|
|
|
|
|
|
MSP Application for Group Enrolment Form |
|
|
|
|
|
Use
Use the MSP Application for Group Enrolment Form if you wish to be covered for the Medical
Services Plan of BC (MSP) through the International
Association of Heat and Frost Insulators & Asbestos
Workers, No. 118 Health and Welfare Trust Fund.
If you are changing your group MSP coverage, you should use the
MSP
Group Change Form instead of this form. |
|
|
|
|
|
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 your dependents,
- 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.
|
|
|
|
|
|
Notes
Questions on completing the form should be directed to the Plan Administrator.
Completed forms should be forwarded to the Plan Administrator.
|
|
|
|
|
|
Plan Administrator
International Association of Heat and Frost Insulators & Asbestos Workers, No. 118 Health and Welfare 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
|
|
|
|
|
|
|
PDF - 18 Kb)