|
|
|
|
|
|
MSP Out of Country Claim Form |
|
|
|
|
|
Use
If you are covered for the Medical Services Plan of BC (MSP)
under your Health Benefit Plan, use the MSP
Out-of-Country Claim Form
to submit claims for medical expenses incurred outside of
Canada.
All medical expenses incurred outside of Canada must be
submitted to MSP prior to being submitted under your Health
& Welfare Plan. |
|
|
|
|
|
Information Needed to Complete the Form
In addition to the Member's personal information, additional information is required
to complete the form, including:
- Information on the claimant's medical expenses
- All original receipts or bills
Additional information to complete the form is listed on
Section D 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 directly to MSP as per
Section D of the form.
|
|
|
|
|
|
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 - 29 Kb)