D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
 
   
        
   
 
 
 
   
 
 
 
 
 
   
 

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 Ironworkers Local 97 Health & Welfare Plan.

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 (4823381), which is pre-printed on the form,
  • 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.


 

Form Link
MSP Application for Group Enrolment Form
 

Related Links
Basic Medical Benefit Information
 
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