Register

How to Register in a PHSP

Brock Health Administration offers two ways in which you can register.

Option 1 – Online Registration

The online method can be used by both incorporated or non-incorporated businesses wishing to sign up. Upon completion, you will be presented options to configure the plan to your business’ needs. As always, feel free to give us a call if you have any questions during the registration process.

Registration in a Brock Health Administration Ltd. Private Health Services Plan (PHSP) requires the payment of a one-time registration fee of $100.00 CAD. We can process your registration fee if paying by Visa, Mastercard or American Express.

Payment is handled securely by PCI Level 1 certified Stripe and no credit card data is stored by Brock Health Administration Ltd.

Option 2 – Mail-In Registration

The postal mail registration method is a simple 4 step process:

1. Click on the following links to download the required forms.

• The Registration Form is required for all plans.
• If you have employees other than your own family you will need to complete Appendix A – List of Covered Employees.
• If you want your employees to send claims directly to us you will need Appendix B – Prepaid Plan Configuration. You may want to call us for assistance while completing this form.
• If you are not incorporated we will need to know about your dependents. Appendix C – Unincorporated Business Details

2. Print off and fill out the form(s). Be sure to sign the Registration Form. This is your 3rd Party Contract of health benefit coverage. If required, use Appendix A to list the names of your Covered Employees.

3. Enclose a cheque for the $100 Registration Fee made payable to Brock Health Administration.

4. Mail the forms and cheque to:

Brock Health Administration Ltd.
Suite 210
239 Midpark Way
Calgary, Alberta
T2Y 2Z9

You can also submit your first claim along with your registration application. We will open your account and adjudicate your claim at the same time. We are committed to responding with your contract and payment within five business days of receiving your claim. You can submit a claim here.