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MSP Group Change Form |
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Use
Use the MSP Group Change Form if you are covered for the Medical Services Plan of BC
(MSP)
through the International Association of Heat and Frost
Insulators & Allied Workers, Local No. 118 Health and Wellness
Trust Fund and you wish to add or delete
a dependent from your MSP coverage.
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Information Needed to Complete the Form
In addition to the Member's personal information, additional information is required
to complete the form, including:
- Group number (3131182),
- Detailed information on any changes to your dependents (if applicable),
- Change in Member information (if applicable),
- Residency information,
- Signatures from both the Member's and spouse.
Additional information to complete the form is listed on the second page of the form.
Please follow the instructions on the form.
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Notes
Questions on completing the form should be directed to the Plan Administrator.
Completed forms should be forwarded to the Plan Administrator. |
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Plan Administrator
International Association of Heat and Frost Insulators & Allied Workers, Local No. 118 Health and Wellness Trust Fund
Administrator
c/o D.A. Townley & Associates Ltd.
101 – 4190 Lougheed Highway
Burnaby, BC V5C 6A8
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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PDF - 24 Kb)