a custom insurance package, with a monthly insurance premium

Individual - COHIP Application
1 person or team
NO APPLICATION FEE
I belong to a participating organization or collaborative space
or
I am applying before November 30th - No health declaration.
I want a custom insurance package, with a monthly insurance premium

Couple or Family - COHIP Application
2+ people
$50 CAD, one-time application fee
Perfect for a couple, with or without children
We want a custom insurance package, with a monthly insurance premium

Small Groups - COHIP Application
Max. 20 people
$100 CAD, one-time group application fee
We are a Small Business, Artist Collective, new or informal organization
Individual COHIP application fees are waived for your 'group members'
Group members customize and purchase their own insurance packages

Collaborative Spaces - COHIP Membership
Max. 150 members
$150 CAD annual COHIP membership fee, per location
Ideal for coworking spaces, artist studios and shared offices
Individual COHIP application fees are waived for your 'members'
Members customize and purchase their own insurance packages

Collective, Organization or Company - COHIP Membership
Max. 250 members
$250 CAD annual COHIP membership fee, per location
Great for multiple locations or cities, and larger collaborative spaces
Individual COHIP application fees are waived for your 'members'
Members customize and purchase their own insurance packages

Collective, Organization or Company - COHIP Membership
Max. 500 members
$450 CAD annual COHIP membership fee, per location
Great for multiple locations or cities, and larger organizations
Individual COHIP application fees are waived for your 'members'
Members customize and purchase their own insurance packages

Large Group - COHIP Membership
Max. 1000 members
$850 CAD annual COHIP membership fee
Perfect for large groups, national organizations or collectives
Individual COHIP application fees are waived for your 'members'
Members customize and purchase their own insurance packages

Large Group - COHIP Membership
Max. 2500 members
$1500 CAD annual COHIP membership fee
Perfect for established groups, national organizations or collectives
Individual COHIP application fees are waived for your 'members'
Members customize and purchase their own insurance packages